Predicting the need for massive transfusion: Prospective validation of a smartphone-based clinical decision support tool.

Background: Improper or delayed activation of a massive transfusion protocol may have consequences to individuals and institutions. We designed a complex predictive algorithm that was packaged within a smartphone application. We hypothesized it would accurately assess the need for massive transfusion protocol activation and assist clinicians in that decision.

Combat-Related Invasive Fungal Infections: Development of a Clinically Applicable Clinical Decision Support System for Early Risk Stratification.

Introduction: Invasive fungal infections (IFI) are associated with high morbidity and mortality. A better method of risk stratifying trauma patients for combat-related IFI is needed to improve clinical outcomes while minimizing morbidity related to overtreatment. We sought to develop combat-related IFI clinical decision support (CDS) tools to assist providers to make treatment decisions both near the point of injury and subsequently at definitive treatment centers.

The Uniformed Services University's Surgical Critical Care Initiative (SC2i): Bringing Precision Medicine to the Critically Ill.

Precision medicine endeavors to leverage all available medical data in pursuit of individualized diagnostic and therapeutic plans to improve patient outcomes in a cost-effective manner. Its promise in the field of critical care remains incompletely realized. The Department of Defense has a vested interest in advancing precision medicine for those sent into harm's way and specifically seeks means of individualizing care in the context of complex and highly dynamic combat clinical decision environments.

Precision diagnosis: a view of the clinical decision support systems (CDSS) landscape through the lens of critical care.

Improving diagnosis and treatment depends on clinical monitoring and computing. Clinical decision support systems (CDSS) have been in existence for over 50 years. While the literature points to positive impacts on quality and patient safety, outcomes, and the avoidance of medical errors, technical and regulatory challenges continue to retard their rate of integration into clinical care processes and thus delay the refinement of diagnoses towards personalized care.

Bringing the heavy: carbon ion therapy in the radiobiological and clinical context.

Radiotherapy for the treatment of cancer is undergoing an evolution, shifting to the use of heavier ion species. For a plethora of malignancies, current radiotherapy using photons or protons yields marginal benefits in local control and survival. One hypothesis is that these malignancies have acquired, or are inherently radioresistant to low LET radiation.

Enhanced dosimetry procedures and assessment for EBT2 radiochromic film.

Purpose: Quantitatively determine an optimum image analysis procedure to mitigate inhomogeneities within the EBT2 film and from scanning for accurate absolute dose measurement deposited by an external radiation therapy beam. Multichannel dosimetry procedures were conceived, described, and quantitatively tested against single and dual channel dosimetry.

Methods: A solid water(TM) block was placed on CT imaging and treatment tables in a configuration that avoids bulky compressive devices.

Fiducial markers in prostate for kV imaging: quantification of visibility and optimization of imaging conditions.

The purpose of this work is to investigate possible smaller, less-dense fiducial markers implantable into the prostate for target localization and patient repositioning verification in an on-board kV-kV imaging system on a proton gantry. The experiments used a pelvic phantom and a variety of commercially available fiducial markers: CIVCO carbon marker of ϕ; 1 × 3 mm, gold seed markers of ϕ; 0.8 × 3 mm and ϕ; 1.

Comparison of intensity-modulated radiotherapy, adaptive radiotherapy, proton radiotherapy, and adaptive proton radiotherapy for treatment of locally advanced head and neck cancer.

Background And Purpose: Various radiotherapy planning methods for locally advanced squamous cell carcinoma of the head and neck (SCCHN) have been proposed to decrease normal tissue toxicity. We compare IMRT, adaptive IMRT, proton therapy (IMPT), and adaptive IMPT for SCCHN.

Materials And Methods: Initial and re-simulation CT images from 10 consecutive patients with SCCHN were used to quantify dosimetric differences between photon and proton therapy.

Improving proton therapy accessibility through seamless electronic integration of remote treatment planning sites.

Objectives: Proton radiotherapy is a relatively scarce treatment modality in radiation oncology, with only nine centers currently operating in the United States. Funded by Public Law 107-248, the University of Pennsylvania and the Walter Reed Army Medical Center have developed a remote proton radiation therapy solution with the goals of improving access to proton radiation therapy for Department of Defense (DoD) beneficiaries while minimizing treatment delays and time spent away from home/work (time savings of up to 3 weeks per patient).

Materials And Methods: To meet both Health Insurance Portability and Accountability Act guidelines and the more stringent security restrictions imposed by the DoD, our program developed a hybrid remote proton radiation therapy solution merging a CITRIX server with a JITIC-certified (Joint Interoperability Test Command) desktop videoconferencing unit.

Predicted rates of secondary malignancies from proton versus photon radiation therapy for stage I seminoma.

Purpose: Photon radiotherapy has been the standard adjuvant treatment for stage I seminoma. Single-dose carboplatin therapy and observation have emerged as alternative options due to concerns for acute toxicities and secondary malignancies from radiation. In this institutional review board-approved study, we compared photon and proton radiotherapy for stage I seminoma and the predicted rates of excess secondary malignancies for both treatment modalities.

A hybrid integrated services digital network-internet protocol solution for resident education.

Objective: The purpose of this study was to explore the effectiveness of incorporating Web-based application sharing of virtual medical simulation software within a multipoint video teleconference (VTC) as a training tool in graduate medical education.

Materials And Methods: National Capital Consortium Radiation Oncology Residency Program resident and attending physicians participated in dosimetry teaching sessions held via VTC using Acrobat Connect application sharing. Residents at remote locations could take turns designing radiation treatments using standard three-dimensional planning software, whereas instructors gave immediate feedback and demonstrated proper techniques.

Development of a remote proton radiation therapy solution over internet2.

Through our existing partnership, our research program has leveraged the benefits of proton radiation therapy through the development a robust telemedicine solution for remote proton therapy planning. Our proof-of-concept system provides a cost-effective and functional videoconferencing desktop platform for both ad-hoc and scheduled communication, as well as a robust interface for data collaboration (application-sharing of a commercial radiation treatment planning package). Over a 2-year period, our evaluation of this model has highlighted the inherent benefits of this affordable remote treatment planning solution, i.