Enhancing pancreatic tumor delineation using dual-energy CT-derived extracellular volume fraction map.

. Precise identification of pancreatic tumors is challenging for radiotherapy planning due to the tumor's anatomical variability and poor visualization on 3D cross-sectional imaging. Low extracellular volume fraction (ECVf) correlates with poor vasculature uptake and possible necrosis or hypoxia in pancreatic tumors.

Predicting Neoadjuvant Treatment Response in Rectal Cancer Using Machine Learning: Evaluation of MRI-Based Radiomic and Clinical Models.

Background: Radiomics is an approach to medical imaging that quantifies the features normally translated into visual display. While both radiomic and clinical markers have shown promise in predicting response to neoadjuvant chemoradiation therapy (nCRT) for rectal cancer, the interrelationship is not yet clear.

Methods: A retrospective, single-institution study of patients treated with nCRT for locally advanced rectal cancer was performed.

Predicting Treatment Response From Extracellular Volume Fraction for Chemoradiation Therapy of Pancreatic Cancer.

Purpose: Dual-energy computed tomography (DECT) data can be used to calculate the extracellular volume fraction (ECVf) in tumors, which has been correlated with treatment outcome. This study sought to find a correlation between ECVf and treatment response as measured by the change in cancer antigen (CA) 19 to 9 during chemoradiation therapy (CRT) for pancreatic cancer.

Methods And Materials: Dual-energy CT data acquired during the late arterial contrast phase in the standard radiation therapy simulation on a dual-source DECT simulator for 25 patients with pancreatic cancer, along with their CA19-9 and hematocrit data, were analyzed.

Auto-segmentation of pancreatic tumor in multi-parametric MRI using deep convolutional neural networks.

Purpose: The recently introduced MR-Linac enables MRI-guided Online Adaptive Radiation Therapy (MRgOART) of pancreatic cancer, for which fast and accurate segmentation of the gross tumor volume (GTV) is essential. This work aims to develop an algorithm allowing automatic segmentation of the pancreatic GTV based on multi-parametric MRI using deep neural networks.

Methods: We employed a square-window based convolutional neural network (CNN) architecture with three convolutional layer blocks.

Estimation of changing gross tumor volume from longitudinal CTs during radiation therapy delivery based on a texture analysis with classifier algorithms: a proof-of-concept study.

Background: Adaptive radiation therapy (ART) is moving into the clinic rapidly. Capability of delineating the tumor change as a result of treatment response during treatment delivery is essential for ART. During image-guided radiation therapy (IGRT), a CT or cone-beam CT is taken at the time of daily setup and the tumor is not visible by eye in regions of soft tissue due to low contrast.

Initial Experience With Staging Rectal Adenocarcinoma Using 7T Magnetic Resonance Imaging.

Background: Magnetic resonance imaging (MRI) has become the preferred method for local staging of rectal cancer. Current MRI technology, operating at 1.5-3 T, results in incorrectly reported tumor depth and therefore inaccurate staging in one-third of individuals.

Pouch Volvulus in Patients Having Undergone Restorative Proctocolectomy for Ulcerative Colitis: A Case Series.

Background: Restorative proctocolectomy with IPAA improves quality of life in patients with medically refractory ulcerative colitis. Although bowel obstruction is common, pouch volvulus is rare and described only in case reports. Diagnosis can be challenging, resulting in delayed care and heightened morbidity.

Appropriate magnetic resonance imaging techniques for gross tumor volume delineation in external beam radiation therapy of locally advanced cervical cancer.

Background: Accurate delineation of the gross tumor volumes (GTV) is a prerequisite for precise radiotherapy planning and delivery. Different MRI sequences have different advantages and limitations in their ability to discriminate primary cervical tumor from normal tissue. The purpose of this work is to determine appropriate MRI techniques for GTV delineation for external-beam radiation therapy of locally advanced cervical cancer (LACC).

Correlation of ADC With Pathological Treatment Response for Radiation Therapy of Pancreatic Cancer.

Purpose: To investigate the feasibility of using apparent diffusion coefficient (ADC) to assesspathological treatment response in pancreatic ductal adenocarcinoma (PDAC) following neoadjuvant chemoradiation (nCR).

Materials/methods: MRI and pathological data collected for 25patients with resectable and borderline resectable PDAC following nCR were retrospectively analyzed. Pre- and post-nCR mean ADC values in the tumors were compared using Wilcoxon matched pairs test.

Pancreatic gross tumor volume contouring on computed tomography (CT) compared with magnetic resonance imaging (MRI): Results of an international contouring conference.

Purpose: Accurate identification of the gross tumor volume (GTV) in pancreatic adenocarcinoma is challenging. We sought to understand differences in GTV delineation using pancreatic computed tomography (CT) compared with magnetic resonance imaging (MRI).

Methods And Materials: Twelve attending radiation oncologists were convened for an international contouring symposium.

Development of a high risk pancreatic screening clinic using 3.0 T MRI.

Selective screening for pancreatic cancer (PC) has been proposed. We describe the establishment of a comprehensive multidisciplinary screening program using 3.0 T MRI.

Assessment of treatment response during chemoradiation therapy for pancreatic cancer based on quantitative radiomic analysis of daily CTs: An exploratory study.

Purpose: In an effort for early assessment of treatment response, we investigate radiation induced changes in quantitative CT features of tumor during the delivery of chemoradiation therapy (CRT) for pancreatic cancer.

Methods: Diagnostic-quality CT data acquired daily during routine CT-guided CRT using a CT-on-rails for 20 pancreatic head cancer patients were analyzed. On each daily CT, the pancreatic head, the spinal cord and the aorta were delineated and the histograms of CT number (CTN) in these contours were extracted.

Thoracostomy tube function not trajectory dictates reintervention.

Background: Hemothorax and/or pneumothorax can be managed successfully managed with tube thoracostomy (TT) in the majority of cases. Improperly placed tubes are common with rates near 30%. This study aimed to determine whether TT trajectory affects the rate of secondary intervention.

Clinical Conundrum: Killian-Jamieson Diverticulum with Paraesophageal Hernia.

Killian-Jamieson diverticulum is a outpouching of the lateral cervical esophageal wall adjacent to the insertion of the recurrent laryngeal to the larynx and is much less common in clinical practice than Zenkers Diverticulum. Surgical management of Killian-Jamieson diverticulum requires open transcervical diverticulectomy due to the proximity of the recurrent laryngeal nerve to the base of the pouch. We present a case of a Killian-Jamieson diverticulum associated with a concurrent large type III paraesophageal hernia causing significant solid-food dysphagia, post-prandial regurgitation of solid foods, and chronic cough managed with open transcervical diverticulectomy and laparoscopic paraesophageal hernia repair with Nissen fundoplication.

Educating Future Environmental Health Professionals.

Future environmental health problems will require a new generation of educated and trained professionals. Efforts to enhance the environmental public health workforce have been promoted by several organizations. While progress has been measured by these organizations, many environmental health academic programs are experiencing budget reductions and lower enrollments.

Food safety knowledge and practices of young adults.

The objective of the study described in this article was to ascertain the food safety knowledge and practices of undergraduate students attending a major American university. The study participants were undergraduate college students (mean age 18.9 +/- 1.

Application of kaizen methodology to foster departmental engagement in quality improvement.

The Toyota Production System, also known as Lean, is a structured approach to continuous quality improvement that has been developed over the past 50 years to transform the automotive manufacturing process. In recent years, these techniques have been successfully applied to quality and safety improvement in the medical field. One of these techniques is kaizen, which is the Japanese word for "good change.

The disruptive physician: a legal perspective.

Rationale And Objectives: This article addresses the medical and legal implications of disruptive physician behavior. In addition, this article will address the appropriate use of due process in peer review of disruptive physician behavior.

Conclusions: While most hospitals and even national organizations, like the American Medical Association, have definitions for what constitutes disruptive physician behavior, these definitions have been further examined and clarified in court rulings.

Fistula between the Jejunum and the Inferior Vena Cava after Esophagojejunal Anastomosis.

Fistulas between the luminal gastrointestinal tract and vascular structures can result from a variety of etiologies. While there have been reports of fistulas between the inferior vena cava and the duodenum, we report the first case to our knowledge of a fistula between the jejunum and the inferior vena cava after esophagojejunal anastomosis for recurrent esophageal adenocarcinoma.

ACR Colon Cancer Committee white paper: status of CT colonography 2009.

Purpose: To review the current status and rationale of the updated ACR practice guidelines for CT colonography (CTC).

Methods: Clinical validation trials in both the United States and Europe are reviewed. Key technical aspects of the CTC examination are emphasized, including low-dose protocols, proper insufflation, and bowel preparation.

National and local trends in CT colonography reimbursement: past, present, and future.

Computed tomographic colonography (CTC) was first introduced in the mid-1990s as a minimally invasive technology for colorectal cancer screening. Given its potential to significantly change colorectal cancer screening practices in the United States, it has attracted widespread multidisciplinary interest among radiologists, gastroenterologists, colorectal surgeons, and primary care physicians. Because of its potential for widespread utilization and the potential associated costs, it has also attracted much scrutiny from payers.

The evolving role of radiologists within the health care system.

The traditional view of radiologists as physicians who add value to the health care system solely by generating and interpreting diagnostic images is outdated. Radiologists' roles have expanded to encompass economic gatekeeping, political advocacy, public health delivery, patient safety, quality-of-care improvement, and information technology. It is through these roles that radiologists will continue to find new ways to add value to the health care system.

Proteomic analysis of bronchoalveolar lavage fluid: effect of acute exposure to diesel exhaust particles in rats.

Background: Inhalation of diesel exhaust particles (DEPs) is characterized by lung injury and inflammation, with significant increases in the numbers of polymorphonuclear leukocytes and alveolar macrophages. This influx of cellular infiltrates is associated with the activation of multiple genes, including cytokines and chemokines, and the production of reactive oxygen species.

Objective: The pathogenesis of the lung injury is not fully understood, but alterations in the presence or abundance of a number of proteins in the lung have been observed.