Evaluation of a Deep Image to Image Network (DI2IN) Auto-Segmentation Algorithm across a Network of Cancer Centers

PURPOSE/OBJECTIVE(S)

Due to manual OAR contouring challenges, various automatic contouring solutions have been introduced. Historically, common clinical auto-segmentation algorithms used were atlas based, which required maintaining a library of self-made contours. Searching the collection was computationally intensive and could take several minutes to complete. Deep learning approaches have shown significant benefits compared to atlas-based methods in improving segmentation accuracy and efficiency in auto-segmentation algorithms. This work represents the first multi-institutional study to describe and evaluate an AI algorithm for auto-segmentation of organs at risk (OARs) based on a deep image-to-image network (DI2IN).

MATERIALS/METHODS

The AI-Rad Companion Organs RT (AIRC) algorithm (Siemens Healthineers, Erlangen, Germany) uses a two-step approach for segmentation. In the first step, the target organ region in the optimal input image is extracted using a trained Deep Reinforcement Learning network (DRL), which is then used as input to create the contours in the second step based on DI2IN. The study was initially designed as a prospective single-center evaluation. The automated contours generated by AIRC were evaluated by three experienced board-certified radiation oncologists using a 4-point scale where 4 is clinically usable and 1 requires re-contouring. After seeing favorable results in a single-center pilot study, we decided to expand the study to 6 additional institutions, encompassing 8 additional evaluators for a total of 11 physician evaluators across 7 institutions.

RESULTS

One hundred fifty-six patients and 1366 contours were prospectively evaluated. The 5 most commonly contoured organs were the lung (136 contours, average rating = 4.0), spinal cord (106 contours, average rating = 3.1), eye globe (80 contours, average rating = 3.9), lens (77 contours, average rating = 3.9), and optic nerve (75 contours, average rating = 4.0). The average rating per evaluator per contour was 3.6. On average 124 contours were evaluated by each evaluator. 65% of the contours were rated as 4 and 31% were rated as 3. Only 4% of contours were rated as 1 or 2. 33 organs were evaluated in the study, with 19 structures having a 3.5 or above average rating (ribs, abdominopelvic cavity, skeleton, larynx, lung, aorta, brachial plexus, lens, eye globe, glottis, heart, parotid glands, bladder, kidneys, supraglottic larynx, submandibular glands, esophagus, optic nerve, oral cavity) and the remaining organs having a rating of 3.0 or greater (female breast, proximal femur, seminal vesicles, rectum, sternum, brainstem, prostate, brain, lips, mandible, liver, optic chiasm, spinal cord, spleen). No organ had an average rating below 3.

CONCLUSION

AIRC performed well with greater than 95% of contours accepted by treating physicians with no or minor edits. It supported a fully automated workflow with the potential for time savings and increased standardization with the use of AI-powered algorithms for high quality OAR contouring.

Pelvic Nodal Auto-Segmentation Using a Deep Image to Image Network (DI2IN) Auto-Segmentation Algorithm: Comparing Male vs. Female Pelvis

PURPOSE/OBJECTIVE(S)

Deep Learning approaches have shown significant benefits compared to atlas-based methods in improving segmentation accuracy and efficiency in auto-segmentation algorithms. The AI-Rad Companion Organs RT pelvic nodal auto-segmentation feature was trained and developed for use in the male pelvis. There is no real-world data on its usability in male pelvis and whether it can be used for female pelvic nodal anatomy. This work represents the first multi-institutional study to describe and evaluate an AI algorithm for auto-segmentation of the pelvic nodal region in female patients based on a deep image-to-image network (DI2IN).

MATERIALS/METHODS

The AIRC algorithm uses a two-step approach for segmentation. In the first step, the target organ region in the optimal input image is extracted using a trained Deep Reinforcement Learning network (DRL), which is then used as input to create the contours in the second step based on DI2IN. We retrospectively evaluated AIRC pelvic nodal auto-segmentation in both male and female patients treated at our network of institutions. The automated pelvic nodal contours generated by AIRC were evaluated by one board-certified radiation oncologist, specializing in prostate and gynecologic malignancies. A 4-point scale was used, where 4 is clinically usable and 1 requires re-contouring. Pelvic nodal regions included the right and left side of the common iliac, external iliac, internal iliac, obturator and midline presacral nodes. A chi-squared test was then used to compare the scores of male and female pelvic nodal cases.

RESULTS

Fifty-two female and 51 male patients were included in the study, representing a total of 468 and 447 pelvic nodal regions, respectively. 96% (450 pelvic nodal contours) and 99% (443 pelvic nodal contours) required no or minor edits for female and male patients, respectively (p = 0.004). The right internal iliac was the only nodal group with a statistically significant difference between female (92% requiring no or minor edits) and male (100% requiring no or minimal edits) patients, p = 0.04. The percentage of patients requiring no, or minor edits was 87% (45 patients) and 92% (47 patients) for female and male patients, respectively (p = 0.36).

CONCLUSION

AIRC pelvic nodal auto-segmentation performed very well in both male and female pelvic nodal regions, with the male pelvic nodal regions performing better especially in the right internal iliac nodal group. It is usable in female pelvic nodal regions, with 96% of contours requiring no or minor edits. As auto-segmentation becomes more widespread, it may be important to have equal representation from all genders in training and validation of auto-segmentation algorithms.

Is 80 the New 70? Octogenarians with Oropharyngeal Squamous Cell Carcinoma

PURPOSE/OBJECTIVE(S)

As the human papilloma virus (HPV) pandemic evolves and life expectancy increases, the number of older adults with oropharyngeal squamous cell carcinoma (OPSCC) continues to increase. However, there is a paucity of data regarding the fastest growing subset of this population: octogenarians (OGs). We sought to understand differences in treatment tolerability and clinical outcomes between septuagenarians (SGs) and OGs with OPSCC.

MATERIALS/METHODS

We identified SGs (age 70-79) and OGs (age 80-89) with OPSCC from a cohort of older adults with nonrecurrent, nonmetastatic head and neck squamous cell carcinoma (HNSCC) treated curatively from 2007-2020. We compared demographics, treatment characteristics and toxicities using Fischer's exact test. Time-to-event outcomes, overall survival (OS), locoregional control (LRC), and disease-specific survival (DSS), were evaluated using the Kaplan-Meier method.

RESULTS

Of 293 patients (age 70-89) with HNSCC, 39% (n = 114) had OPSCC: 93 SGs (median age: 73; interquartile range [IQR]: 71-76), and 21 OGs (median age: 81, IQR: 80-84). The median follow-up for included patients was 2.4 years; 82% were male, 64% white, 48% > 20 pack year smoking history, 37% ECOG 1. Patients had AJCC 8th edition Stage: I (27%); II (33%); III (18%); IV (22%) OPSCC. Treatment consisted of adjuvant radiation (RT) (19%), adjuvant chemoradiation (CRT) (8%), surgery alone (6%), induction/concurrent CRT (27%), concurrent CRT (28%), or RT (12%), with no significant differences in stage or treatment modalities noted between SGs and OGs. Of note, 69% of SGs and 76% of OGs were HPV+. Among 107 patients who received any RT, 24% experienced a treatment interruption (19% of SGs vs. 48% of OGs, p = 0.001) and 2 patients (both HPV- SGs) died on treatment due to unrelated health conditions. Percutaneous endoscopic gastrostomy (PEG) tubes were placed prior to or during treatment in 43% of SGs and 62% of OGs, with OGs more likely to have a PEG placed during treatment (p = 0.025). There was no difference in the prevalence of late (> 6 months) CTCAE grade 2+ dysphagia (36%) or xerostomia (31%) between SGs and OGs. Estimated 3-year LRC, DSS, and OS were not significantly different between SGs (LRC:85%; DSS:87%; OS:76%) and OGs (LRC: 81%; DSS:94%; OS: 55%, p-values: 0.98, 0.42, 0.052, respectively). However, HPV+ disease significantly increased estimated 3-year OS for both SGs (HPV+: 84%; HPV-: 56%, p = 0.0006) and OGs (HPV+: 68%; HPV-: 20%, p = 0.008).

CONCLUSION

In our cohort, OGs had a higher proportion of HPV+ OPSCC, which was associated with improved OS. This finding may provide insight into the latency of the virus. While there were similar amounts of toxicities among SGs and OGs, OGs more frequently underwent PEG tube placement and experienced more treatment interruptions. Given high rates of HPV+ OPSCC in OGs, our findings suggest that de-escalation strategies should be further investigated to improve tolerability and maximize outcomes for this neglected population.

Pilot Study of Peer Review in Low Middle-Income Country (LMIC) through Cloud-Based Platform

PURPOSE/OBJECTIVE(S)

Peer review is an essential step in clinical quality assurance and can impact patient safety and treatment outcomes. Most published data on peer review is from developed nations, with little data on peer review from low middle income countries (LMIC). Major challenges to peer review can include a lack of time, expertise and commitment from team members. With increasing access to advanced technology in LMIC, peer review is becoming more important to maintain quality and standard of care. We evaluated cloud-based e- peer review (Varian) in our network of hospitals in India with an aim to see feasibility and impact on care.

MATERIALS/METHODS

Four of 15 centers across India were selected for this pilot study. All team members were trained on the platform prior to implementation. New cases for the week treated with definitive intent were selected by the dosimetrist. The link to the cases were sent through email to reviewing physicians. Various aspects which were reviewed for each case were.1) Work up & staging (Documents were scanned and loaded).2) Treatment intent & prescription.3) Target contours.4) Normal Organ at risk contours.5) Dose- Volume -Histogram (DVH) with clinical goals attached. Cases were marked as "Not Appropriate", "Appropriate", "Appropriate with minor finding", "Represent with major revisions" as per volume and plan review.

RESULTS

Over a period of 2 months, a total of 80 cases underwent e-Peer Review at our network of hospitals prior to the start of treatment. Median turnover time (like from link sent to time to completion of review) was 48 (6-360) hours. Mean time taken by physician for review was 9 minutes (range 3 to15). 31.2% of cases were accepted without any changes, 51.9 % had a minor change and 16.9 % cases had major changes. Most frequent reason of major changes was contouring corrections 16.9%. 31% of major changes underwent recontouring and replanning before initiation of treatment.

CONCLUSION

Peer review was feasible in our network through this e-peer review system, with average turnover time and mean time taken for review of 48 hours & 9 min respectively. Peer review led to significant changes which could impact patient care delivery and outcome. The ability to review cases asynchronously via this cloud-based e-peer review system, helped to ease the burden of scheduling between treating and reviewing physician. We plan to implement this across the remaining centers in our network.

Identification of plastic rice in adulterated raw and cooked rice

In the present study, attempts have been made to identify the presence of plastic rice in adulterated raw and cooked rice by comparing the compositional and morphological properties of fake rice and real rice using Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM) and thermogravimetric analysis (TGA) techniques. Various rice samples from the national capital region of India were studied for their compositional and morphological properties. The surface morphology of real rice and plastic rice was analyzed using scanning electron microscopy. Results suggest that plastic rice used as an adulterant in raw or cooked rice is made up of polystyrene, which is a well-known toxic chemical entity. The studies suggest that these techniques can be used as a scientific tool to detect and identify the presence of plastic rice in adulterated raw and cooked rice.

Management of Atrial Fibrillation Post Transcatheter Aortic Valve Implantation

Atrial fibrillation (AF) is a common complication in patients who underwent transcatheter aortic valve implantation. Some of these patients have preexisting AF as well. The management of these patients is complex, especially after the procedure, when there is a sudden change in hemodynamics. There are no established guidelines about the management of the patients who underwent transcatheter aortic valve replacement with preexisting or new-onset AF. This review article discusses the management of these patients with rate and rhythm control strategies with medications. This article also highlights the role of newer oral anticoagulation medications and left atrial occlusion devices to prevent stroke after the procedure. We will also discuss new advances in the care of this patient population to prevent the occurrence of AF after transcatheter aortic valve implantation. In conclusion, this article is a synopsis of both pharmacologic and device interventions for the management of AF in patients who underwent transcatheter aortic valve replacement.

Real world single center experience with saphenous vein grafts interventions: should filters be filtered out?

BACKGROUND

Percutaneous coronary intervention (PCI) of saphenous vein grafts (SVG) can be challenging due to no reflow phenomenon from distal embolization of debris and microvascular vasoconstriction, resulting in myocardial injury post-procedure. Guidelines promote the use of distal embolic protection devices (EPD) to protect the distal arterial bed during SVG PCI. However, this approach has shown less-than-optimal results in many studies. We report our data using the Borgess protocol [prophylactic intracoronary (IC) nicardipine injection and direct stenting], as an alternative to EPDs in a large series of SVG interventions.

METHODS

This is a retrospective, cohort study of our single center experience with SVG interventions between 2017 and 2021. The primary outcome of the study was major adverse cardiovascular events (MACE) [a composite of death, emergent coronary artery bypass graft surgery (CABG), myocardial infarction (MI), and target vessel revascularization (TVR)] at 30 days post-procedure.

RESULTS

There were 424 consecutive SVG interventions performed during the study period, and 76% of cases presented with acute coronary syndrome. Full adherence to the Borgess protocol was observed in 36% of cases; IC nicardipine was utilized in 72% of cases. MACE rate was 3.5% at 30 days driven primarily by MI (2.6%).

CONCLUSION

The Borgess protocol approach to vein graft interventions proved good outcomes when compared to SVG PCI in randomized trials utilizing EPDs. Our study is limited by the retrospective nature and single center experience.

Advancement in biological and mechanical behavior of 3D printed poly lactic acid bone plates using polydopamine coating: Innovation for healthcare

The metallic biomaterials have been proclaimed to exhibit stress shielding with discharge of toxic ions, leading to polymeric implants attracting interest in 3D Printing domain. In this study, Poly Lactic Acid based 336 bone plates are fabricated using Fused Filament Fabrication with printing parameters being varied. Polydopamine, being biocompatible, is deposited on fabricated bone plates at varying submersion time, shaker speed and coating solutions concentration. The study involves witnessing the effect of printing and coating parameters on biological behavior of bone plates upon preservation in Simulated Body Fluid and Hank's Balanced Salt Solution. The findings propose the close relation of degradation with apatite growth. The highest degradation rate with significant reduction in mechanical characteristics are shown by uncoated bone plates. These bone plates have porous structure at 20% infill density, 0.5 mm layer height, 0.4 mm wall thickness and 100 mm/s print speed which could result in complete degradation with partial healing of bone fracture. The study suggests the preservation of bone plates coated at 120 h' submersion time and 120 RPM shaker speed in 3 mg/ml concentrated solution which showed lower apatite formation. Thus, the coating would slow down degradation of PLA bone plates, resulting in complete healing of bone fracture.

Association of pre-treatment lymphocyte-monocyte ratio with survival outcome in patients with head and neck cancer treated with chemoradiation

BACKGROUND

Given the role of systematic inflammation in cancer progression, lymphocyte-monocyte ratio (LMR) from peripheral blood has been suggested as a biomarker to assess the extent of inflammation in several solid malignancies. However, the role of LMR as a prognostic factor in head and neck cancer was unclear in several meta-analyses, and there is a paucity of literature including patients in North America. We performed an observational cohort study to evaluate the association of LMR with survival outcomes in North American patients with head and neck cancer.

METHODS

A single-institution, retrospective database was queried for patients with non-metastatic head and neck cancer who underwent definitive chemoradiation from June 2007 to April 2021 at the Roswell Park Comprehensive Cancer Center. Primary endpoints were overall survival (OS) and cancer-specific survival (CSS). The association of LMR with OS and CSS was examined using nonlinear Cox proportional hazard model using restricted cubic splines (RCS). Cox multivariable analysis (MVA) and Kaplan-Meier method were used to analyze OS and CSS. Pre-radiation LMR was then stratified into high and low based on its median value. Propensity scored matching was used to reduce the selection bias.

RESULTS

A total of 476 patients met our criteria. Median follow up was 45.3 months (interquartile range 22.8-74.0). The nonlinear Cox regression model showed that low LMR was associated with worse OS and CSS in a continuous fashion without plateau for both OS and CSS. On Cox MVA, higher LMR as a continuous variable was associated with improved OS (adjusted hazard ratio [aHR] 0,90, 95% confidence interval [CI] 0.82-0.99, p = 0.03) and CSS (aHR 0.83, 95% CI 0.72-0.95, p = 0.009). The median value of LMR was 3.8. After propensity score matching, a total of 186 pairs were matched. Lower LMR than 3.8 remained to be associated with worse OS (HR 1.59, 95% CI 1.12-2.26, p = 0.009) and CSS (HR 1.68, 95% CI 1.08-2.63, p = 0.02).

CONCLUSION

Low LMR, both as a continuous variable and dichotomized variable, was associated with worse OS and CSS. Further studies would be warranted to evaluate the role of such prognostic marker to tailor interventions.

Inosine attenuates post-stroke neuroinflammation by modulating inflammasome mediated microglial activation and polarization

To date, various agents and molecules have been developed to treat post-stroke neuroinflammation; however, none of them are clinically successful. Post-stroke neuroinflammation is primarily attributed to microglial polarization as the generation of inflammasome complexes shifts microglia to their M1 phenotype and regulate the downstream cascade. Inosine, an adenosine derivative reported to maintain cellular energy homeostasis in stressed condition. Although, the exact mechanism is still unexplored, various studies have reported that it can stimulate axonal sprouting in different neurodegenerative diseases. Hence, our present study aims to decipher the molecular mechanism of inosine mediated neuroprotection by modulating inflammasome signaling towards altered microglial polarization in ischemic stroke. Inosine was administered intraperitoneally to male Sprague Dawley rats at 1 h post ischemic stroke and were further evaluated for neurodeficit score, motor coordination and long-term neuroprotection. Brains were harvested for infarct size estimation, biochemical assays and molecular studies. Inosine administration at 1 h post ischemic stroke decreased infarct size, neurodeficit score, and improved motor co-ordination. Normalization of biochemical parameters were achieved in the treatment groups. Microglial polarization towards its anti-inflammatory phenotype and modulation of inflammation were evident by relevant gene and protein expression studies. The outcome provides preliminary evidence of inosine mediated alleviation of post-stroke neuroinflammation via modulation of microglial polarization towards its anti-inflammatory form through regulating the inflammasome activation.

Association of Body Mass Index With Outcomes Among Patients With Head and Neck Cancer Treated With Chemoradiotherapy

Importance

Combined modality therapy, such as chemoradiotherapy, often results in significant morbidity among patients with head and neck cancer. Although the role of body mass index (BMI) varies based on cancer subtypes, its association with treatment response, tumor recurrence, and survival outcomes among patients with head and neck cancer remains unclear.

Objective

To evaluate the role of BMI in treatment response, tumor recurrence, and survival outcomes among patients with head and neck cancer undergoing chemoradiotherapy.

Design, Setting, and Participants

This retrospective, observational, single-institution cohort study conducted at a comprehensive cancer center included 445 patients with nonmetastatic head and neck cancer who underwent chemoradiotherapy from January 1, 2005, to January 31, 2021.

Exposure

Normal vs overweight or obese BMI.

Main Outcomes and Measures

Metabolic response after chemoradiotherapy, locoregional failure (LRF), distant failure (DF), overall survival (OS), and progression-free survival (PFS), with Bonferroni correction used to adjust for multiple comparisons and P < .025 being considered statistically significant.

Results

A total of 445 patients (373 men [83.8%]; median age, 61 years [IQR, 55-66 years]; 107 [24.0%] with normal BMI, 179 [40.2%] with overweight BMI, and 159 [35.7%] with obese BMI) were included for analysis. Median follow-up was 48.1 months (IQR, 24.7-74.9 months). On Cox proportional hazards regression multivariable analysis, only overweight BMI was associated with improved OS (5-year OS, 71.5% vs 58.4%; adjusted hazard ratio [AHR], 0.59 [95% CI, 0.39-0.91]; P = .02) and PFS (5-year PFS, 68.3% vs 50.8%; AHR, 0.51 [95% CI, 0.34-0.75]; P < .001). On logistic multivariable analysis, overweight BMI (91.6% vs 73.8%; adjusted odds ratio [AOR], 0.86 [95% CI, 0.80-0.93]; P < .001) and obese BMI (90.6% vs 73.8%; AOR, 0.89 [95% CI, 0.81-0.96]; P = .005) were associated with complete metabolic response on follow-up positron emission tomography-computed tomography after treatments. On Fine-Gray multivariable analysis, overweight BMI was associated with reduction in LRF (5-year LRF, 7.0% vs 25.9%; AHR, 0.30 [95% CI, 0.12-0.71]; P = .01), but not DF (5-year DF, 17.4% vs 21.5%; AHR, 0.92 [95% CI, 0.47-1.77]; P = .79). Obese BMI was not associated with LRF (5-year LRF, 10.4% vs 25.9%; AHR, 0.63 [95% CI, 0.29-1.37]; P = .24) or DF (5-year DF, 15.0% vs 21.5%; AHR, 0.70 [95% CI, 0.35-1.38]; P = .30).

Conclusion

In this cohort study of patients with head and neck cancer, when compared with normal BMI, overweight BMI was an independent factor favorably associated with complete response after treatments, OS, PFS, and LRF. Further investigations are warranted to improve understanding on the role of BMI among patients with head and neck cancer.

Synthesis, characterization, and assessment of chitosan-nanomatrix enriched with antifungal formulation against biodeterioration of active ingredients of selected herbal raw materials

Aflatoxin B₁ (AFB₁), a potent natural group 1 carcinogen produced by Aspergillus flavus is considered an unavoidable toxic contaminant of herbal raw materials, which often deteriorates their active ingredients making them less effective and hazardous during their formulation in herbal drugs. The present investigation reports the antifungal (0.5 μl/ml) and AFB₁ inhibitory (0.4 μl/ml) effects of the developed formulation CIM based on a mixture of essential oils (Carum carvi, and Illicium verum), and methyl anthranilate using mathematical modeling. The insight into the mechanism of action has also been explored using biochemical, molecular docking, and RT-PCR. Further, the nanoencapsulation of CIM (Ne-CIM) was prepared using a green facile synthesis of chitosan-based nanomatrix and characterized by Dynamic light scattering (DLS), Fourier transform-infrared, (FTIR), and X-ray diffraction analysis (XRD). The in-situ results showed that at MIC doses Ne-CIM effectively controls the A. flavus (81.25-89.57 %), AFB₁ contamination (100 %), and protects the active ingredients deterioration of Piper nigrum, P. longum, Andrographis paniculata, Silybum marianum, and Withania somnifera caused by toxigenic species of A. flavus without affecting their sensory properties. Hence, Ne-CIM could be used as a green chemical agent to protect the biodeterioration of active ingredients of herbal raw materials caused by toxigenic species of A. flavus.

Tracheo-oesophageal fistula in a case of organophosphate poisoning

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Temperature dependent characteristics of flexible p-PANI/n-ZnO based hybrid heterojunction diode

This study aims to develop and characterize a flexible p-PANI/n-ZnO heterojunction diode developed from a combination of electrochemical and sputtering technique. Investigation of structural properties and morphology of the thin films has been done from XRD and SEM analysis. To study the temperature effect on the electrical properties of the diode, current-voltage-temperature (I-V-T) measurements were done for the temperature range 25-300 K. Applying the ideal thermionic emission theory, various diode parameters like reverse saturation current, quality factor, series resistance and barrier height were computed utilizing the semilogarithmic plot ofI-Vcurve and Cheungs' method. Barrier height, reverse saturation current and quality factor calculated from ln(I)versusVcurve were observed to vary from 0.0627-0.725 eV, 0.236-98.8 nA and 54.43-3.29 respectively over the temperature range 25-300 K. It has been found that the series resistance falls with a rise in temperature. The barrier height, series resistance and ideality factor were observed to vary from 0.0628-0.692 eV, 15 900-46.8 Kohm and 41.88-2.27 respectively for the temperature range 25-300 K. The activation energy estimated from Arrhenius plot was observed to be 14.51 meV. Additionally, the fabricated PANI/ZnO diode was mechanically robust that can be bent without affecting its performance.

Newly Recognized CNS Tumors in the 2021 World Health Organization Classification: Imaging Overview with Histopathologic and Genetic Correlation

In 2021, the World Health Organization released an updated classification of CNS tumors. This update reflects the growing understanding of the importance of genetic alterations related to tumor pathogenesis, prognosis, and potential targeted treatments and introduces 22 newly recognized tumor types. Herein, we review these 22 newly recognized entities and emphasize their imaging appearance with correlation to histologic and genetic features.

The Diagnostic Accuracy of a Novel Scoring System Using Multi-Detector Computed Tomography to Diagnose Lung Cancer

INTRODUCTION

Lung cancer is the leading cause amongst the cancer deaths in the world. Detection of malignancy at an early stage and with precision is the utmost objective of radiological evaluation. The final diagnosis of lung cancer is histopathological evaluation of the mass. The authors hereby have tried to convert the multi-detector CT (MDCT) characteristics and patient demographics into quantitative data to formulate a scoring system that can predict lung malignancy as close to histopathology as possible.

MATERIALS AND METHODS

After obtaining ethical clearance, 104 cases of suspected lung cancer by history, clinical and radiographic evaluation were enrolled in the study. These patients were undergoing CT thorax (contrast) on 384 slice siemens somatom force. After undergoing the radiological evaluation biopsy of the mass was done either by CT guided or bronchoscopy guided. Radiological and histopathological findings were correlated. Patients aged >50, lymphadenopathy, tumor volume >50 cc, enhancement >15 HU (Hounsfield unit) after contrast injection were given a score of 15 each. History of smoking, bronchus cut off, spiculated/lobulated margins, mediastinal/pleural involvement, and angiogram sign positive were given a score of 20 each. So, a maximum score of 160 can be achieved by history and MDCT evaluation.

RESULTS

Sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV), and diagnostic accuracy of MDCT by using conventional parameters against histopathology was 97.5%, 85%, 96.29%, 89.47%, and 95.0%. The sensitivity and specificity calculated through Receiver-Operating-Characteristic (ROC) for predicting malignancy were found to be 98.8% and 90.0% for a cut-off score of >97.5 out of maximum of 160.  Conclusion: MDCT serves as a tool for early diagnosis of lung cancer, and it is the utmost important tool for cases where biopsy or fine needle aspiration cytology (FNAC) is not possible. By creating a quantitative criterion to diagnose lung malignancy, the subjective nature of MDCT diagnosis can be converted into an objective based evaluation.

Edge-Enhancing Gradient-Echo MP2RAGE for Clinical Epilepsy Imaging at 7T

The 3D edge-enhancing gradient-echo (EDGE) MR imaging sequence offers superior contrast-to-noise ratio in the detection of focal cortical dysplasia. EDGE could benefit from 7T MR imaging but also faces challenges such as image inhomogeneity and low acquisition efficiency. We propose an EDGE-MP2RAGE sequence that can provide both EDGE and T1-weighted contrast, simultaneously, improving data-acquisition efficiency. We demonstrate that with sequence optimization, EDGE images with sufficient uniformity and T1-weighted images with high gray-to-white matter contrast can be achieved.

How to achieve the critical view of safety for safe laparoscopic cholecystectomy: Technical aspects

Laparoscopic cholecystectomy is associated with a higher incidence of biliary/vasculobiliary injuries than open cholecystectomy. Anatomical misperception is the most common underlying mechanism of such injuries. Although a number of strategies have been described to prevent these injuries, critical view of safety method of structural identification seems to be the most effective preventive measure. The critical view of safety can be achieved in the majority of cases during laparoscopic cholecystectomy. It is highly recommended by various guidelines. However, its poor understanding and low adoption rates among practicing surgeons have been global problems. Educational intervention and increasing awareness about the critical view of safety can increase its penetration in routine surgical practice. In this article, a technique of achieving critical view of safety during laparoscopic cholecystectomy is described with the aim to enhance its understanding among general surgery trainees and practicing general surgeons.