Automatic plan selection using deep network-A prostate study.

Background: Recently, high-dose-rate (HDR) brachytherapy treatment plans generation was improved with the development of multicriteria optimization (MCO) algorithms that can generate thousands of pareto optimal plans within seconds. This brings a shift, from the objective of generating an acceptable plan to choosing the best plans out of thousands.

Purpose: In order to choose the best plans, new criteria beyond usual dosimetrics volumes histogram (DVH) metrics are introduced and a deep learning (DL) framework is added as an automatic plan selection algorithm.

Proof-of-concept of real-time electromagnetic guidance for gynecologic interstitial catheters in high dose rate brachytherapy.

Background And Purpose: The addition of interstitial needles to intracavitary gynecologic (GYN) high dose rate (HDR) brachytherapy has been shown to improve target coverage and organs-at-risk (OAR) sparing. However, no commercial solution allows real-time guidance of interstitial catheter placement. This phantom study aimed to evaluate the feasibility of an electromagnetic (EM) tracking system guidance workflow for GYN HDR brachytherapy treatment in a magnetic resonance imaging (MRI) and real-time transrectal ultrasound (TRUS) fusion scenario.

Commissioning and implementing a Quality Assurance program for dedicated radiation oncology MRI scanners.

Purpose: ACR and AAPM task group's guidelines addressing commissioning for dedicated MR simulators were recently published. The goal of the current paper is to present the authors' 2-year experience regarding the commissioning and introduction of a QA program based on these guidelines and an associated automated workflow.

Methods: All mandatory commissioning tests suggested by AAPM report 284 were performed and results are reported for two MRI scanners (MAGNETOM Sola and Aera).

Commissioning of GPU-based multi-criteria optimizer combined with plan navigation tools for high-dose-rate brachytherapy.

Purpose: Recently, our GPU-based multi-criteria optimization (gMCO) algorithm has been integrated in a graphical user interface (gMCO-GUI) that allows real-time plan navigation through a gMCO-generated set of Pareto-optimal plans for high-dose-rate (HDR) brachytherapy. This work reports on the commissioning of the gMCO algorithm into clinical workflow.

Material And Methods: Our MCO workflow was validated against Oncentra Prostate v.

Catheters and dose optimization using a modified CVT algorithm and multi-criteria optimization in prostate HDR brachytherapy.

Purpose: Currently, in high-dose rate (HDR) brachytherapy planning, the catheter's positions are often selected by the planner, which involves the planner's experience. The catheters are then inserted using a template that helps to guide the catheters. For certain applications, it is of interest to choose the optimal location and number of catheters needed for dose coverage and potential decrease of the treatment's toxicity.

Inter-observer evaluation of a GPU-based multicriteria optimization algorithm combined with plan navigation tools for HDR brachytherapy.

Purpose: Recently, a GPU-based multicriteria optimization (gMCO) algorithm was integrated in a graphical user interface (gMCO-GUI) that allowed real-time plan navigation through a set of Pareto-optimal plans for high-dose-rate (HDR) brachytherapy. This work reports on the inter-observer evaluation of the gMCO algorithm into the clinical workflow.

Methods And Materials: Twenty HDR brachytherapy prostate cancer patients were retrospectively replanned with the gMCO algorithm.

Advantages of TRUS-based delineation for high-dose-rate prostate brachytherapy planning.

Purpose: To evaluate the variability of prostate contours delineated on computed tomography (CT) and transrectal ultrasound (TRUS).

Material And Methods: A TRUS-based high-dose-rate (HDR) brachytherapy procedure was introduced in 2016 in our center. The first thirty patients were additionally imaged with CT immediately after the treatment.

In-line cosmetic end-point detection of batch coating processes for colored tablets using multivariate image analysis.

In this study, an in-line Process Analytical Technology (PAT) for cosmetic (non-functional) coating unit operations is developed using images of the tablet bed acquired in real-time by an inexpensive industrial camera and lighting system. The cosmetic end-point of multiple batches, run under different operating conditions, is automatically computed from these images using a Multivariate Image Analysis (MIA) methodology in conjunction with a stability determination strategy. The end-points detected by the algorithm differed, on average, by 3% in terms of total batch time from those identified visually by a trained operator.

Evaluating the impact of real-time multicriteria optimizers integrated with interactive plan navigation tools for HDR brachytherapy.

Purpose: Currently in high-dose-rate (HDR) brachytherapy planning, manual fine-tuning of an objective function is a common practice. Furthermore, automated planning approaches such as multicriteria optimization (MCO) are still limited to the automatic generation of a single treatment plan. This study aims to quantify planning efficiency gains when using a graphics processing unit-based MCO (gMCO) algorithm combined with a novel graphical user interface (gMCO-GUI) that integrates efficient automated and interactive plan navigation tools.

Essential Office Procedures for Medicare Patients in Primary Care: Comparison With Family Medicine Residency Training.

Background And Objectives: Demographic trends show an increasing older adult population. Therefore, family medicine training programs may need to reevaluate how well their residents perform clinic procedures essential to older adults. Our objective was to compare the rates of the most frequently performed clinic procedures for Medicare patients in a large multiregional health care system (MRHCS) with those in a family medicine residency clinic.

Validation of MRI to TRUS registration for high-dose-rate prostate brachytherapy.

Purpose: The objective of this study was to develop and validate an open-source module for MRI to transrectal ultrasound (TRUS) registration to support tumor-targeted prostate brachytherapy.

Methods And Materials: In this study, 15 patients with prostate cancer lesions visible on multiparametric MRI were selected for the validation. T2-weighted images with 1-mm isotropic voxel size and diffusion weighted images were acquired on a 1.

Validation of a novel robot-assisted 3DUS system for real-time planning and guidance of breast interstitial HDR brachytherapy.

Purpose: In current clinical practice, there is no integrated 3D ultrasound (3DUS) guidance system clinically available for breast brachytherapy. In this study, the authors present a novel robot-assisted 3DUS system for real-time planning and guidance of breast interstitial high dose rate (HDR) brachytherapy treatment.

Methods: For this work, a new computer controlled robotic 3DUS system was built to perform a hybrid motion scan, which is a combination of a 6 cm linear translation with a 30° rotation at both ends.

Comparison of dose and catheter optimization algorithms in prostate high-dose-rate brachytherapy.

Purpose: The purpose of this work was to compare the hybrid inverse treatment planning optimization (HIPO), inverse dose-volume histogram-based optimization (DVHO), and fast simulated annealing stochastic algorithm (IPSA). The catheter optimization algorithm HIPO was also compared with the Centroidal Voronoi Tessellation (CVT) algorithm.

Methods And Materials: In this study, eight high-dose-rate prostate cases were randomly selected from an anonymized bank of patients.

Fast, automatic, and accurate catheter reconstruction in HDR brachytherapy using an electromagnetic 3D tracking system.

Purpose: In high dose rate brachytherapy (HDR-B), current catheter reconstruction protocols are relatively slow and error prone. The purpose of this technical note is to evaluate the accuracy and the robustness of an electromagnetic (EM) tracking system for automated and real-time catheter reconstruction.

Methods: For this preclinical study, a total of ten catheters were inserted in gelatin phantoms with different trajectories.

Towards real-time 3D ultrasound planning and personalized 3D printing for breast HDR brachytherapy treatment.

Two different end-to-end procedures were tested for real-time planning in breast HDR brachytherapy treatment. Both methods are using a 3D ultrasound (3DUS) system and a freehand catheter optimization algorithm. They were found fast and efficient.

Optimization of the reference region method for dual pharmacokinetic modeling using Gd-DTPA/MRI and (18) F-FDG/PET.

Purpose: The combination of MRI and positron emission tomography (PET) offers new possibilities for the development of novel methodologies. In pharmacokinetic image analysis, the blood concentration of the imaging compound as a function of time, [i.e.

Arterial input function sampling without surgery in rats for positron emission tomography molecular imaging.

Aim: The purpose of this study was to develop a minimally invasive procedure to derive an arterial input function (AIF) in rats through tail artery blood sampling for pharmacokinetic modeling in preclinical PET molecular imaging studies. The procedure involved a microvolumetric blood counter (μBC) and a correction to compensate for delay and dispersion of the automatic blood sampling.

Materials And Methods: AIFs were simultaneously obtained from femoral and tail arteries in rats, manually and using a μBC, after (18)F-FDG injection (n=6) in order to compare the shape of the AIFs and the kinetic analysis results at equilibrium and after implementation of a dispersion correction method.

Adaptation of the CVT algorithm for catheter optimization in high dose rate brachytherapy.

Purpose: An innovative, simple, and fast method to optimize the number and position of catheters is presented for prostate and breast high dose rate (HDR) brachytherapy, both for arbitrary templates or template-free implants (such as robotic templates).

Methods: Eight clinical cases were chosen randomly from a bank of patients, previously treated in our clinic to test our method. The 2D Centroidal Voronoi Tessellations (CVT) algorithm was adapted to distribute catheters uniformly in space, within the maximum external contour of the planning target volume.

Plastic freezer bags: a cost-effective method to protect extraction sites in laparoscopic colorectal procedures?

Purpose: To review surgical-site infection (SSI) and retrieval-site tumor recurrence rates in laparoscopic colorectal procedures when using a plastic freezer bag as a wound protector.

Methods: Laparoscopic colorectal procedures where a plastic freezer bag used as a wound protector at the extraction site were reviewed between 1991 and 2008 from a prospectively collected database. χ test was used to compare SSI and tumor recurrence rates between groups.

The myth of informed consent in rectal cancer surgery: what do patients retain?

Background: Previous research in colorectal cancer has focused on survival, recurrence, and functional outcomes. Few have assessed the decisional needs of patients or the information patients are retaining from the informed consent process.

Objectives: The aims of this study were to describe the decisional needs of adult patients with rectal cancer when deciding on the surgical treatment of their disease and to identify gaps in patients' recollection of the informed consent discussion.

Conversion of arterial input functions for dual pharmacokinetic modeling using Gd-DTPA/MRI and 18F-FDG/PET.

Reaching the full potential of magnetic resonance imaging (MRI)-positron emission tomography (PET) dual modality systems requires new methodologies in quantitative image analyses. In this study, methods are proposed to convert an arterial input function (AIF) derived from gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA) in MRI, into a (18)F-fluorodeoxyglucose ((18)F-FDG) AIF in PET, and vice versa. The AIFs from both modalities were obtained from manual blood sampling in a F98-Fisher glioblastoma rat model.

Pharmacokinetics of tacrolimus and mycophenolate mofetil in renal transplant recipients on a corticosteroid-free regimen.

Purpose: The pharmacokinetics of both tacrolimus and mycophenolic acid in renal transplant recipients on a corticosteroid-free regimen was evaluated.

Methods: Upon administration of steady-state morning tacrolimus and mycophenolate mofetil doses, 28 patients for whom at least three months had passed after renal transplantation underwent serial blood sample collection over a 12-hour dosing period. Whole blood concentrations of tacrolimus were measured, as were mycophenolic acid, mycophenolic acid 7-0-glucuronide (MPAG), and acyl glucuronide MPAG (AcMPAG) concentrations.

Assessing the impact of a 2-day laparoscopic intestinal workshop.

Background: Surgical educators have responded to the demand for increased skills in minimally invasive surgery by offering short technique-focused workshops at academic centres. The purpose of this study was to determine the impact of a comprehensive laparoscopic intestinal workshop for the adoption of laparoscopic colonic surgery.

Methods: A 2-day comprehensive laparoscopic intestinal surgery workshop included didactic teaching and supervised hands-on practice of numerous laparoscopic colon resections on a cadaveric model.

Laparoscopic colostomy reversal after a Hartmann procedure: a prospective series, literature review and an argument against laparotomy as the primary approach.

Background: Open restoration of bowel continuity after a Hartmann procedure has been associated with significant morbidity, including anastomotic leak, incisional hernia, wound infections and inability to re-establish intestinal continuity. Few studies have examined the role of laparoscopy in performing a Hartmann reversal. The aim of this study was to review our laparoscopic Hartmann reversal (LHR) experience with an emphasis on intra- and postoperative adverse events.

Development and validation of limited sampling strategies for tacrolimus and mycophenolate in steroid-free renal transplant regimens.

Purpose: 1) To develop and validate limited sampling strategies (LSSs) for tacrolimus (TAC) and mycophenolic acid (MPA) in renal transplant recipients not receiving corticosteroids; and 2) to evaluate predictive performance of published LSSs (for steroid-based regimens) in a steroid-free population.

Methods: On administration of steady-state morning TAC and mycophenolate mofetil doses, 12-hour serial blood samples from 28 stable renal transplant recipients were collected and measured by validated high-performance liquid chromatography methods and area under the curve (AUC) by trapezoidal rule. TAC LSSs were developed and validated by multiple regression analysis by a two-group method (index n = 18; validation n = 10) and MPA LSSs by the jackknife method (n = 28).