1
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Pascual TNB, Paez D, Iagaru A, Gnanasegaran G, Lee ST, Sathekge M, Buatti JM, Giammarile F, Al-Ibraheem A, Pardo MA, Baum RP, De Bari B, Ben-Haim S, Blay JY, Brink A, Estrada-Lobato E, Fanti S, Golubic AT, Hatazawa J, Israel O, Kiess A, Knoll P, Louw L, Mariani G, Mirzaei S, Orellana P, Prior JO, Urbain JL, Vichare S, Vinjamuri S, Virgolini I, Scott AM. Guiding principles on the education and practice of theranostics. Eur J Nucl Med Mol Imaging 2024; 51:2320-2331. [PMID: 38453729 PMCID: PMC11178594 DOI: 10.1007/s00259-024-06657-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/13/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE The recent development and approval of new diagnostic imaging and therapy approaches in the field of theranostics have revolutionised nuclear medicine practice. To ensure the provision of these new imaging and therapy approaches in a safe and high-quality manner, training of nuclear medicine physicians and qualified specialists is paramount. This is required for trainees who are learning theranostics practice, and for ensuring minimum standards for knowledge and competency in existing practising specialists. METHODS To address the need for a training curriculum in theranostics that would be utilised at a global level, a Consultancy Meeting was held at the IAEA in May 2023, with participation by experts in radiopharmaceutical therapy and theranostics including representatives of major international organisations relevant to theranostics practice. RESULTS Through extensive discussions and review of existing curriculum and guidelines, a harmonised training program for theranostics was developed, which aims to ensure safe and high quality theranostics practice in all countries. CONCLUSION The guiding principles for theranostics training outlined in this paper have immediate relevance for the safe and effective practice of theranostics.
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Affiliation(s)
| | - Diana Paez
- Division of Human Health, Department of Nuclear Science and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Andrei Iagaru
- Division of Nuclear Medicine and Molecular Imaging, Stanford University Medical Center, Stanford, CA, USA
| | - Gopi Gnanasegaran
- Department of Nuclear Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Sze Ting Lee
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Australia
- Olivia Newton-John Cancer Research Institute, Melbourne, Australia
- School of Cancer Medicine, La Trobe University, Melbourne, Australia
- School of Health and Biomedicine, Royal Melbourne Institute of Technology (RMIT) University, Melbourne, Australia
- Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Mike Sathekge
- Steve Biko Academic Hospital, Pretoria, South Africa
- University of Pretoria, Pretoria, South Africa
| | - John M Buatti
- Department of Radiation Oncology, Holden Comprehensive Cancer Center, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Francesco Giammarile
- Division of Human Health, Department of Nuclear Science and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Akram Al-Ibraheem
- Department of Nuclear Medicine, King Hussein Cancer Center (KHCC), Amman, Jordan
- School of Medicine, University of Jordan, Amman, Jordan
| | - Manuela Arevalo Pardo
- Division of Human Health, Department of Nuclear Science and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Richard P Baum
- Center for Advanced Radiomolecular Precision Oncology, Curanosticum Wiesbaden, FrankfurtWiesbaden, Germany
| | - Berardino De Bari
- Radiation Oncology Department, Réseau Hospitalier Neuchâtelois, La Chaux-de-Fonds, Switzerland
| | - Simona Ben-Haim
- Department of Biophysics and Nuclear Medicine, Hadassah University Hospital, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
- University College London, London, UK
| | - Jean-Yves Blay
- Department of Medicine, Centre Leon Berard, Lyon, France
- University Claude Bernard Lyon, Lyon, France
| | - Anita Brink
- Division of Human Health, Department of Nuclear Science and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Enrique Estrada-Lobato
- Division of Human Health, Department of Nuclear Science and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Stefano Fanti
- Nuclear Medicine Division, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Policlinico S.Orsola, Bologna, Italy
| | - Anja Tea Golubic
- Department of Nuclear Medicine and Radiation Protection, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
| | - Jun Hatazawa
- Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Ora Israel
- B. Rappaport School of Medicine, Israel Institute of Technology-Technion, Haifa, Israel
| | - Ana Kiess
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter Knoll
- Division of Human Health, Department of Nuclear Science and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Lizette Louw
- Center of Molecular Imaging and Theranostics, Johannesburg, South Africa
- University of the Witwatersrand, Johannesburg, South Africa
| | - Giuliano Mariani
- Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Siroos Mirzaei
- Department of Nuclear Medicine With PET-Centre, Clinic Ottakring, Vienna, Austria
| | | | - John O Prior
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | | | - Shrikant Vichare
- Division of Human Health, Department of Nuclear Science and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Sobhan Vinjamuri
- Nuclear Medicine Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Irene Virgolini
- Department of Nuclear Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Andrew M Scott
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Australia.
- Olivia Newton-John Cancer Research Institute, Melbourne, Australia.
- School of Cancer Medicine, La Trobe University, Melbourne, Australia.
- Faculty of Medicine, University of Melbourne, Melbourne, Australia.
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2
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Wang X, Ding Q, Groleau RR, Wu L, Mao Y, Che F, Kotova O, Scanlan EM, Lewis SE, Li P, Tang B, James TD, Gunnlaugsson T. Fluorescent Probes for Disease Diagnosis. Chem Rev 2024; 124:7106-7164. [PMID: 38760012 PMCID: PMC11177268 DOI: 10.1021/acs.chemrev.3c00776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 05/19/2024]
Abstract
The identification and detection of disease-related biomarkers is essential for early clinical diagnosis, evaluating disease progression, and for the development of therapeutics. Possessing the advantages of high sensitivity and selectivity, fluorescent probes have become effective tools for monitoring disease-related active molecules at the cellular level and in vivo. In this review, we describe current fluorescent probes designed for the detection and quantification of key bioactive molecules associated with common diseases, such as organ damage, inflammation, cancers, cardiovascular diseases, and brain disorders. We emphasize the strategies behind the design of fluorescent probes capable of disease biomarker detection and diagnosis and cover some aspects of combined diagnostic/therapeutic strategies based on regulating disease-related molecules. This review concludes with a discussion of the challenges and outlook for fluorescent probes, highlighting future avenues of research that should enable these probes to achieve accurate detection and identification of disease-related biomarkers for biomedical research and clinical applications.
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Affiliation(s)
- Xin Wang
- College
of Chemistry, Chemical Engineering and Materials Science, Key Laboratory
of Molecular and Nano Probes, Ministry of Education, Collaborative
Innovation Center of Functionalized Probes for Chemical Imaging in
Universities of Shandong, Institutes of Biomedical Sciences, Shandong Normal University, Jinan 250014, People’s Republic of China
| | - Qi Ding
- College
of Chemistry, Chemical Engineering and Materials Science, Key Laboratory
of Molecular and Nano Probes, Ministry of Education, Collaborative
Innovation Center of Functionalized Probes for Chemical Imaging in
Universities of Shandong, Institutes of Biomedical Sciences, Shandong Normal University, Jinan 250014, People’s Republic of China
| | | | - Luling Wu
- Department
of Chemistry, University of Bath, Bath BA2 7AY, U.K.
| | - Yuantao Mao
- College
of Chemistry, Chemical Engineering and Materials Science, Key Laboratory
of Molecular and Nano Probes, Ministry of Education, Collaborative
Innovation Center of Functionalized Probes for Chemical Imaging in
Universities of Shandong, Institutes of Biomedical Sciences, Shandong Normal University, Jinan 250014, People’s Republic of China
| | - Feida Che
- College
of Chemistry, Chemical Engineering and Materials Science, Key Laboratory
of Molecular and Nano Probes, Ministry of Education, Collaborative
Innovation Center of Functionalized Probes for Chemical Imaging in
Universities of Shandong, Institutes of Biomedical Sciences, Shandong Normal University, Jinan 250014, People’s Republic of China
| | - Oxana Kotova
- School
of Chemistry and Trinity Biomedical Sciences Institute (TBSI), Trinity College Dublin, The University of Dublin, Dublin 2 D02 R590, Ireland
- Advanced
Materials and BioEngineering Research (AMBER) Centre, Trinity College
Dublin, The University of Dublin, Dublin 2 D02 W9K7, Ireland
| | - Eoin M. Scanlan
- School
of Chemistry and Trinity Biomedical Sciences Institute (TBSI), Trinity College Dublin, The University of Dublin, Dublin 2 D02 R590, Ireland
- Synthesis
and Solid-State Pharmaceutical Centre (SSPC), School of Chemistry, Trinity College Dublin, The University of Dublin, Dublin 2 , Ireland
| | - Simon E. Lewis
- Department
of Chemistry, University of Bath, Bath BA2 7AY, U.K.
| | - Ping Li
- College
of Chemistry, Chemical Engineering and Materials Science, Key Laboratory
of Molecular and Nano Probes, Ministry of Education, Collaborative
Innovation Center of Functionalized Probes for Chemical Imaging in
Universities of Shandong, Institutes of Biomedical Sciences, Shandong Normal University, Jinan 250014, People’s Republic of China
| | - Bo Tang
- College
of Chemistry, Chemical Engineering and Materials Science, Key Laboratory
of Molecular and Nano Probes, Ministry of Education, Collaborative
Innovation Center of Functionalized Probes for Chemical Imaging in
Universities of Shandong, Institutes of Biomedical Sciences, Shandong Normal University, Jinan 250014, People’s Republic of China
- Laoshan
Laboratory, 168 Wenhai
Middle Road, Aoshanwei Jimo, Qingdao 266237, Shandong, People’s Republic of China
| | - Tony D. James
- Department
of Chemistry, University of Bath, Bath BA2 7AY, U.K.
- School
of Chemistry and Chemical Engineering, Henan
Normal University, Xinxiang 453007, People’s
Republic of China
| | - Thorfinnur Gunnlaugsson
- School
of Chemistry and Trinity Biomedical Sciences Institute (TBSI), Trinity College Dublin, The University of Dublin, Dublin 2 D02 R590, Ireland
- Advanced
Materials and BioEngineering Research (AMBER) Centre, Trinity College
Dublin, The University of Dublin, Dublin 2 D02 W9K7, Ireland
- Synthesis
and Solid-State Pharmaceutical Centre (SSPC), School of Chemistry, Trinity College Dublin, The University of Dublin, Dublin 2 , Ireland
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3
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Martinez ME, Schmeler KM, Lajous M, Newman LA. Cancer Screening in Low- and Middle-Income Countries. Am Soc Clin Oncol Educ Book 2024; 44:e431272. [PMID: 38843475 DOI: 10.1200/edbk_431272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
The worldwide cancer burden is growing, and populations residing in low- and middle-income countries (LMICs) are experiencing a disproportionate extent of this growth. Breast, colorectal, and cervical cancers are among the top 10 most frequently diagnosed malignancies, and they also account for a substantial degree of cancer mortality internationally. Effective screening strategies are available for all three of these cancers. Individuals from LMICs face substantial cost and access barriers to early detection programs, and late stage at diagnosis continues to be a major cause for cancer mortality in these communities. This chapter will review the epidemiology of breast, colorectal, and cervical cancers, and will explore prospects for improving global control through novel approaches to screening in cost-constrained environments.
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Affiliation(s)
- Maria Elena Martinez
- Herbert Wertheim School of Public Health and Moores Cancer Center, University of California, San Diego, La Jolla, CA
| | - Kathleen M Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center
| | - Martin Lajous
- Centro de Investigación de Salud Poblacional, Instituto Nacional de Salud Pública, Mexico City, Mexico
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Lisa A Newman
- Department of Surgery, Weill Cornell Medicine, New York, NY
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4
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Sahu B, Madani G. Imaging inequality: exploring the differences in radiology between high- and low-income countries. Clin Radiol 2024; 79:399-403. [PMID: 38616473 DOI: 10.1016/j.crad.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/02/2024] [Indexed: 04/16/2024]
Affiliation(s)
- B Sahu
- Imperial College Healthcare NHS Trust, United Kingdom.
| | - G Madani
- Imperial College Healthcare NHS Trust, United Kingdom.
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5
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Scott AM, Zeglis BM, Lapi SE, Scott PJH, Windhorst AD, Abdel-Wahab M, Giammarile F, Piaez D, Jalilian A, Knoll P, Korde A, Vichare S, Ayati N, Lee ST, Lyashchenko SK, Zhang J, Urbain JL, Lewis JS. Trends in nuclear medicine and the radiopharmaceutical sciences in oncology: workforce challenges and training in the age of theranostics. Lancet Oncol 2024; 25:e250-e259. [PMID: 38821099 DOI: 10.1016/s1470-2045(24)00037-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 06/02/2024]
Abstract
Although the promise of radionuclides for the diagnosis and treatment of disease was recognised soon after the discovery of radioactivity in the late 19th century, the systematic use of radionuclides in medicine only gradually increased over the subsequent hundred years. The past two decades, however, has seen a remarkable surge in the clinical application of diagnostic and therapeutic radiopharmaceuticals, particularly in oncology. This development is an exciting time for the use of theranostics in oncology, but the rapid growth of this area of nuclear medicine has created challenges as well. In particular, the infrastructure for the manufacturing and distribution of radiopharmaceuticals remains in development, and regulatory bodies are still optimising guidelines for this new class of drug. One issue of paramount importance for achieving equitable access to theranostics is building a sufficiently trained workforce in high-income, middle-income, and low-income countries. Here, we discuss the key challenges and opportunities that face the field as it seeks to build its workforce for the 21st century.
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Affiliation(s)
- Andrew M Scott
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, VIC, Australia; Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia; School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia; Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Brian M Zeglis
- Department of Chemistry, Hunter College, City University of New York, New York, NY, USA; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Suzanne E Lapi
- Department of Radiology and Department of Chemistry, O'Neal Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Peter J H Scott
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Albert D Windhorst
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, Netherlands; Cancer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - May Abdel-Wahab
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Francesco Giammarile
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Diana Piaez
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Amirreza Jalilian
- Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Peter Knoll
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Aruna Korde
- Division of Physical and Chemical Sciences, International Atomic Energy Agency, Vienna, Austria
| | - Shrikant Vichare
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Nayyereh Ayati
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Sze Ting Lee
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, VIC, Australia; Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia; School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia; Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia; Department of Surgery, University of Melbourne, Melbourne, VIC, Australia; School of Health and Biomedical Science, RMIT University, Melbourne, VIC, Australia
| | - Serge K Lyashchenko
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Jingjing Zhang
- Department of Diagnostic Radiology, National University of Singapore, Singapore; Clinical Imaging Research Centre, Nanomedicine Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jean Luc Urbain
- Department of Diagnostic Imaging (Radiology and Nuclear Medicine), Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Jason S Lewis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Program in Molecular Pharmacology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Radiology, Weill Cornell Medical College, New York, NY, USA; Department of Pharmacology, Weill Cornell Medical College, New York, NY, USA.
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6
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Mikhail-Lette M, Cordero L, Lievens Y, Al-Ibraheem A, Urbain JL, Chera B, Muylle K, Vaandering A, Rosa AA, Cerci JJ, Sathekge M, Minjgee M, Nansalmaa E, Erdenechimeg S, Ruiz RL, Scott A, Paez D, Giammarile F, Veduta A, Minoshima E, Vichare S, Abdel-Wahab M. Six country vignettes: Strengthening radiotherapy and theranostics. J Cancer Policy 2024; 40:100471. [PMID: 38556128 DOI: 10.1016/j.jcpo.2024.100471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/11/2024] [Accepted: 03/16/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND For cancer patient populations worldwide, the synchronous scale-up of diagnostics and treatments yields meaningful gains in survival and quality of life. Among advanced cancer therapies, radiotherapy (RT) and theranostics are key to achieving practical, high-quality, and personalized precision medicine - targeting disease manifestations of individual patients and broad populations, alike. Aiming to learn from one another across different world regions, the six country vignettes presented here depict both challenges and victories in de novo establishment or improvement of RT and theranostics infrastructure. METHODS The International Atomic Energy Agency (IAEA) convened global RT and theranostics experts from diverse world regions and contexts to identify relevant challenges and report progress in their own six countries: Belgium, Brazil, Costa Rica, Jordan, Mongolia, and South Africa. These accounts are collated, compared, and contrasted herein. RESULTS Common challenges persist which could be more strategically assessed and addressed. A quantifiable discrepancy entails personnel. The estimated radiation oncologists (ROs), nuclear medicine physicians (NMPs), and medical physicists (MPs for RT and nuclear medicine) per million inhabitants in the six collective countries respectively range between 2.69-38.00 ROs, 1.00-26.00 NMPs, and 0.30-3.45 MPs (Table 1), reflecting country-to-country inequities which largely match World Bank country-income stratifications. CONCLUSION Established goals for RT and nuclear medicine advancement worldwide have proven elusive. The pace of progress could be hastened by enhanced approaches such as more sustainably phased implementation; better multinational networking to share lessons learned; routine quality and safety audits; as well as capacity building employing innovative, resource-sparing, cutting-edge technologic approaches. Bodies such as ministries of health, professional societies, and the IAEA shall serve critical roles in convening and coordinating more innovative RT and theranostics translational research, including expanding nuanced global database metrics to inform, reach, and potentiate milestones most meaningfully. POLICY SUMMARY Aligned with WHO 25×25 NCDs target; WHA70.12 and WHA76.5 resolutions.
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Affiliation(s)
- Miriam Mikhail-Lette
- International Atomic Energy Agency Department of Nuclear Sciences and Applications, Division of Human Health, Nuclear Medicine and Diagnostic Imaging Section, Vienna, Austria.
| | - Lisbeth Cordero
- International Atomic Energy Agency Department of Nuclear Sciences and Applications, Division of Human Health, Nuclear Medicine and Diagnostic Imaging Section, Vienna, Austria
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Akram Al-Ibraheem
- Department of Nuclear Medicine and PET/CT, King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Jean-Luc Urbain
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Bhishamjit Chera
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC, USA
| | | | - Aude Vaandering
- Department of Radiation Oncology, Université Catholique de Louvain, Saint-Luc University Hospital, Brussels, Belgium
| | - Arthur Accioly Rosa
- Department of Radiation Oncology, Oncoclínicas Salvador and Hospital Santa Izabel, Salvador, Bahia, Brazil
| | - Juliano Julio Cerci
- Department of Nuclear Medicine, Quanta Diagnóstico e Terapia, Curitiba, Brazil
| | - Mike Sathekge
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | | | | | | | - Rolando Loría Ruiz
- Radiation Therapy Center Siglo 21, Hospital México and Clínica Bíblica, Caja Costarricense de Seguro Social, San Jose, Costa Rica
| | - Andrew Scott
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, VIC, Australia; Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia; School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Diana Paez
- International Atomic Energy Agency Department of Nuclear Sciences and Applications, Division of Human Health, Nuclear Medicine and Diagnostic Imaging Section, Vienna, Austria
| | - Francesco Giammarile
- International Atomic Energy Agency Department of Nuclear Sciences and Applications, Division of Human Health, Nuclear Medicine and Diagnostic Imaging Section, Vienna, Austria
| | - Anna Veduta
- International Atomic Energy Agency Department of Nuclear Sciences and Applications, Division of Human Health, Nuclear Medicine and Diagnostic Imaging Section, Vienna, Austria
| | - Erika Minoshima
- International Atomic Energy Agency Department of Nuclear Sciences and Applications, Division of Human Health, Nuclear Medicine and Diagnostic Imaging Section, Vienna, Austria
| | - Shrikant Vichare
- International Atomic Energy Agency Department of Nuclear Sciences and Applications, Division of Human Health, Nuclear Medicine and Diagnostic Imaging Section, Vienna, Austria
| | - May Abdel-Wahab
- International Atomic Energy Agency Department of Nuclear Sciences and Applications, Division of Human Health, Nuclear Medicine and Diagnostic Imaging Section, Vienna, Austria
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7
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Abdel-Wahab M, Coleman CN, Eriksen JG, Lee P, Kraus R, Harsdorf E, Lee B, Dicker A, Hahn E, Agarwal JP, Prasanna PGS, MacManus M, Keall P, Mayr NA, Jereczek-Fossa BA, Giammarile F, Kim IA, Aggarwal A, Lewison G, Lu JJ, Guedes de Castro D, Kong FMS, Afifi H, Sharp H, Vanderpuye V, Olasinde T, Atrash F, Goethals L, Corn BW. Addressing challenges in low-income and middle-income countries through novel radiotherapy research opportunities. Lancet Oncol 2024; 25:e270-e280. [PMID: 38821101 DOI: 10.1016/s1470-2045(24)00038-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 06/02/2024]
Abstract
Although radiotherapy continues to evolve as a mainstay of the oncological armamentarium, research and innovation in radiotherapy in low-income and middle-income countries (LMICs) faces challenges. This third Series paper examines the current state of LMIC radiotherapy research and provides new data from a 2022 survey undertaken by the International Atomic Energy Agency and new data on funding. In the context of LMIC-related challenges and impediments, we explore several developments and advances-such as deep phenotyping, real-time targeting, and artificial intelligence-to flag specific opportunities with applicability and relevance for resource-constrained settings. Given the pressing nature of cancer in LMICs, we also highlight some best practices and address the broader need to develop the research workforce of the future. This Series paper thereby serves as a resource for radiation professionals.
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Affiliation(s)
- May Abdel-Wahab
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria.
| | - C Norman Coleman
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jesper Grau Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Lee
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Ryan Kraus
- Department of Radiation Oncology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Ekaterina Harsdorf
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Becky Lee
- Department of Radiation Medicine, Loma Linda University, Loma Linda, CA, USA; Department of Radiation Oncology, Summa Health, Akron, OH, USA
| | - Adam Dicker
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ezra Hahn
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, ON, Canada
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Pataje G S Prasanna
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael MacManus
- Department of Radiation Oncology, Peter MacCallum Cancer Centre and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Paul Keall
- Image X Institute, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Nina A Mayr
- College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Barbara Alicja Jereczek-Fossa
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Division of Radiotherapy, European Institute of Oncology, IRCCS, Milan, Italy
| | | | - In Ah Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul, South Korea; Seoul National University, College of Medicine, Seoul, South Korea
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Grant Lewison
- Institute of Cancer Policy, King's College London, London, UK
| | - Jiade J Lu
- Shanghai Proton and Heavy Ion Centre, Fudan University School of Medicine, Shanghai, China
| | | | - Feng-Ming Spring Kong
- Department of Clinical Oncology, HKU-Shenzhen Hospital and Queen Mary Hospital, Li Ka Shing Faculty of Medicine, Hong Kong Special Administrative Region, China
| | - Haidy Afifi
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Hamish Sharp
- Institute of Cancer Policy, King's College London, London, UK
| | - Verna Vanderpuye
- National Center for Radiotherapy, Oncology and Nuclear Medicine, Korlebu Teaching Hospital, Accra, Ghana
| | | | - Fadi Atrash
- Augusta Victoria Hospital, Jerusalem, Israel
| | - Luc Goethals
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
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Giammarile F, Paez D, Zimmermann R, Cutler CS, Jalilian A, Korde A, Knoll P, Ayati N, Lewis JS, Lapi SE, Delgado Bolton RC, Kunikowska J, Estrada Lobato E, Urbain JL, Holmberg O, Abdel-Wahab M, Scott AM. Production and regulatory issues for theranostics. Lancet Oncol 2024; 25:e260-e269. [PMID: 38821100 DOI: 10.1016/s1470-2045(24)00041-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/22/2024] [Accepted: 01/22/2024] [Indexed: 06/02/2024]
Abstract
Theranostics has become a major area of innovation and progress in cancer care over the last decade. In view of the introduction of approved therapeutics in neuroendocrine tumours and prostate cancer in the last 10 years, the ability to provide access to these treatments has emerged as a key factor in ensuring global benefits from this cancer therapy approach. In this Series paper we explore the issues that affect access to and availability of theranostic radiopharmaceuticals, including supply and regulatory issues that might affect the availability of theranostic treatments for patients with cancer.
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Affiliation(s)
- Francesco Giammarile
- Division of Human Health, Department of Nuclear Safety and Security, International Atomic Energy Agency, Vienna, Austria
| | - Diana Paez
- Division of Human Health, Department of Nuclear Safety and Security, International Atomic Energy Agency, Vienna, Austria
| | - Richard Zimmermann
- Chrysalium Consulting, Lalaye, France; MEDraysintell, Louvain la Neuve, Belgium; Oncidium Foundation, Auderghem, Belgium
| | - Cathy S Cutler
- Isotope Research and Production Department, Brookhaven National Laboratory Upton, New York City, NY, USA
| | - Amirreza Jalilian
- Division of Physical and Chemical Sciences, Department of Nuclear Safety and Security, International Atomic Energy Agency, Vienna, Austria
| | - Aruna Korde
- Division of Physical and Chemical Sciences, Department of Nuclear Safety and Security, International Atomic Energy Agency, Vienna, Austria
| | - Peter Knoll
- Division of Physical and Chemical Sciences, Department of Nuclear Safety and Security, International Atomic Energy Agency, Vienna, Austria
| | - Nayyereh Ayati
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Jason S Lewis
- Department of Radiology and Program in Molecular Pharmacology, Memorial Sloan Kettering Cancer Center, Upton, NY, USA; Departments of Radiology and Pharmacology, Weill Cornell Medical College, New York City, NY, USA
| | - Suzanne E Lapi
- Departments of Radiology and Chemistry, O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Roberto C Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja, Logroño, Spain; Servico Cántabro de Salud, Santander, Spain
| | - Jolanta Kunikowska
- Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poland
| | - Enrique Estrada Lobato
- Division of Human Health, Department of Nuclear Safety and Security, International Atomic Energy Agency, Vienna, Austria
| | | | - Ola Holmberg
- Department of Nuclear Science and Applications, and Division of Radiation, Transport and Waste Safety, Department of Nuclear Safety and Security, International Atomic Energy Agency, Vienna, Austria
| | - May Abdel-Wahab
- Division of Human Health, Department of Nuclear Safety and Security, International Atomic Energy Agency, Vienna, Austria
| | - Andrew M Scott
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, VIC, Australia; Department of Molecular Imaging and Therapy, Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia; School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia; Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia.
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9
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Wulaningsih W, Villamaria C, Akram A, Benemile J, Croce F, Watkins J. Deep Learning Models for Predicting Malignancy Risk in CT-Detected Pulmonary Nodules: A Systematic Review and Meta-analysis. Lung 2024:10.1007/s00408-024-00706-1. [PMID: 38782779 DOI: 10.1007/s00408-024-00706-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/12/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND There has been growing interest in using artificial intelligence/deep learning (DL) to help diagnose prevalent diseases earlier. In this study we sought to survey the landscape of externally validated DL-based computer-aided diagnostic (CADx) models, and assess their diagnostic performance for predicting the risk of malignancy in computed tomography (CT)-detected pulmonary nodules. METHODS An electronic search was performed in four databases (from inception to 10 August 2023). Studies were eligible if they were peer-reviewed experimental or observational articles comparing the diagnostic performance of externally validated DL-based CADx models with models widely used in clinical practice to predict the risk of malignancy. A bivariate random-effect approach for the meta-analysis on the included studies was used. RESULTS Seventeen studies were included, comprising 8553 participants and 9884 nodules. Pooled analyses showed DL-based CADx models were 11.6% more sensitive than physician judgement alone, and 14.5% more than clinical risk models alone. They had a similar pooled specificity to physician judgement alone [0.77 (95% CI 0.68-0.84) v 0.81 (95% CI 0.71-0.88)], and were 7.4% more specific than clinical risk models alone. They had superior pooled areas under the receiver operating curve (AUC), with relative pooled AUCs of 1.03 (95% CI 1.00-1.07) and 1.10 (95% CI 1.07-1.13) versus physician judgement and clinical risk models alone, respectively. CONCLUSION DL-based models are already used in clinical practice in certain settings for nodule management. Our results show their diagnostic performance potentially justifies wider, more routine deployment alongside experienced physician readers to help inform multidisciplinary team decision-making.
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Affiliation(s)
- Wahyu Wulaningsih
- The Royal Marsden, London, UK.
- Faculty of Life Sciences & Medicine, King's College London, London, UK.
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10
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Lugossy AM, Anton K, Dako F, Dixon RG, DuCharme PA, Duggan C, Durand MA, Einstein SA, Elahi A, Kesselman A, Kulinski LF, Mango VL, Pollack EB, Scheel JR, Schweitzer A, Svolos P, Wetherall M, Mollura DJ. Building Radiology Equity: Themes from the 2023 RAD-AID Conference on International Radiology and Global Health. J Am Coll Radiol 2024:S1546-1440(24)00441-1. [PMID: 38763441 DOI: 10.1016/j.jacr.2024.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/12/2024] [Accepted: 04/24/2024] [Indexed: 05/21/2024]
Abstract
Low- and middle-income countries are significantly impacted by the global scarcity of medical imaging services. Medical imaging is an essential component for diagnosis and guided treatment, which is needed to meet the current challenges of increasing chronic diseases and preparedness for acute-care response. We present some key themes essential for improving global health equity, which were discussed at the 2023 RAD-AID Conference on International Radiology and Global Health. They include (1) capacity building, (2) artificial intelligence, (3) community-based patient navigation, (4) organizational design for multidisciplinary global health strategy, (5) implementation science, and (6) innovation. Although not exhaustive, these themes should be considered influential as we guide and expand global health radiology programs in low- and middle-income countries in the coming years.
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Affiliation(s)
| | - Kevin Anton
- Director of Interventional Radiology, RAD-AID International; Assistant Professor of Radiology, Director Global Health Elective, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Farouk Dako
- Director, RAD-AID Nigeria, RAD-AID International; Assistant Professor of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert G Dixon
- Director, RAD-AID Kenya, RAD-AID International; Professor of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Catherine Duggan
- Research Project Manager for RAD-AID USA Women's Health Access Initiative, RAD-AID International; Director, Collaborative Data Services, Public Health Sciences, Fred Hutch Cancer Center, Seattle, Washington
| | - Melissa A Durand
- Program Manager of Breast Imaging, RAD-AID International; Associate Professor of Radiology & Biomedical Imaging, Department of Radiology and Biomedical Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Samuel A Einstein
- Director of Medical Physics, RAD-AID International; Assistant Professor, Department of Radiology, Pennsylvania State University, University Park, Pennsylvania
| | - Ameena Elahi
- Operations Director of Informatics, RAD-AID International; IS Application Manager, Department of Information Services, Penn Medicine, Philadelphia, Pennsylvania
| | - Andrew Kesselman
- Associate Director of Interventional Radiology, RAD-AID International; Clinical Assistant Professor, Radiology, Stanford University School of Medicine, Stanford, Cailfornia
| | | | - Victoria L Mango
- Program Manager (Breast Imaging), RAD-AID Nigeria, RAD-AID International; Associate Attending Radiologist, Breast Imaging Service, Assistant Director, Global Cancer Disparities Initiatives, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Erica B Pollack
- Director of Breast Imaging, RAD-AID International; Associate Professor, Diagnostic Radiology, Division of Breast Imaging and Intervention, University of Colorado School of Medicine, Aurora, Colorado
| | - John R Scheel
- Director, RAD-AID USA Women's Health Access Initiative, RAD-AID Peru, RAD-AID International; Professor of Radiology and Radiological Sciences, Vice Chair of Global and Planetary Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Patricia Svolos
- Program Manager of Medical Physics, RAD-AID International; Assistant Professor, Department of Diagnostic and Interventional Imaging, UTHealth McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Mary Wetherall
- Nursing Director, RAD-AID USA Women's Health Access Initiative, Associate Program Manager, RAD-AID Nursing, RAD-AID International
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11
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Mumuni AN, Eyre K, Montalba C, Harrison A, Maharjan S, Botwe F, Garcia MF, Zeraii A, Friedrich MG, Fatade A, Ntusi NAB, Lim T, Garg R, Umair M, Ninalowo HA, Adeleke S, Anosike C, Dako F, Anazodo UC. Scan With Me: A Train-the-Trainer Program to Upskill MRI Personnel in Low- and Middle-Income Countries. J Am Coll Radiol 2024:S1546-1440(24)00442-3. [PMID: 38763442 DOI: 10.1016/j.jacr.2024.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/29/2024] [Accepted: 04/24/2024] [Indexed: 05/21/2024]
Abstract
PURPOSE Access to MRI in low- and middle-income countries (LMICs) remains among the poorest in the world. The lack of skilled MRI personnel exacerbates access gaps, reinforcing long-standing health disparities. The Scan With Me (SWiM) program aims to sustainably create a network of highly skilled MRI technologists in LMICs who will facilitate the transfer of MRI knowledge and skills to their peers and contribute to the implementation of highly valuable imaging protocols for effective clinical and research use. METHODS The program introduces a case-based curriculum designed using a novel train-the-trainer approach, integrated with peer-collaborative learning to upskill practicing MRI technologists in LMICs. The 6-week curriculum uses the teach-try-use approach, which combines self-paced didactic lectures covering the basics of MR image acquisition (teach) with hands-on expert-guided scanning experience (try) and the implementation of protocols tailored to provide the best possible images on their infrastructures (use). Each program includes research translation skills training using an established advanced MRI technique relevant to LMICs. A pilot program focused on cardiac MRI (CMR) was conducted to assess the program's curriculum, delivery, and evaluation methods. RESULTS Forty-three MRI technologists from 16 LMICs participated in the pilot CMR program and, over the course of the training, implemented optimized CMR protocols that reduced acquisition times while improving image quality. The training resources and scanner-specific standardized protocols are published openly for public use in an online repository. In general, at the end of the program, learners reported considerable improvements in CMR knowledge and skills. All respondents to the program evaluation survey agreed to recommend the program to their colleagues, while 87% indicated interest in returning to help train others. CONCLUSIONS The SWiM program is the first master class in MRI acquisition for practicing imaging technologists in LMICs. The program holds the potential to help reduce disparities in MRI expertise and access. The support of the MRI community, imaging societies, and funding agencies will increase its reach and further its impact in democratizing MRI.
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Affiliation(s)
| | - Katerina Eyre
- Courtois CMR Research Group at the Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
| | - Cristian Montalba
- Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Aduluwa Harrison
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Surendra Maharjan
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
| | - Francis Botwe
- Clinical Imaging Sciences Centre, University of Sussex, Brighton, United Kingdom
| | - Marina Fernandez Garcia
- Institute for Molecular Imaging and Instrumentation, Universitat Politenica de Valencia, Valencia, Spain
| | - Abderrazek Zeraii
- Biophysics Department, Higher Institute of Medical Technologies of Tunis, Tunis, Tunisia
| | - Matthias G Friedrich
- Courtois CMR Research Group at the Research Institute of the McGill University Health Center, Montreal, Quebec, Canada; Departments of Cardiology and Diagnostic Radiology, McGill University Health Center, Montreal, Quebec, Canada
| | | | - Ntobeko A B Ntusi
- Department of Medicine, University of Cape Town, Cape Town, South Africa; South African Medical Research Council Extramural Unit on Intersection of Noncommunicable Diseases and Infectious Diseases, Cape Town, South Africa
| | - Tchoyoson Lim
- National Neuroscience Institute, Singapore, Singapore
| | - Ria Garg
- Department of Internal Medicine, Geisinger Wyoming Valley Hospital, Wilkes-Barre, Pennsylvania
| | | | | | - Sola Adeleke
- Department of Oncology, Guy's & St. Thomas' Hospital, London, United Kingdom
| | - Chinedum Anosike
- Accuread Radiology Nigeria, Lagos, Nigeria; Warrington and Halton Hospitals National Health Service Foundation Trust, Warrington, United Kingdom
| | - Farouk Dako
- RAD-AID International, Chevy Chase, Maryland; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Udunna C Anazodo
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Department of Medicine, University of Cape Town, Cape Town, South Africa.
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12
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Eissler N, Altena R, Alhuseinalkhudhur A, Bragina O, Feldwisch J, Wuerth G, Loftenius A, Brun N, Axelsson R, Tolmachev V, Sörensen J, Frejd FY. Affibody PET Imaging of HER2-Expressing Cancers as a Key to Guide HER2-Targeted Therapy. Biomedicines 2024; 12:1088. [PMID: 38791050 PMCID: PMC11118066 DOI: 10.3390/biomedicines12051088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 04/27/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Human epidermal growth factor receptor 2 (HER2) is a major prognostic and predictive marker overexpressed in 15-20% of breast cancers. The diagnostic reference standard for selecting patients for HER2-targeted therapy is based on the analysis of tumor biopsies. Previously patients were defined as HER2-positive or -negative; however, with the approval of novel treatment options, specifically the antibody-drug conjugate trastuzumab deruxtecan, many breast cancer patients with tumors expressing low levels of HER2 have become eligible for HER2-targeted therapy. Such patients will need to be reliably identified by suitable diagnostic methods. Biopsy-based diagnostics are invasive, and repeat biopsies are not always feasible. They cannot visualize the heterogeneity of HER2 expression, leading to a substantial number of misdiagnosed patients. An alternative and highly accurate diagnostic method is molecular imaging with radiotracers. In the case of HER2, various studies demonstrate the clinical utility and feasibility of such approaches. Radiotracers based on Affibody® molecules, small, engineered affinity proteins with a size of ~6.5 kDa, are clinically validated molecules with favorable characteristics for imaging. In this article, we summarize the HER2-targeted therapeutic landscape, describe our experience with imaging diagnostics for HER2, and review the currently available clinical data on HER2-Affibody-based molecular imaging as a novel diagnostic tool in breast cancer and beyond.
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Affiliation(s)
| | - Renske Altena
- Department of Oncology-Pathology, Karolinska Institutet, 17164 Solna, Sweden
- Medical Unit Breast, Endocrine Tumors and Sarcoma, Theme Cancer, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, 17164 Solna, Sweden
- Medical Radiation Physics and Nuclear Medicine, Functional Unit of Nuclear Medicine, Karolinska University Hospital, 14157 Huddinge, Sweden
| | - Ali Alhuseinalkhudhur
- Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, 75310 Uppsala, Sweden
- Department of Immunology, Genetics and Pathology, Uppsala University, 75310 Uppsala, Sweden
| | - Olga Bragina
- Department of Nuclear Therapy and Diagnostic, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 634055 Tomsk, Russia
- Research Centrum for Oncotheranostics, Research School of Chemistry and Applied Biomedical Sciences, Tomsk Polytechnic University, 634050 Tomsk, Russia
| | | | | | | | | | - Rimma Axelsson
- Medical Radiation Physics and Nuclear Medicine, Functional Unit of Nuclear Medicine, Karolinska University Hospital, 14157 Huddinge, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 14152 Stockholm, Sweden
| | - Vladimir Tolmachev
- Department of Immunology, Genetics and Pathology, Uppsala University, 75310 Uppsala, Sweden
| | - Jens Sörensen
- Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, 75310 Uppsala, Sweden
| | - Fredrik Y. Frejd
- Affibody AB, 17165 Solna, Sweden
- Department of Immunology, Genetics and Pathology, Uppsala University, 75310 Uppsala, Sweden
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13
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Olawole T, Oyetunde T, Uzomah U, Shanahan J, Hartmann K, Rotimi S, Dako F. Exploring the State of Cancer Imaging Research in Africa. J Am Coll Radiol 2024:S1546-1440(24)00422-8. [PMID: 38719103 DOI: 10.1016/j.jacr.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/07/2024] [Accepted: 04/24/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION The growing cancer burden in Africa demands urgent action. Medical imaging is crucial for cancer diagnosis and management and is an essential enabler of precision medicine. To understand the readiness for quantitative imaging analysis to support cancer management in Africa, we analyzed the utilization patterns of imaging modalities for cancer research across the continent. METHODS We retrieved articles by systematically searching PubMed, using a combination of search terms {"Neoplasm"} AND {"Radiology" or "Diagnostic imaging" or "Radiography" or "Interventional Radiology" or "Radiotherapy" or "Radiation Oncology"} AND {Africa∗ or 54 African countries}. Articles describing cancer diagnosis or management in humans with the utilization of imaging were included. Exclusion criteria were review articles, non-English articles, publications before 2000, noncancer diagnoses, and studies conducted outside Africa. RESULTS The analysis of diagnostic imaging in Africa revealed a diverse utilization pattern across different cancer types and regions. The literature search identified 107 publications on cancer imaging in Africa. The studies were carried out in 19 African countries on 12 different cancer types with 6 imaging modalities identified. Most cancer imaging research studies used multiple imaging modalities. Ultrasound was the most used distinct imaging modality and MRI was the least frequently used. Most research studies originated from Nigeria, South Africa, and Egypt. CONCLUSION We demonstrate substantial variability in the presence of imaging modalities, widespread utilization of ultrasonography, and limited availability of advanced imaging modalities for cancer research.
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Affiliation(s)
- Tolulope Olawole
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Postdoctoral Researcher, Center for Global and Population Health Research in Radiology
| | - Tolulope Oyetunde
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Postdoctoral Researcher and Program Manager, Center for Global and Population Health Research in Radiology
| | - Uche Uzomah
- Medical Student, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Justin Shanahan
- Medical Student, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Katherine Hartmann
- Chief Radiology Resident, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Solomon Rotimi
- Department of Biochemistry, Covenant University, Ota, Nigeria; Professor and Department Chair of Biochemistry, Covenant University; Visiting Consultant, Directorate of Research and Innovation, National Institute on Cancer Research and Treatment
| | - Farouk Dako
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Director, Center for Global and Population Health Research in Radiology.
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14
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Horvat N, Jayaprakasam VS, Crane CH, Zheng J, Gangai N, Romesser PB, Golia Pernicka JS, Capanu M, Gollub MJ. Comparison between pelvic MRI, CT, and PET/CT in baseline staging and radiation planning of anal squamous cell carcinoma. Abdom Radiol (NY) 2024; 49:1351-1362. [PMID: 38456896 DOI: 10.1007/s00261-024-04213-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE To investigate the differences in baseline staging of anal squamous cell carcinoma based on CT, MRI, and PET/CT, and the resultant impact on the radiation plan. METHODS This retrospective study included consecutive patients with anal squamous cell carcinoma who underwent baseline pelvic MRI, CT, and PET/CT (all examinations within 3 weeks of each other) from January 2010 to April 2020. CTs, MRIs, and PET/CTs were re-interpreted by three separate radiologists. Several imaging features were assessed; tumor stage was determined based on the eight edition of the American Joint Committee on Cancer (AJCC) staging manual; and T (tumor), N (node), and M (metastasis) categories were determined based on National Comprehensive Cancer Network (NCCN) guidelines. Radiologist assessments were then randomly presented to a radiation oncologist who formulated the radiation plan in a blinded fashion. RESULTS Across 28 patients (median age, 62 years [range, 31-78], T-category classification was significantly different on PET/CT compared to MRI and CT (p = 0.037 and 0.031, respectively). PET/CT staged a higher proportion of patients with T1/T2 disease (16/28, 57%) compared to MRI (11/28, 39%) and CT (10/28, 36%). MRI staged a higher proportion of patients with T3/T4 disease (14/28, 50%) compared to CT (12/28, 43%) and PET/CT (11/28, 39%). However, there was no significant difference between the three imaging modalities in terms of either N-category, AJCC staging, or NCCN TNM group classification, or in treatment planning. CONCLUSION Our exploratory study showed that MRI demonstrated a higher proportion of T3/T4 tumors, while PET/CT demonstrated more T1/T2 tumors; however, MRI, CT, and PET/CT did not show any significant differences in AJCC and TNM group categories, nor was there any significant difference in treatment doses between them when assessed independently by an experienced radiation oncologist.
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Affiliation(s)
- Natally Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Vetri Sudar Jayaprakasam
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Christopher H Crane
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Junting Zheng
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Natalie Gangai
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Paul B Romesser
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jennifer S Golia Pernicka
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Marinela Capanu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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15
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Paez D, Giammarile F, Brink A, García-Pérez O, Estrada-Lobato E. The Role of 18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F-FDG PET/CT) in the Diagnosis and Evaluation of Spondylodiscitis. Semin Nucl Med 2024; 54:409-414. [PMID: 38688771 DOI: 10.1053/j.semnuclmed.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 05/02/2024]
Abstract
Spondylodiscitis, characterized by inflammation of the intervertebral disc and adjacent vertebral bodies, presents a diagnostic challenge due to its nonspecific clinical manifestations and variable imaging findings. This review examines the role of PET-CT with FDG, in the evaluation of spondylodiscitis, focusing on its utility in diagnosis, assessment of disease extent, treatment response monitoring, and prognostication. FDG PET-CT, by combining metabolic and anatomical imaging modalities, offers superior sensitivity and specificity compared to conventional imaging techniques in detecting infectious foci, distinguishing between infection and post-treatment changes, and identifying occult sources of infection. Additionally, FDG PET-CT facilitates the localization of infection, aiding in targeted biopsy and guiding surgical intervention. Moreover, quantitative PET parameters, such as standardized uptake values (SUVs), hold promise for predicting treatment response and prognosis. Despite its advantages, FDG PET-CT has limitations, including false-positive results in the setting of inflammation and limited availability in resource-constrained settings. Collaborative efforts between radiologists, nuclear medicine specialists, infectious disease specialists, and spine surgeons are essential to optimize the role of FDG PET-CT in the multidisciplinary management of spondylodiscitis. Further research is warranted to elucidate the cost-effectiveness and clinical impact of FDG PET-CT in this challenging clinical entity.
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Affiliation(s)
- Diana Paez
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency. Vienna, Austria
| | - Francesco Giammarile
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency. Vienna, Austria
| | - Anita Brink
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency. Vienna, Austria
| | | | - Enrique Estrada-Lobato
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency. Vienna, Austria.
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16
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Briercheck E, Pyle D, Adams C, Atun R, Booth C, Dent J, Garcia-Gonzalez P, Ilbawi A, Jazieh AR, Kerr D, Knaul F, Kobayashi E, Lim C, Maza M, Milner D, Navarro MF, O'Brien M, Rodriguez-Galindo C, Sullivan R, Torode J, Vokes E, Gralow J. Unification of Efforts to Improve Global Access to Cancer Therapeutics: Report From the 2022/2023 Access to Essential Cancer Medicines Stakeholder Summit. JCO Glob Oncol 2024; 10:e2300256. [PMID: 38781548 DOI: 10.1200/go.23.00256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/06/2023] [Accepted: 03/24/2024] [Indexed: 05/25/2024] Open
Abstract
PURPOSE There is an urgent need to improve access to cancer therapy globally. Several independent initiatives have been undertaken to improve access to cancer medicines, and additional new initiatives are in development. Improved sharing of experiences and increased collaboration are needed to achieve substantial improvements in global access to essential oncology medicines. METHODS The inaugural Access to Essential Cancer Medicines Stakeholder Meeting was organized by ASCO and convened at the June 2022 ASCO Annual Meeting in Chicago, IL, with two subsequent meetings, Union for International Cancer Control World Cancer Congress held in Geneva, Switzerland, in October 2022 and at the ASCO Annual Meeting in June of 2023. Invited stakeholders included representatives from cancer institutes, physicians, researchers, professional societies, the pharmaceutical industry, patient advocacy organizations, funders, cancer organizations and foundations, policy makers, and regulatory bodies. The session was moderated by ASCO. Past efforts and current and upcoming initiatives were initially discussed (2022), updates on progress were provided (2023), and broad agreement on resulting action steps was achieved with participants. RESULTS Summit participants recognized that while much work was ongoing to enhance access to cancer therapeutics globally, communication and synergy across projects and organizations could be enhanced by providing a platform for collaboration and shared expertise. CONCLUSION The summit resulted in new cross-stakeholder insights and planned collaboration addressing barriers to accessing cancer medications. Specific actions and timelines for implementation and reporting were established.
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Affiliation(s)
- Edward Briercheck
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Doug Pyle
- American Society of Clinical Oncology, Alexandria, VA
| | - Cary Adams
- Union for International Cancer Control, Geneva, Switzerland
| | - Rifat Atun
- Department of Global Health and Population, Harvard University, Boston, MA
| | - Christopher Booth
- Division of Cancer Care and Epidemiology, Queen's University, Kingston, Canada
| | | | | | - Andre Ilbawi
- Cancer Programme, World Health Organization, Geneva, Switzerland
| | | | - David Kerr
- Nuffield Department of Clinical Laboratory Sciences, Oxford University, Oxford, United Kingdom
| | - Felicia Knaul
- Department of Public Health Sciences, University of Miami, Miami, FL
| | | | | | | | - Danny Milner
- Union for International Cancer Control, Geneva, Switzerland
| | | | | | | | - Richard Sullivan
- Institute of Cancer Policy, King's College London, London, United Kingdom
| | - Julie Torode
- Institute of Cancer Policy, King's College London, London, United Kingdom
| | - Everett Vokes
- Department of Medicine, University of Chicago, Chicago, IL
| | - Julie Gralow
- American Society of Clinical Oncology, Alexandria, VA
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17
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Safari M, Eidex Z, Chang CW, Qiu RL, Yang X. Fast MRI Reconstruction Using Deep Learning-based Compressed Sensing: A Systematic Review. ARXIV 2024:arXiv:2405.00241v1. [PMID: 38745700 PMCID: PMC11092677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Magnetic resonance imaging (MRI) has revolutionized medical imaging, providing a non-invasive and highly detailed look into the human body. However, the long acquisition times of MRI present challenges, causing patient discomfort, motion artifacts, and limiting real-time applications. To address these challenges, researchers are exploring various techniques to reduce acquisition time and improve the overall efficiency of MRI. One such technique is compressed sensing (CS), which reduces data acquisition by leveraging image sparsity in transformed spaces. In recent years, deep learning (DL) has been integrated with CS-MRI, leading to a new framework that has seen remarkable growth. DL-based CS-MRI approaches are proving to be highly effective in accelerating MR imaging without compromising image quality. This review comprehensively examines DL-based CS-MRI techniques, focusing on their role in increasing MR imaging speed. We provide a detailed analysis of each category of DL-based CS-MRI including end-to-end, unroll optimization, self-supervised, and federated learning. Our systematic review highlights significant contributions and underscores the exciting potential of DL in CS-MRI. Additionally, our systematic review efficiently summarizes key results and trends in DL-based CS-MRI including quantitative metrics, the dataset used, acceleration factors, and the progress of and research interest in DL techniques over time. Finally, we discuss potential future directions and the importance of DL-based CS-MRI in the advancement of medical imaging. To facilitate further research in this area, we provide a GitHub repository that includes up-to-date DL-based CS-MRI publications and publicly available datasets - https://github.com/mosaf/Awesome-DL-based-CS-MRI.
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Affiliation(s)
- Mojtaba Safari
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA 30322, United States of America
| | - Zach Eidex
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA 30322, United States of America
| | - Chih-Wei Chang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA 30322, United States of America
| | - Richard L.J. Qiu
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA 30322, United States of America
| | - Xiaofeng Yang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA 30322, United States of America
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18
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James ND, Tannock I, N'Dow J, Feng F, Gillessen S, Ali SA, Trujillo B, Al-Lazikani B, Attard G, Bray F, Compérat E, Eeles R, Fatiregun O, Grist E, Halabi S, Haran Á, Herchenhorn D, Hofman MS, Jalloh M, Loeb S, MacNair A, Mahal B, Mendes L, Moghul M, Moore C, Morgans A, Morris M, Murphy D, Murthy V, Nguyen PL, Padhani A, Parker C, Rush H, Sculpher M, Soule H, Sydes MR, Tilki D, Tunariu N, Villanti P, Xie LP. The Lancet Commission on prostate cancer: planning for the surge in cases. Lancet 2024; 403:1683-1722. [PMID: 38583453 DOI: 10.1016/s0140-6736(24)00651-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/28/2023] [Accepted: 03/27/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Nicholas D James
- Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK.
| | - Ian Tannock
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Felix Feng
- University of California, San Francisco, USA
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Syed Adnan Ali
- University of Manchester, Manchester, UK; The Christie Hospital, Manchester, UK
| | | | | | | | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
| | - Eva Compérat
- Tenon Hospital, Sorbonne University, Paris; AKH Medical University, Vienna, Austria
| | - Ros Eeles
- Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | | | | | | | - Áine Haran
- The Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | | | | | | | - Stacy Loeb
- New York University, New York, NY, USA; Manhattan Veterans Affairs, New York, NY, USA
| | | | | | | | - Masood Moghul
- Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | | | | | - Michael Morris
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Declan Murphy
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | | | | | | | | | | | | | - Howard Soule
- Prostate Cancer Foundation, Santa Monica, CA, USA
| | | | - Derya Tilki
- Martini-Klinik Prostate Cancer Center and Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Türkiye
| | - Nina Tunariu
- Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | | | - Li-Ping Xie
- First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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19
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Tam S, Wear D, Morrone CD, Yu WH. The complexity of extracellular vesicles: Bridging the gap between cellular communication and neuropathology. J Neurochem 2024. [PMID: 38650384 DOI: 10.1111/jnc.16108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/12/2024] [Accepted: 03/31/2024] [Indexed: 04/25/2024]
Abstract
Brain-derived extracellular vesicles (EVs) serve a prominent role in maintaining homeostasis and contributing to pathology in health and disease. This review establishes a crucial link between physiological processes leading to EV biogenesis and their impacts on disease. EVs are involved in the clearance and transport of proteins and nucleic acids, responding to changes in cellular processes associated with neurodegeneration, including autophagic disruption, organellar dysfunction, aging, and other cell stresses. In neurodegenerative disorders (e.g., Alzheimer's disease, Parkinson's disease, etc.), EVs contribute to the spread of pathological proteins like amyloid β, tau, ɑ-synuclein, prions, and TDP-43, exacerbating neurodegeneration and accelerating disease progression. Despite evidence for both neuropathological and neuroprotective effects of EVs, the mechanistic switch between their physiological and pathological functions remains elusive, warranting further research into their involvement in neurodegenerative disease. Moreover, owing to their innate ability to traverse the blood-brain barrier and their ubiquitous nature, EVs emerge as promising candidates for novel diagnostic and therapeutic strategies. The review uniquely positions itself at the intersection of EV cell biology, neurophysiology, and neuropathology, offering insights into the diverse biological roles of EVs in health and disease.
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Affiliation(s)
- Stephanie Tam
- Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Darcy Wear
- Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Christopher D Morrone
- Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Wai Haung Yu
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
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20
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Liu RH, Lindeborg M, Ncogoza I, Nyiraneza SE, Barrera KJ, Shaye DA. Geospatial evaluation of radiologic access in Rwanda. Insights Imaging 2024; 15:105. [PMID: 38589631 PMCID: PMC11001820 DOI: 10.1186/s13244-024-01624-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/18/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Rwanda has aimed to rebuild its health care system since the Rwandan genocide against the Tutsis in 1994, though one of the challenges has been a scarcity of radiologic resources. OBJECTIVE To assess the location and accessibility of radiologic facilities in Rwanda using geospatial mapping and population-based data. METHODS A cross-sectional study was conducted in May 2023 using location and radiologic modality data provided by the Department of Radiology at the University Teaching Hospital of Kigali and the WorldPop database, a publicly available database providing open-access geospatial population data. Radiologic equipment included magnetic resonance (MR), computed tomography (CT), positron emission tomography (PET), radiotherapy, X-ray, mammography, and fluoroscopy machines. Geospatial analysis was performed using ArcGIS Pro 2.8.6 software. RESULTS Fifty-six radiologic facilities were identified, including 5 MR, 7 CT, 1 radiotherapy, 52 X-ray, 5 mammography, 5 fluoroscopy, and 0 PET machines. There were 0.4 MR, 0.5 CT, 0 PET, 0.1 radiotherapy, 3.9 X-ray, 0.4 mammography, and 0.4 fluoroscopy units per 1 million people. CONCLUSION Rwanda is one of the countries with the lowest radiologic access in East Africa; however, there is evidence of progress, particularly in more advanced diagnostic imaging techniques such as computed tomography and magnetic resonance imaging. CRITICAL RELEVANCE STATEMENT This study provides a 10-year update on current radiologic resources and access in Rwanda, identifying areas of progress and ongoing scarcity, serving as a guide for future direction of growth. KEY POINTS • As Rwanda works on rebuilding its health care system, this study provides an assessment of the current radiologic resources within the country. • There is less than one radiologic unit for every million of the Rwandan population for every imaging modality other than X-ray. • While radiologic access in Rwanda lags behind that of its neighbors, there has been growth focused on advanced imaging modalities and the training of human resources.
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Affiliation(s)
- Rui Han Liu
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA.
| | - Michael Lindeborg
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Isaie Ncogoza
- University Teaching Hospital of Kigali, University of Rwanda, College of Medicine & Health Sciences, Kigali, Rwanda
| | - Sabine E Nyiraneza
- University Teaching Hospital of Kigali, University of Rwanda, College of Medicine & Health Sciences, Kigali, Rwanda
| | - Keisha J Barrera
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA
| | - David A Shaye
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA
- University Teaching Hospital of Kigali, University of Rwanda, College of Medicine & Health Sciences, Kigali, Rwanda
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21
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Omofoye TS, Refinetti APC, Kizub D, Bond M. Value-Based Care in Low- to Middle-Income Countries: Low-Cost, Context-Specific, Imaging Technologies to Meet Population Health Needs. J Am Coll Radiol 2024:S1546-1440(24)00357-0. [PMID: 38599360 DOI: 10.1016/j.jacr.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/07/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Affiliation(s)
- Toma S Omofoye
- Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas; Director of Breast Imaging, Global Oncology Cancer Network, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Ana Paula Correa Refinetti
- Department of Breast Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas; Director of Breast Surgical Oncology, Global Oncology Cancer Network, The University of Texas MD Anderson Cancer Center, Houston, Texas. https://twitter.com/Drefinetti
| | - Darya Kizub
- Department of Breast Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas. https://twitter.com/DKizub
| | - Meaghan Bond
- Rice360 Institute for Global Health Technologies, Rice University, Houston, Texas
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22
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Chen DC, Huang S, Buteau JP, Kashyap R, Hofman MS. Clinical Positron Emission Tomography/Computed Tomography: Quarter-Century Transformation of Prostate Cancer Molecular Imaging. PET Clin 2024; 19:261-279. [PMID: 38199918 DOI: 10.1016/j.cpet.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Although positron emission tomography/computed tomography (PET/CT) underwent rapid growth during the last quarter-century, becoming a new standard-of-care for imaging most cancer types, CT and bone scan remained the gold standard for patients with prostate cancer. This occurred as 2-fluorine-18-fluoro-2-deoxy-d-glucose was perceived to have a limited role owing to low sensitivity in many patients. A resurgence of interest occurred with the use of fluorine-18-sodium-fluoride PET/CT as a replacement for bone scintigraphy, and then choline, fluciclovine, and dihydrotestosterone (DHT) PET/CT as prostate "specific" radiotracers. The last decade, however, has seen a true revolution with the meteoric rise of prostate-specific membrane antigen PET/CT.
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Affiliation(s)
- David C Chen
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Siyu Huang
- Department of Surgery, The University of Melbourne
| | - James P Buteau
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Raghava Kashyap
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael S Hofman
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.
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23
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Tao Y, Yu H, Zhang M, Zou X, Li P, Qiu JG, Jiang BH, Ying W. Green autofluorescence of the skin and fingernails is a novel biomarker for evaluating the risk for developing acute ischemic stroke. JOURNAL OF BIOPHOTONICS 2024; 17:e202300473. [PMID: 38247109 DOI: 10.1002/jbio.202300473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/25/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024]
Abstract
The only existing approach for assessing the risk of developing acute ischemic stroke (AIS) necessitates that individuals possess a strong understanding of their health status. Our research gathered compelling evidence in favor of our hypothesis, suggesting that the likelihood of developing AIS can be assessed by analyzing the green autofluorescence (AF) of the skin and fingernails. Utilizing machine learning-based analyses of AF images, we found that the area under the curve (AUC) for distinguishing subjects with three risk factors from those with zero, one, or two risk factors was 0.79, 0.76, and 0.75, respectively. Our research has revealed that green AF serves as an innovative biomarker for assessing the risk of developing AIS. Our method is objective, non-invasive, efficient, and economic, which shows great promise to boost a technology for screening natural populations for risk of developing AIS.
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Affiliation(s)
- Yue Tao
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Haibo Yu
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Mingchao Zhang
- Multiscale Research Institute of Complex Systems, Fudan University, Shanghai, People's Republic of China
| | - Xiaofeng Zou
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, People's Republic of China
| | - Peilu Li
- School of Pharmacy, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Jian-Ge Qiu
- Academy of Medical Science, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Bing-Hua Jiang
- Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Weihai Ying
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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24
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Lambrechts MJ, Schroeder GD, Karamian BA, Canseco JA, Bransford R, Oner C, Benneker LM, Kandziora F, Shanmuganathan R, Kanna R, Joaquim AF, Chapman JR, Vialle E, El-Sharkawi M, Dvorak M, Schnake K, Kepler CK, Vaccaro AR. Global Validation of the AO Spine Upper Cervical Injury Classification: Geographic Region Affects Reliability and Reproducibility. Global Spine J 2024; 14:821-829. [PMID: 36036763 PMCID: PMC11192108 DOI: 10.1177/21925682221124100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Global Survey. OBJECTIVE To determine the accuracy, interobserver reliability, and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System based on surgeons' AO Spine region of practice (Africa, Asia, Central/South America, Europe, Middle East, and North America). METHODS A total of 275 AO Spine members assessed 25 upper cervical spine injuries and classified them according to the AO Spine Upper Cervical Injury Classification System. Reliability, reproducibility, and accuracy scores were obtained over two assessments administered at three-week intervals. Kappa coefficients (ƙ) determined the interobserver reliability and intraobserver reproducibility. RESULTS On both assessments, participants from Europe and North America had the highest classification accuracy, while participants from Africa and Central/South America had the lowest accuracy (P < .0001). Participants from Africa (assessment 1 (AS1):ƙ = .487; AS2:0.491), Central/South America (AS1:ƙ = .513; AS2:0.511), and the Middle East (AS1:0.591; AS2: .599) achieved moderate reliability, while participants from North America (AS1:ƙ = .673; AS2:0.648) and Europe (AS1:ƙ = .682; AS2:0.681) achieved substantial reliability. Asian participants obtained substantial reliability on AS1 (ƙ = .632), but moderate reliability on AS2 (ƙ = .566). Although there was a large effect size, the low number of participants in certain regions did not provide adequate certainty that AO regions affected the likelihood of participants having excellent reproducibility (P = .342). CONCLUSIONS The AO Spine Upper Cervical Injury Classification System can be applied with high accuracy, interobserver reliability, and intraobserver reproducibility. However, lower classification accuracy and reliability were found in regions of Africa and Central/South America, especially for severe atlas injuries (IIB and IIC) and atypical hangman's type fractures (IIIB injuries).
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Affiliation(s)
| | | | - Brian A. Karamian
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Jose A. Canseco
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Richard Bransford
- Department of Orthopaedicand Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Cumhur Oner
- Department of Orthopedic Surgery, University Medical Center, University of Utrecht, Utrecht, the Netherlands
| | - Lorin M. Benneker
- Spine Unit, Sonnenhof Spital Bern, University of Bern, Bern, Switzerland
| | | | | | - Rishi Kanna
- Department of Orthopedics and Spine Surgery, Ganga Hospital, Coimbatore, India
| | - Andrei F. Joaquim
- Department of Neurology, Neurosurgery Division, State University of Campinas, Campinas, Sao Paulo, Brazil
| | - Jens R Chapman
- Swedish Medical Center, Swedish Neuroscience Institute, Seattle, WA, USA
| | - Emiliano Vialle
- Cajuru University Hospital, Catholic University of Paraná, Curitiba, Brazil
| | | | - Marcel Dvorak
- University of British Columbia, Vancouver, BC, Canada
| | - Klaus Schnake
- Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
- Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
| | | | | | - AO Spine Upper Cervical Injury Classification International Members
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
- Department of Orthopaedicand Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA
- Department of Orthopedic Surgery, University Medical Center, University of Utrecht, Utrecht, the Netherlands
- Spine Unit, Sonnenhof Spital Bern, University of Bern, Bern, Switzerland
- Unfallklinik Frankfurt Am Main, Frankfurt, Germany
- Department of Orthopedics and Spine Surgery, Ganga Hospital, Coimbatore, India
- Department of Neurology, Neurosurgery Division, State University of Campinas, Campinas, Sao Paulo, Brazil
- Swedish Medical Center, Swedish Neuroscience Institute, Seattle, WA, USA
- Cajuru University Hospital, Catholic University of Paraná, Curitiba, Brazil
- Department of Orthopaedic and Trauma Surgery, Assiut University, Assiut, Egypt
- University of British Columbia, Vancouver, BC, Canada
- Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
- Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
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25
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Jalloul M, Derbew HM, Miranda-Schaeubinger M, De Leon Benedetti L, Mekete Y, Jr Carbajal JA, Doherty M, Noor A, Dako F, Otero HJ. Case competition sessions: a global education and academic engagement tool. Pediatr Radiol 2024; 54:385-391. [PMID: 37535093 DOI: 10.1007/s00247-023-05723-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Radiology virtual teaching sessions utilize live video conferencing to promote collaborative learning and engagement by discussing radiology cases. Because of its convenience and flexibility, this mode of education has gained popularity, particularly after the corona virus disease 2019 pandemic. OBJECTIVE We describe our experience in organizing a series of "Global Health Imaging Case Competitions" for trainees in low- and middle-income countries (LMICs). These competitions provide the trainees with an opportunity to present unique radiology cases, network with radiologists, learn about various radiology topics, win prizes and potentially publish their case reports in a peer-reviewed journal. MATERIALS AND METHODS Planning and execution of the competition involves several steps. First, trainees are invited to participate and submit abstracts discussing unique cases. The organizing committee grades these abstracts; the authors of the 20 abstracts with the highest scores are asked to submit a video presentation of their cases to be presented during the live webinar. During this webinar, presentations are displayed and graded to select winners. Additionally, the audience votes to choose a participant as the people's favorite. We have completed four cycles (Africa, Latin America and the Caribbean, Africa and the Middle East and Asia) and will continue in the same order of rotation. RESULTS Attendance totalled 2,510 participants from 50 countries. Pediatric cases represented the majority of cases among finalists. Feedback was positive; 26 out of 29 (90%) participants surveyed indicated that the webinar was "very good" to "excellent" with well-organized and challenging cases. Diversity of participating countries was noted. Limitations included technology barriers such as internet connectivity. CONCLUSION This innovative approach emphasizing audience participation engaged trainees from LMICs and fostered locoregional collegiality and mentoring.
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Affiliation(s)
- Mohammad Jalloul
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - Hermon Miliard Derbew
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
- College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Yadel Mekete
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Jesus A Jr Carbajal
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Megan Doherty
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Abass Noor
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Farouk Dako
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Hansel J Otero
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Hospital of the University of Pennsylvania, Philadelphia, USA
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26
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Rastogi A, Brugnara G, Foltyn-Dumitru M, Mahmutoglu MA, Preetha CJ, Kobler E, Pflüger I, Schell M, Deike-Hofmann K, Kessler T, van den Bent MJ, Idbaih A, Platten M, Brandes AA, Nabors B, Stupp R, Bernhardt D, Debus J, Abdollahi A, Gorlia T, Tonn JC, Weller M, Maier-Hein KH, Radbruch A, Wick W, Bendszus M, Meredig H, Kurz FT, Vollmuth P. Deep-learning-based reconstruction of undersampled MRI to reduce scan times: a multicentre, retrospective, cohort study. Lancet Oncol 2024; 25:400-410. [PMID: 38423052 DOI: 10.1016/s1470-2045(23)00641-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/20/2023] [Accepted: 12/07/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND The extended acquisition times required for MRI limit its availability in resource-constrained settings. Consequently, accelerating MRI by undersampling k-space data, which is necessary to reconstruct an image, has been a long-standing but important challenge. We aimed to develop a deep convolutional neural network (dCNN) optimisation method for MRI reconstruction and to reduce scan times and evaluate its effect on image quality and accuracy of oncological imaging biomarkers. METHODS In this multicentre, retrospective, cohort study, MRI data from patients with glioblastoma treated at Heidelberg University Hospital (775 patients and 775 examinations) and from the phase 2 CORE trial (260 patients, 1083 examinations, and 58 institutions) and the phase 3 CENTRIC trial (505 patients, 3147 examinations, and 139 institutions) were used to develop, train, and test dCNN for reconstructing MRI from highly undersampled single-coil k-space data with various acceleration rates (R=2, 4, 6, 8, 10, and 15). Independent testing was performed with MRIs from the phase 2/3 EORTC-26101 trial (528 patients with glioblastoma, 1974 examinations, and 32 institutions). The similarity between undersampled dCNN-reconstructed and original MRIs was quantified with various image quality metrics, including structural similarity index measure (SSIM) and the accuracy of undersampled dCNN-reconstructed MRI on downstream radiological assessment of imaging biomarkers in oncology (automated artificial intelligence-based quantification of tumour burden and treatment response) was performed in the EORTC-26101 test dataset. The public NYU Langone Health fastMRI brain test dataset (558 patients and 558 examinations) was used to validate the generalisability and robustness of the dCNN for reconstructing MRIs from available multi-coil (parallel imaging) k-space data. FINDINGS In the EORTC-26101 test dataset, the median SSIM of undersampled dCNN-reconstructed MRI ranged from 0·88 to 0·99 across different acceleration rates, with 0·92 (95% CI 0·92-0·93) for 10-times acceleration (R=10). The 10-times undersampled dCNN-reconstructed MRI yielded excellent agreement with original MRI when assessing volumes of contrast-enhancing tumour (median DICE for spatial agreement of 0·89 [95% CI 0·88 to 0·89]; median volume difference of 0·01 cm3 [95% CI 0·00 to 0·03] equalling 0·21%; p=0·0036 for equivalence) or non-enhancing tumour or oedema (median DICE of 0·94 [95% CI 0·94 to 0·95]; median volume difference of -0·79 cm3 [95% CI -0·87 to -0·72] equalling -1·77%; p=0·023 for equivalence) in the EORTC-26101 test dataset. Automated volumetric tumour response assessment in the EORTC-26101 test dataset yielded an identical median time to progression of 4·27 months (95% CI 4·14 to 4·57) when using 10-times-undersampled dCNN-reconstructed or original MRI (log-rank p=0·80) and agreement in the time to progression in 374 (95·2%) of 393 patients with data. The dCNN generalised well to the fastMRI brain dataset, with significant improvements in the median SSIM when using multi-coil compared with single-coil k-space data (p<0·0001). INTERPRETATION Deep-learning-based reconstruction of undersampled MRI allows for a substantial reduction of scan times, with a 10-times acceleration demonstrating excellent image quality while preserving the accuracy of derived imaging biomarkers for the assessment of oncological treatment response. Our developments are available as open source software and hold considerable promise for increasing the accessibility to MRI, pending further prospective validation. FUNDING Deutsche Forschungsgemeinschaft (German Research Foundation) and an Else Kröner Clinician Scientist Endowed Professorship by the Else Kröner Fresenius Foundation.
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Affiliation(s)
- Aditya Rastogi
- Division for Computational Neuroimaging, Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany; Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Gianluca Brugnara
- Division for Computational Neuroimaging, Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany; Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martha Foltyn-Dumitru
- Division for Computational Neuroimaging, Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany; Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Mustafa Ahmed Mahmutoglu
- Division for Computational Neuroimaging, Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany; Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Chandrakanth J Preetha
- Division for Computational Neuroimaging, Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany; Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Erich Kobler
- Department of Neuroradiology, University Medical Center Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Irada Pflüger
- Division for Computational Neuroimaging, Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany; Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Marianne Schell
- Division for Computational Neuroimaging, Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany; Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Katerina Deike-Hofmann
- Department of Neuroradiology, University Medical Center Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany; German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Tobias Kessler
- Neurology Clinic, Heidelberg University Hospital, Heidelberg, Germany; Clinical Cooperation Unit Neurooncology, German Cancer Consortium within German Cancer Research Center, Heidelberg, Germany
| | | | - Ahmed Idbaih
- Assistance Publique-Hôpitaux de Paris, Service de Neurologie 1, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Michael Platten
- Department of Neurology, Medical Faculty Mannheim, Mannheim Center for Translational Neuroscience, University of Heidelberg, Mannheim, Germany; Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, German Cancer Consortium within German Cancer Research Center, Heidelberg, Germany
| | - Alba A Brandes
- Department of Medical Oncology, Azienda UnitàSanitaria Locale of Bologna, Bologna, Italy
| | - Burt Nabors
- Department of Neurology, Division of Neuro-Oncology, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Roger Stupp
- Lou and Jean Malnati Brain Tumor Institute, Robert H Lurie Comprehensive Cancer Center, Northwestern Medicine and Northwestern University, Chicago, USA; Department of Neurological Surgery, Northwestern Medicine and Northwestern University, Chicago, USA; Department of Neurology, Northwestern Medicine and Northwestern University, Chicago, USA
| | - Denise Bernhardt
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Amir Abdollahi
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Thierry Gorlia
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Jörg-Christian Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany; German Cancer Consortium within German Center Research Center, partner site Munich, Germany
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Klaus H Maier-Hein
- Medical Image Computing, German Cancer Research Center, Heidelberg, Germany; Pattern Analysis and Learning Group, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Alexander Radbruch
- Department of Neuroradiology, University Medical Center Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Wolfgang Wick
- Neurology Clinic, Heidelberg University Hospital, Heidelberg, Germany; Clinical Cooperation Unit Neurooncology, German Cancer Consortium within German Cancer Research Center, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Hagen Meredig
- Division for Computational Neuroimaging, Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany; Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix T Kurz
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Geneva, Switzerland; Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Philipp Vollmuth
- Division for Computational Neuroimaging, Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany; Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany; Department of Neuroradiology, University Medical Center Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany; Medical Image Computing, German Cancer Research Center, Heidelberg, Germany.
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Dyer MR, Jing Z, Duncan K, Godbe J, Shokeen M. Advancements in the development of radiopharmaceuticals for nuclear medicine applications in the treatment of bone metastases. Nucl Med Biol 2024; 130-131:108879. [PMID: 38340369 DOI: 10.1016/j.nucmedbio.2024.108879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Abstract
Bone metastases are a painful and complex condition that overwhelmingly impacts the prognosis and quality of life of cancer patients. Over the years, nuclear medicine has made remarkable progress in the diagnosis and management of bone metastases. This review aims to provide a comprehensive overview of the recent advancements in nuclear medicine for the diagnosis and management of bone metastases. Furthermore, the review explores the role of targeted radiopharmaceuticals in nuclear medicine for bone metastases, focusing on radiolabeled molecules that are designed to selectively target biomarkers associated with bone metastases, including osteocytes, osteoblasts, and metastatic cells. The applications of radionuclide-based therapies, such as strontium-89 (Sr-89) and radium-223 (Ra-223), are also discussed. This review also highlights the potential of theranostic approaches for bone metastases, enabling personalized treatment strategies based on individual patient characteristics. Importantly, the clinical applications and outcomes of nuclear medicine in osseous metastatic disease are discussed. This includes the assessment of treatment response, predictive and prognostic value of imaging biomarkers, and the impact of nuclear medicine on patient management and outcomes. The review identifies current challenges and future perspectives on the role of nuclear medicine in treating bone metastases. It addresses limitations in imaging resolution, radiotracer availability, radiation safety, and the need for standardized protocols. The review concludes by emphasizing the need for further research and advancements in imaging technology, radiopharmaceutical development, and integration of nuclear medicine with other treatment modalities. In summary, advancements in nuclear medicine have significantly improved the diagnosis and management of osseous metastatic disease and future developements in the integration of innovative imaging modalities, targeted radiopharmaceuticals, radionuclide production, theranostic approaches, and advanced image analysis techniques hold great promise in improving patient outcomes and enhancing personalized care for individuals with bone metastases.
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Affiliation(s)
- Michael R Dyer
- Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Zhenghan Jing
- Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Kathleen Duncan
- Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jacqueline Godbe
- Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Monica Shokeen
- Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA; Alvin J. Siteman Cancer Center, Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, MO 63110, USA; Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63110, USA; Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
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Häggström I, Leithner D, Alvén J, Campanella G, Abusamra M, Zhang H, Chhabra S, Beer L, Haug A, Salles G, Raderer M, Staber PB, Becker A, Hricak H, Fuchs TJ, Schöder H, Mayerhoefer ME. Deep learning for [ 18F]fluorodeoxyglucose-PET-CT classification in patients with lymphoma: a dual-centre retrospective analysis. Lancet Digit Health 2024; 6:e114-e125. [PMID: 38135556 DOI: 10.1016/s2589-7500(23)00203-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/29/2023] [Accepted: 09/26/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND The rising global cancer burden has led to an increasing demand for imaging tests such as [18F]fluorodeoxyglucose ([18F]FDG)-PET-CT. To aid imaging specialists in dealing with high scan volumes, we aimed to train a deep learning artificial intelligence algorithm to classify [18F]FDG-PET-CT scans of patients with lymphoma with or without hypermetabolic tumour sites. METHODS In this retrospective analysis we collected 16 583 [18F]FDG-PET-CTs of 5072 patients with lymphoma who had undergone PET-CT before or after treatment at the Memorial Sloa Kettering Cancer Center, New York, NY, USA. Using maximum intensity projection (MIP), three dimensional (3D) PET, and 3D CT data, our ResNet34-based deep learning model (Lymphoma Artificial Reader System [LARS]) for [18F]FDG-PET-CT binary classification (Deauville 1-3 vs 4-5), was trained on 80% of the dataset, and tested on 20% of this dataset. For external testing, 1000 [18F]FDG-PET-CTs were obtained from a second centre (Medical University of Vienna, Vienna, Austria). Seven model variants were evaluated, including MIP-based LARS-avg (optimised for accuracy) and LARS-max (optimised for sensitivity), and 3D PET-CT-based LARS-ptct. Following expert curation, areas under the curve (AUCs), accuracies, sensitivities, and specificities were calculated. FINDINGS In the internal test cohort (3325 PET-CTs, 1012 patients), LARS-avg achieved an AUC of 0·949 (95% CI 0·942-0·956), accuracy of 0·890 (0·879-0·901), sensitivity of 0·868 (0·851-0·885), and specificity of 0·913 (0·899-0·925); LARS-max achieved an AUC of 0·949 (0·942-0·956), accuracy of 0·868 (0·858-0·879), sensitivity of 0·909 (0·896-0·924), and specificity of 0·826 (0·808-0·843); and LARS-ptct achieved an AUC of 0·939 (0·930-0·948), accuracy of 0·875 (0·864-0·887), sensitivity of 0·836 (0·817-0·855), and specificity of 0·915 (0·901-0·927). In the external test cohort (1000 PET-CTs, 503 patients), LARS-avg achieved an AUC of 0·953 (0·938-0·966), accuracy of 0·907 (0·888-0·925), sensitivity of 0·874 (0·843-0·904), and specificity of 0·949 (0·921-0·960); LARS-max achieved an AUC of 0·952 (0·937-0·965), accuracy of 0·898 (0·878-0·916), sensitivity of 0·899 (0·871-0·926), and specificity of 0·897 (0·871-0·922); and LARS-ptct achieved an AUC of 0·932 (0·915-0·948), accuracy of 0·870 (0·850-0·891), sensitivity of 0·827 (0·793-0·863), and specificity of 0·913 (0·889-0·937). INTERPRETATION Deep learning accurately distinguishes between [18F]FDG-PET-CT scans of lymphoma patients with and without hypermetabolic tumour sites. Deep learning might therefore be potentially useful to rule out the presence of metabolically active disease in such patients, or serve as a second reader or decision support tool. FUNDING National Institutes of Health-National Cancer Institute Cancer Center Support Grant.
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Affiliation(s)
- Ida Häggström
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Doris Leithner
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Radiology, NYU Langone Health, Grossman School of Medicine, New York, NY, USA
| | - Jennifer Alvén
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Gabriele Campanella
- Hasso Plattner Institute for Digital Health, Mount Sinai Medical School, New York, NY, USA; Department of AI and Human Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Murad Abusamra
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Honglei Zhang
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shalini Chhabra
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lucian Beer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Alexander Haug
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Gilles Salles
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Markus Raderer
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Philipp B Staber
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anton Becker
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, Cornell University, New York, NY, USA; Department of Radiology, NYU Langone Health, Grossman School of Medicine, New York, NY, USA
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Thomas J Fuchs
- Hasso Plattner Institute for Digital Health, Mount Sinai Medical School, New York, NY, USA; Department of AI and Human Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Heiko Schöder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Marius E Mayerhoefer
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria; Weill Cornell Medical College, Cornell University, New York, NY, USA; Department of Radiology, NYU Langone Health, Grossman School of Medicine, New York, NY, USA.
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Quang DT, Luong Thi T, Nguyen Di K, Vu Thi Quynh C, Nguyen Thi Hoa H, Phan Ngoc Q. Illuminating the breast cancer survival rates among Southeast Asian women: A systematic review and meta-analysis spanning four decades. Curr Probl Cancer 2024; 48:101062. [PMID: 38309146 DOI: 10.1016/j.currproblcancer.2024.101062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 12/27/2023] [Accepted: 01/16/2024] [Indexed: 02/05/2024]
Abstract
In Southeast Asia, breast cancer is the most prevalent cancer among women and ranks as the second leading cause of cancer-related deaths. This systematic review and meta-analysis, encompassing 27 observational cohort studies with a minimum one-year follow-up period, aimed to examine temporal trends in breast cancer survival rates. Among the subset of five out of eleven Southeast Asian nations with available data, our analysis revealed pooled survival rates of 88.8 % at 1 year, 73.8 % at 3 years, 70.8 % at 5 years, and 49.3 % at 10 years for breast cancer patients. The mean age at diagnosis was 50.77±10.07 years, with 52.81 % of patients presenting with positive lymph nodes. Notably, stages I and II remained predominant even five years post-diagnosis. Although an overall amelioration in survival rates transpired over the preceding four decades, a noticeable exception pertained to the 3-year rate, demonstrating limited improvement. These findings underscore the pressing need for enhanced research efforts, particularly in countries within the region that lack survival data, to enable accurate estimations. Furthermore, our review also emphasizes the crucial need for future comprehensive, well-designed studies to delve into the factors behind survival rate disparities in Southeast Asia and the younger age at diagnosis compared to other regions.
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Affiliation(s)
- Duc Tran Quang
- Faculty of Health Sciences, Dong Nai Technology University, Nguyen Khuyen Street, Trang Dai Ward, Bien Hoa City, Vietnam.
| | - Thanh Luong Thi
- Faculty of Health Sciences, Dong Nai Technology University, Nguyen Khuyen Street, Trang Dai Ward, Bien Hoa City, Vietnam
| | - Khanh Nguyen Di
- Faculty of Health Sciences, Dong Nai Technology University, Nguyen Khuyen Street, Trang Dai Ward, Bien Hoa City, Vietnam
| | - Chi Vu Thi Quynh
- The University of Danang, School of Medicine and Pharmacy, 41 Le Duan, Hai Chau, Danang 550000, Vietnam
| | - Huyen Nguyen Thi Hoa
- College of Health Sciences, VinUniveristy, Vinhomes Ocean Park, Gia Lam District, Hanoi, Vietnam
| | - Quang Phan Ngoc
- The Center Service For Technology Science Of Medi-Phar. Thai Binh University of Medicine and Pharmacy, 373 Ly Bon Street Thai Binh city, Vietnam
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McGinty GB. First Do No Harm. J Am Coll Radiol 2024; 21:271-273. [PMID: 37690536 DOI: 10.1016/j.jacr.2023.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Geraldine B McGinty
- Senior Associate Dean for Clinical Affairs, Departments of Radiology and Population Health Sciences, Weill Cornell Medicine, New York, New York
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Omofoye TS, Vlahos I, Marom EM, Bassett R, Blasinska K, Ye X, Tan BS, Yang WT. Backlogs in formal interpretation of radiology examinations: a pilot global survey. Clin Imaging 2024; 106:110049. [PMID: 38070475 DOI: 10.1016/j.clinimag.2023.110049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/20/2023] [Accepted: 11/24/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVE Anecdotal reports from imaging facilities globally suggest growing radiology interpretation reporting delays. This pilot study's primary aim was to estimate the backlog of formal interpretation of imaging examinations. METHODS An online survey was distributed to radiologists globally to gather practice-specific characteristics, imaging volumes, and reporting for 3 types of examinations (brain/head CT scans, chest CT scans, and chest radiographs) at 4 time points: 7, 30, 90 days, and 6 months. RESULTS We received responses from 49 radiologists in 16 countries on six continents. Unreported examinations (backlog) were present in thirty of 44 (68%) facilities. Backlogs for brain/head CT, chest CT, and chest radiographs were present in, respectively, 48%, 50%, and 59% of facilities at 7 days and 20%, 23%, and 32% of facilities at 6 months. When present, the mean proportion of backlog (range) at 7 days was 17% (1 to 96) for brain/head CT, 18% (3 to 82) for chest CT, and 22% (1 to 99) for chest radiographs. CONCLUSIONS Our findings from this pilot study show a widespread global backlog in reporting common imaging examinations, and further research is needed on the issue and contributing factors.
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Affiliation(s)
- Toma S Omofoye
- Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Ioannis Vlahos
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Edith M Marom
- Department of Diagnostic Radiology, Chaim Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel
| | - Roland Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Xiaodan Ye
- Department of Radiology, Shanghai Chest Hospital (affiliated with Shanghai Jiaotong University, Shanghai, China
| | - Bien Soo Tan
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore, Singapore
| | - Wei T Yang
- Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Joannides AJ, Korhonen TK, Clark D, Gnanakumar S, Venturini S, Mohan M, Bashford T, Baticulon R, Bhagavatula ID, Esene I, Fernández-Méndez R, Figaji A, Gupta D, Khan T, Laeke T, Martin M, Menon D, Paiva W, Park KB, Pattisapu JV, Rubiano AM, Sekhar V, Shabani HK, Sichizya K, Solla D, Tirsit A, Tripathi M, Turner C, Depreitere B, Iaccarino C, Lippa L, Reisner A, Rosseau G, Servadei F, Trivedi RA, Waran V, Kolias A, Hutchinson P. Consensus-Based Development of a Global Registry for Traumatic Brain Injury: Establishment, Protocol, and Implementation. Neurosurgery 2024; 94:278-288. [PMID: 37747225 DOI: 10.1227/neu.0000000000002661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/05/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Global disparity exists in the demographics, pathology, management, and outcomes of surgically treated traumatic brain injury (TBI). However, the factors underlying these differences, including intervention effectiveness, remain unclear. Establishing a more accurate global picture of the burden of TBI represents a challenging task requiring systematic and ongoing data collection of patients with TBI across all management modalities. The objective of this study was to establish a global registry that would enable local service benchmarking against a global standard, identification of unmet need in TBI management, and its evidence-based prioritization in policymaking. METHODS The registry was developed in an iterative consensus-based manner by a panel of neurotrauma professionals. Proposed registry objectives, structure, and data points were established in 2 international multidisciplinary neurotrauma meetings, after which a survey consisting of the same data points was circulated within the global neurotrauma community. The survey results were disseminated in a final meeting to reach a consensus on the most pertinent registry variables. RESULTS A total of 156 professionals from 53 countries, including both high-income countries and low- and middle-income countries, responded to the survey. The final consensus-based registry includes patients with TBI who required neurosurgical admission, a neurosurgical procedure, or a critical care admission. The data set comprised clinically pertinent information on demographics, injury characteristics, imaging, treatments, and short-term outcomes. Based on the consensus, the Global Epidemiology and Outcomes following Traumatic Brain Injury (GEO-TBI) registry was established. CONCLUSION The GEO-TBI registry will enable high-quality data collection, clinical auditing, and research activity, and it is supported by the World Federation of Neurosurgical Societies and the National Institute of Health Research Global Health Program. The GEO-TBI registry ( https://geotbi.org ) is now open for participant site recruitment. Any center involved in TBI management is welcome to join the collaboration to access the registry.
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Affiliation(s)
- Alexis J Joannides
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | - Tommi K Korhonen
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
- Neurocenter, Neurosurgery, Oulu University Hospital & University of Oulu, Oulu , Finland
| | - David Clark
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | - Sujit Gnanakumar
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | - Sara Venturini
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | - Midhun Mohan
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | - Thomas Bashford
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
- Division of Anaesthesia, Department of Medicine, University of Cambridge & Cambridge University Hospitals NHS Foundation Trust, Cambridge , Cambridgeshire , UK
- Health Systems Design Group, Department of Engineering, University of Cambridge, Cambridge , UK
| | - Ronnie Baticulon
- Division of Neurosurgery, Department of Neurosciences, Philippine General Hospital & University of the Philippines Manila, Manila , Philippines
| | - Indira Devi Bhagavatula
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, NIMHANS, Bengaluru , Karnataka , India
| | - Ignatius Esene
- Division of Neurosurgery, Faculty of Health Sciences, The University of Bamenda, Bambili , Cameroon
| | - Rocío Fernández-Méndez
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | - Anthony Figaji
- Division of Neurosurgery, Neurosciences Institute, University of Cape Town, Cape Town , South Africa
| | - Deepak Gupta
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi , India
| | - Tariq Khan
- Department of Neurosurgery, North Western General and Research Hospital, Peshawar , Pakistan
| | - Tsegazeab Laeke
- Division of Neurosurgery, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa , Ethiopia
| | - Michael Martin
- Orion MedTech Ltd. CIC, Cambridge , Cambridgeshire , UK
- Obex Technologies Ltd., Cambridge , Cambridgeshire , UK
| | - David Menon
- Division of Anaesthesia, Department of Medicine, University of Cambridge & Cambridge University Hospitals NHS Foundation Trust, Cambridge , Cambridgeshire , UK
| | - Wellingson Paiva
- Division of Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, São Paulo , Brazil
| | - Kee B Park
- Department of Global Health and Social Medicine, Global Neurosurgery Initiative-Program in Global Surgery and Social Change, Harvard Medical School, Boston , Massachusetts , USA
| | - Jogi V Pattisapu
- University of Central Florida College of Medicine, Orlando , Florida , USA
- Department of Neurosurgery, King George Hospital, Visakhapatnam , Andhra Pradesh , India
| | - Andres M Rubiano
- Neurosciences Institute, El Bosque University, Bogotá , Colombia
| | - Vijaya Sekhar
- Department of Neurosurgery, King George Hospital, Visakhapatnam , Andhra Pradesh , India
- Current Affiliation: Department of Neurosurgery, Government General Hospital & Rangaraya Medical College, Kakinada , Andhra Pradesh , India
| | - Hamisi K Shabani
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam , Tanzania
| | - Kachinga Sichizya
- Department of Neurosurgery, University Teaching Hospital, Lusaka , Zambia
| | - Davi Solla
- Division of Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, São Paulo , Brazil
| | - Abenezer Tirsit
- Division of Neurosurgery, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa , Ethiopia
| | - Manjul Tripathi
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh , India
| | - Carole Turner
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | | | - Corrado Iaccarino
- Department of Biomedical, Metabolic and Neural Sciences, School of Neurosurgery, University of Modena and Reggio Emilia, Modena , Italy
- Division of Neurosurgery, University Hospital of Modena, Modena , Italy
- Emergency Neurosurgery Unit, AUSL RE IRCCS, Reggio Emilia , Italy
| | - Laura Lippa
- Department of Neurosurgery, Ospedale Niguarda, Milan , Italy
| | - Andrew Reisner
- Departments of Neurosurgery and Pediatrics, Children's Healthcare of Atlanta & Emory University School of Medicine, Atlanta , Georgia , USA
| | - Gail Rosseau
- Barrow Global, Barrow Neurological Institute, Phoenix , Arizona , USA
- Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington , District of Columbia , USA
| | - Franco Servadei
- Humanitas Research Hospital-IRCCS & Humanitas University, Rozzano, Milan , Italy
| | - Rikin A Trivedi
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | - Vicknes Waran
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur , Malaysia
| | - Angelos Kolias
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
| | - Peter Hutchinson
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge , Cambridgeshire , UK
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Ndarukwa S, Flores JA, Rosenblatt E, Berger D, Akbarov K, Hedden N, Chopra S, Hande V, Rubio AP. Brachytherapy Workflow Practices: Analysis of Different Workflow Scenarios in Patients With Cervical Cancer and Impact on IGBT Implementation-An IAEA Study. JCO Glob Oncol 2024; 10:e2300336. [PMID: 38386958 PMCID: PMC10898675 DOI: 10.1200/go.23.00336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/19/2023] [Accepted: 12/19/2023] [Indexed: 02/24/2024] Open
Abstract
PURPOSE The workflow of brachytherapy (BT) is an essential aspect of treatment to consider in image-guided brachytherapy (IGBT). It has an overarching effect influencing patient throughput and the number of cancer treatments that can be performed as it occupies equipment, space, and personnel. There is limited research addressing this issue. Under the International Atomic Energy Agency's Coordinated Research Activity titled IGBT for cervix cancer: An implementation study, our study analyzes various scenarios in the clinical workflow of BT delivery for cervical cancer. It aims to determine the extent to which these scenarios allow the routine implementation of IGBT. With this information, current barriers and individualized adaptations to efficient workflows can be identified to enhance the global application of IGBT, leading to better cervical cancer treatment. MATERIALS AND METHODS A web-based poll of questions regarding practices in BT workflow was presented to 62 participants from low-, lower middle-, upper middle-, and high-income countries (19 countries). RESULTS This study highlighted diversity in BT practices across countries, income levels, and regions. It identified variations in workflow, patient throughput, and resource availability, which can have implications for the efficiency and quality of BT treatments. Scenario A, utilizing multiple locations for the steps of the BT procedure, was the most commonly used. The availability of resources, such as imaging devices and trained personnel, varied among the participating centers and remained challenging for IGBT implementation and sustainability. CONCLUSION The design of the BT facility plays a vital role in improving efficiency, with a dedicated BT suite contributing to an efficient workflow but limiting patient throughput, especially for high-volume centers. Although IGBT is effective, its implementation requires consideration of various logistical challenges and should be individualized.
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Affiliation(s)
- Sandra Ndarukwa
- Applied Radiobiology and Radiotherapy Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Jerickson Abbie Flores
- Applied Radiobiology and Radiotherapy Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Eduardo Rosenblatt
- Applied Radiobiology and Radiotherapy Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Daniel Berger
- Section of Dosimetry and Medical Radiation Physics, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Kamal Akbarov
- Applied Radiobiology and Radiotherapy Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Natasha Hedden
- Applied Radiobiology and Radiotherapy Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Supriya Chopra
- Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Varsha Hande
- Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Alfredo Polo Rubio
- City Cancer Challenge, Technical Cooperation and Capacity Development, Geneva, Switzerland
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Robertson NM, Centner CS, Siddharthan T. Integrating Artificial Intelligence in the Diagnosis of COPD Globally: A Way Forward. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2024; 11:114-120. [PMID: 37828644 PMCID: PMC10913925 DOI: 10.15326/jcopdf.2023.0449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/14/2023]
Abstract
The advancement of artificial intelligence (AI) capabilities has paved the way for a new frontier in medicine, which has the capability to reduce the burden of COPD globally. AI may reduce health care-associated expenses while potentially increasing diagnostic specificity, improving access to early COPD diagnosis, and monitoring COPD progression and subsequent disease management. We evaluated how AI can be integrated into COPD diagnosing globally and leveraged in resource-constrained settings.AI has been explored in diagnosing and phenotyping COPD through auscultation, pulmonary function testing, and imaging. Clinician collaboration with AI has increased the performance of COPD diagnosing and highlights the important role of clinical decision-making in AI integration. Likewise, AI analysis of computer tomography (CT) imaging in large population-based cohorts has increased diagnostic ability, severity classification, and prediction of outcomes related to COPD. Moreover, a multimodality approach with CT imaging, demographic data, and spirometry has been shown to improve machine learning predictions of the progression to COPD compared to each modality alone. Prior research has primarily been conducted in high-income country settings, which may lack generalization to a global population. AI is a World Health Organization priority with the potential to reduce health care barriers in low- and middle-income countries. We recommend a collaboration between clinicians and an AI-supported multimodal approach to COPD diagnosis as a step towards achieving this goal. We believe the interplay of CT imaging, spirometry, biomarkers, and sputum analysis may provide unique insights across settings that could provide a basis for clinical decision-making that includes early intervention for those diagnosed with COPD.
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Affiliation(s)
- Nicole M. Robertson
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Connor S. Centner
- University of Louisville School of Medicine, Louisville, Kentucky, United States
- Department of Bioengineering, School of Engineering, University of Louisville, Louisville, Kentucky, United States
| | - Trishul Siddharthan
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Miami, Miami, Florida, United States
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Leithner D, Sala E, Neri E, Schlemmer HP, D'Anastasi M, Weber M, Avesani G, Caglic I, Caruso D, Gabelloni M, Goh V, Granata V, Kunz WG, Nougaret S, Russo L, Woitek R, Mayerhoefer ME. Perceptions of radiologists on structured reporting for cancer imaging-a survey by the European Society of Oncologic Imaging (ESOI). Eur Radiol 2024:10.1007/s00330-023-10397-6. [PMID: 38206405 DOI: 10.1007/s00330-023-10397-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/20/2023] [Accepted: 09/07/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES To assess radiologists' current use of, and opinions on, structured reporting (SR) in oncologic imaging, and to provide recommendations for a structured report template. MATERIALS AND METHODS An online survey with 28 questions was sent to European Society of Oncologic Imaging (ESOI) members. The questionnaire had four main parts: (1) participant information, e.g., country, workplace, experience, and current SR use; (2) SR design, e.g., numbers of sections and fields, and template use; (3) clinical impact of SR, e.g., on report quality and length, workload, and communication with clinicians; and (4) preferences for an oncology-focused structured CT report. Data analysis comprised descriptive statistics, chi-square tests, and Spearman correlation coefficients. RESULTS A total of 200 radiologists from 51 countries completed the survey: 57.0% currently utilized SR (57%), with a lower proportion within than outside of Europe (51.0 vs. 72.7%; p = 0.006). Among SR users, the majority observed markedly increased report quality (62.3%) and easier comparison to previous exams (53.5%), a slightly lower error rate (50.9%), and fewer calls/emails by clinicians (78.9%) due to SR. The perceived impact of SR on communication with clinicians (i.e., frequency of calls/emails) differed with radiologists' experience (p < 0.001), and experience also showed low but significant correlations with communication with clinicians (r = - 0.27, p = 0.003), report quality (r = 0.19, p = 0.043), and error rate (r = - 0.22, p = 0.016). Template use also affected the perceived impact of SR on report quality (p = 0.036). CONCLUSION Radiologists regard SR in oncologic imaging favorably, with perceived positive effects on report quality, error rate, comparison of serial exams, and communication with clinicians. CLINICAL RELEVANCE STATEMENT Radiologists believe that structured reporting in oncologic imaging improves report quality, decreases the error rate, and enables better communication with clinicians. Implementation of structured reporting in Europe is currently below the international level and needs society endorsement. KEY POINTS • The majority of oncologic imaging specialists (57% overall; 51% in Europe) use structured reporting in clinical practice. • The vast majority of oncologic imaging specialists use templates (92.1%), which are typically cancer-specific (76.2%). • Structured reporting is perceived to markedly improve report quality, communication with clinicians, and comparison to prior scans.
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Affiliation(s)
- Doris Leithner
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Evis Sala
- Department of Radiology, Universita Cattolica del Sacro Cuore, Rome, Italy
- Advanced Radiology Center, Fondazione Universitario Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Emanuele Neri
- Diagnostic and Interventional Radiology, Department of Translational Research, University of Pisa, Pisa, Italy
| | | | - Melvin D'Anastasi
- Medical Imaging Department, Mater Dei Hospital, University of Malta, Msida, Malta
| | - Michael Weber
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Giacomo Avesani
- Department of Radiology, Radiation Oncology and Hematology, Fondazione Policlinico Universitario, A. Gemelli IRCCS, Rome, Italy
| | - Iztok Caglic
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Damiano Caruso
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Michela Gabelloni
- Nuclear Medicine Unit, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Vicky Goh
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Department of Radiology, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS, Naples, Italy
| | - Wolfgang G Kunz
- Department of Radiology, University Hospital LMU Munich, Munich, Germany
| | | | - Luca Russo
- Department of Radiology, Radiation Oncology and Hematology, Fondazione Policlinico Universitario, A. Gemelli IRCCS, Rome, Italy
| | - Ramona Woitek
- Research Centre for Medical Image Analysis and Artificial Intelligence, Danube Private University, Krems, Austria
| | - Marius E Mayerhoefer
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA.
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.
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Korde A, Patt M, Selivanova SV, Scott AM, Hesselmann R, Kiss O, Ramamoorthy N, Todde S, Rubow SM, Gwaza L, Lyashchenko S, Andersson J, Hockley B, Kaslival R, Decristoforo C. Position paper to facilitate patient access to radiopharmaceuticals: considerations for a suitable pharmaceutical regulatory framework. EJNMMI Radiopharm Chem 2024; 9:2. [PMID: 38165504 PMCID: PMC10761641 DOI: 10.1186/s41181-023-00230-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/13/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Nuclear medicine has made enormous progress in the past decades. However, there are still significant inequalities in patient access among different countries, which could be mitigated by improving access to and availability of radiopharmaceuticals. MAIN BODY This paper summarises major considerations for a suitable pharmaceutical regulatory framework to facilitate patient access to radiopharmaceuticals. These include the distinct characteristics of radiopharmaceuticals which require dedicated regulations, considering the impact of the variable complexity of radiopharmaceutical preparation, personnel requirements, manufacturing practices and quality assurance, regulatory authority interfaces, communication and training, as well as marketing authorisation procedures to ensure availability of radiopharmaceuticals. Finally, domestic and regional supply to ensure patient access via alternative regulatory pathways, including in-house production of radiopharmaceuticals, is described, and an outlook on regulatory challenges faced by new developments, such as the use of alpha emitters, is provided. CONCLUSIONS All these considerations are an outcome of a dedicated Technical Meeting organised by the IAEA in 2023 and represent the views and opinions of experts in the field, not those of any regulatory authorities.
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Affiliation(s)
- Aruna Korde
- Division of Physical and Chemical Sciences, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Marianne Patt
- Section Radiopharmacy, Department of Nuclear Medicine, University Hospital Augsburg, Augsburg, Germany
| | - Svetlana V Selivanova
- Canadian Nuclear Laboratories, Chalk River, ON, Canada
- Faculty of Pharmacy, Universite Laval, Quebec City, QC, Canada
| | - Andrew M Scott
- Department of Molecular Imaging and Therapy, Austin Health, and Faculty of Medicine, University of Melbourne, Melbourne, Australia
- Olivia Newton-John Cancer Research Institute, and School of Cancer Medicine, La Trobe University, Melbourne, Australia
| | - Rolf Hesselmann
- Health Protection Directorate, Radiation Protection Division, Section for Research Facilities and Nuclear Medicine, Federal Office of Public Health, Bern, Switzerland
| | - Oliver Kiss
- Department of Targetry, Target Chemistry and Radiopharmacy, Institute for Radipopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | | | - Sergio Todde
- Department of Medicine and Surgery, University of Milano-Bicocca, Tecnomed Foundation, Via Pergolesi, 33, 20900, Monza, Italy
| | - Sietske M Rubow
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Luther Gwaza
- Health Products Policy and Standards Department, World Health Organization, Geneva, Switzerland
| | - Serge Lyashchenko
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jan Andersson
- Edmonton Radiopharmaceutical Centre, Alberta Health Services, Edmonton, Canada
- Department of Oncology, University of Alberta, Edmonton, Canada
| | - Brian Hockley
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Ravindra Kaslival
- Office of New Drug Products, Office of Pharmaceutical Quality, CDER, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Clemens Decristoforo
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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Adjei ANA, Donkor A, Wiafe YA, Anyitey-Kokor IC, Hyde E. Elements of person-centred diagnostic imaging care in low-and middle-income countries: A systematic review. Radiography (Lond) 2024; 30:394-407. [PMID: 38176130 DOI: 10.1016/j.radi.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 12/21/2023] [Accepted: 12/25/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION Diagnostic imaging professionals are trained to deliver safe and high-quality person-centred radiographic diagnostic imaging care. The term person-centred care has been described as a confused concept without a unified definition. This systematic review identified the elements that have been used to measure person-centred care in diagnostic imaging in low- and middle-income countries (LMICs). METHODS A systematic review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Embase, MEDLINE and Cochrane library were searched. Bias was assessed using the Critical Appraisal Skill Programme and Mixed Method Appraisal Tool. A narrative synthesis guided by the Picker Principles of person-centred care was undertaken. RESULTS Of the 4482 articles identified, 26 articles were included. The studies were from 12 LMICs. Synthesis of the literature generated six themes, namely access to high quality and safe diagnostic imaging care, effective communication and shared diagnostic imaging decision making, suitable diagnostic imaging environment for physical comfort, respectful and compassionate diagnostic radiographers, effective coordination of diagnostic imaging care process, and family and friends' involvement in diagnostic imaging care. CONCLUSION Medical imaging facilities in most LMICs continue to struggle with issues of access, safety, quality, and responsiveness to the needs of patients. The need for innovative person-centred diagnostic imaging care interventions in LMICs has become urgent. IMPLICATIONS FOR PRACTICE If diagnostic imaging services in LMICs are to move beyond the current models of limited person-centred access to care, a greater focus on systems thinking is required. It is imperative to involve all stakeholders, not only patients and radiographers, but also policymakers whose works impact on equitable access to diagnostic imaging services.
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Affiliation(s)
- A N A Adjei
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - A Donkor
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; IMPACCT, Faculty of Health, University of Technology Sydney, Australia.
| | - Y A Wiafe
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - I C Anyitey-Kokor
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - E Hyde
- Provost for Learning & Teaching, University of Derby, United Kingdom.
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Miyashita Y, Hitsumoto T, Fukuda H, Kim J, Ito S, Kimoto N, Asakura K, Yata Y, Yabumoto M, Washio T, Kitakaze M. Metabolic syndrome is linked to the incidence of pancreatic cancer. EClinicalMedicine 2024; 67:102353. [PMID: 38169901 PMCID: PMC10758702 DOI: 10.1016/j.eclinm.2023.102353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 01/05/2024] Open
Abstract
Background Although previous studies have showed that metabolic syndrome is one of the contributors of pancreatic cancer, there is no clear consensus that early stages of metabolic syndrome are linked to increased incidence of pancreatic cancer. Therefore, we confirmed the linkage between metabolic syndrome and pancreatic cancer, and shown that even early stage of metabolic syndrome is linked to pancreatic cancer in the retrospective observational study. Methods We recruited approximately 4.6 million Japanese in 2005 and followed up these subjects for more than 10 years. At the time of the enrollment, after obtaining clinical data with prescribed drugs and examining the presence or absence of metabolic syndrome (MetS), we followed up on these subjects with and without MetS to examine the incidence of pancreatic cancer. The modified criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATPIII) were used to define MetS. Findings During the 40.7-month average follow-up period for 2,707,296 subjects with complete data for identifying MetS and important risk factors without pancreatic cancer before the enrollment, 87,857 suffered from pancreatic cancer. Pancreatic cancers occurred in 16,154 of 331,229 subjects (4.9%) in the MetS group and 71,703 of 2,376,067 patients (3.0%) in the non-MetS group (hazard ratio (HR), 1.37; 95% confidence interval [CI], 1.34-1.39; p < 0.0001 after the adjustment with age, smoking and sex). As the number of the constituent factors of MetS increased from one to five, the incidence of pancreatic cancer correspondingly increased (HR: 1.11, 1.23, 1.42, 1.66 and 2.03 using Cox proportional hazard models, p < 0.0001 each). When we defined MetS using the Japanese criteria, the results are in accord with the results using NCEP/ATPIII. Especially pre-metabolic syndrome (pre-MetS) in the Japanese criteria was tightly linked to the incidence of pancreatic cancers. Interpretation MetS is confirmed to be linked to pancreatic cancer. Although we cannot conclude causality. We also demonstrated the link between pre-MetS and pancreatic cancer. Funding The sponsors of the study were Japanese Heart Foundation and Japan Cardiovascular Research Foundation. This is also partially supported by Grants-in-Aid from the Ministry of Education, Culture, Sports, Science and Technology of Japan; and Grants-in-Aid from the Japan Agency for Medical Research and Development.
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Affiliation(s)
- Yohei Miyashita
- Department of Legal Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Tatsuro Hitsumoto
- Department of Clinical Research and Development, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, Japan
| | - Hiroki Fukuda
- Department of Clinical Research and Development, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, Japan
| | - Jiyoong Kim
- Kim Cardiovascular Clinic, 3-6-8 Katsuyama, Tennoji-ku, Osaka, Japan
| | - Shin Ito
- Department of Clinical Research and Development, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, Japan
| | - Naoki Kimoto
- Non Profit Organization Think of Medicine in Science, 3-7-11 Minami-Sumiyoshi, Sumiyoshi-ku, Osaka, Japan
| | - Koko Asakura
- Department of Data Science, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, Japan
| | - Yutaka Yata
- Hanwa Memorial Hospital, 3-5-8 Minamisumiyoshi, Sumiyoshi-ku, Osaka, Japan
| | - Masami Yabumoto
- Hanwa Memorial Hospital, 3-5-8 Minamisumiyoshi, Sumiyoshi-ku, Osaka, Japan
| | - Takashi Washio
- The Institute of Scientific and Industrial Research, Osaka University, 1-1 Yamadaoka, Suita, Osaka, Japan
| | - Masafumi Kitakaze
- Non Profit Organization Think of Medicine in Science, 3-7-11 Minami-Sumiyoshi, Sumiyoshi-ku, Osaka, Japan
- Hanwa Memorial Hospital, 3-5-8 Minamisumiyoshi, Sumiyoshi-ku, Osaka, Japan
- The Osaka Medical Research Foundation for Intractable Diseases, 2-6-29 Abikohigashi, Sumiyoshi-ku, Osaka, Japan
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Aggarwal A, Choudhury A, Fearnhead N, Kearns P, Kirby A, Lawler M, Quinlan S, Palmieri C, Roques T, Simcock R, Walter FM, Price P, Sullivan R. The future of cancer care in the UK-time for a radical and sustainable National Cancer Plan. Lancet Oncol 2024; 25:e6-e17. [PMID: 37977167 DOI: 10.1016/s1470-2045(23)00511-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 11/19/2023]
Abstract
Cancer affects one in two people in the UK and the incidence is set to increase. The UK National Health Service is facing major workforce deficits and cancer services have struggled to recover after the COVID-19 pandemic, with waiting times for cancer care becoming the worst on record. There are severe and widening disparities across the country and survival rates remain unacceptably poor for many cancers. This is at a time when cancer care has become increasingly complex, specialised, and expensive. The current crisis has deep historic roots, and to be reversed, the scale of the challenge must be acknowledged and a fundamental reset is required. The loss of a dedicated National Cancer Control Plan in England and Wales, poor operationalisation of plans elsewhere in the UK, and the closure of the National Cancer Research Institute have all added to a sense of strategic misdirection. The UK finds itself at a crossroads, where the political decisions of governments, the cancer community, and research funders will determine whether we can, together, achieve equitable, affordable, and high-quality cancer care for patients that is commensurate with our wealth, and position our outcomes among the best in the world. In this Policy Review, we describe the challenges and opportunities that are needed to develop radical, yet sustainable plans, which are comprehensive, evidence-based, integrated, patient-outcome focused, and deliver value for money.
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Affiliation(s)
- Ajay Aggarwal
- Department of Health Services Research & Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ananya Choudhury
- Department of Clinical Oncology and Division of Cancer Sciences, The Christie NHS Foundation Trust, Manchester, UK
| | - Nicola Fearnhead
- Department of Colorectal Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Pam Kearns
- Institute of Cancer and Genomic Sciences NIHR Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Anna Kirby
- Department of Radiotherapy, Royal Marsden Hospital, London, UK
| | - Mark Lawler
- Patrick G Johnston Centre for Cancer Research, Queens University Belfast Belfast, UK
| | | | - Carlo Palmieri
- The Clatterbridge Cancer Centre NHS Foundation Trust, & Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Tom Roques
- Royal College of Radiologists & Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Richard Simcock
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Fiona M Walter
- Wolfson Institute of Population Health, Faculty of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Pat Price
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | - Richard Sullivan
- Institute of Cancer Policy, Centre for Cancer, Society & Public Health, King's College London, London, UK
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Are C, Murthy SS, Sullivan R, Schissel M, Chowdhury S, Alatise O, Anaya D, Are M, Balch C, Bartlett D, Brennan M, Cairncross L, Clark M, Deo SVS, Dudeja V, D'Ugo D, Fadhil I, Giuliano A, Gopal S, Gutnik L, Ilbawi A, Jani P, Kingham TP, Lorenzon L, Leiphrakpam P, Leon A, Martinez-Said H, McMasters K, Meltzer DO, Mutebi M, Zafar SN, Naik V, Newman L, Oliveira AF, Park DJ, Pramesh CS, Rao S, Subramanyeshwar Rao T, Bargallo-Rocha E, Romanoff A, Rositch AF, Rubio IT, Salvador de Castro Ribeiro H, Sbaity E, Senthil M, Smith L, Toi M, Turaga K, Yanala U, Yip CH, Zaghloul A, Anderson BO. Global Cancer Surgery: pragmatic solutions to improve cancer surgery outcomes worldwide. Lancet Oncol 2023; 24:e472-e518. [PMID: 37924819 DOI: 10.1016/s1470-2045(23)00412-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 11/06/2023]
Abstract
The first Lancet Oncology Commission on Global Cancer Surgery was published in 2015 and serves as a landmark paper in the field of cancer surgery. The Commission highlighted the burden of cancer and the importance of cancer surgery, while documenting the many inadequacies in the ability to deliver safe, timely, and affordable cancer surgical care. This Commission builds on the first Commission by focusing on solutions and actions to improve access to cancer surgery globally, developed by drawing upon the expertise from cancer surgery leaders across the world. We present solution frameworks in nine domains that can improve access to cancer surgery. These nine domains were refined to identify solutions specific to the six WHO regions. On the basis of these solutions, we developed eight actions to propel essential improvements in the global capacity for cancer surgery. Our initiatives are broad in scope, pragmatic, affordable, and contextually applicable, and aimed at cancer surgeons as well as leaders, administrators, elected officials, and health policy advocates. We envision that the solutions and actions contained within the Commission will address inequities and promote safe, timely, and affordable cancer surgery for every patient, regardless of their socioeconomic status or geographic location.
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Affiliation(s)
- Chandrakanth Are
- Division of Surgical Oncology, Department of Surgery, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Shilpa S Murthy
- Division of Surgical Oncology, Department of Surgery, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Richard Sullivan
- Institute of Cancer Policy, School of Cancer Sciences, King's College London, London, UK
| | - Makayla Schissel
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sanjib Chowdhury
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Olesegun Alatise
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Daniel Anaya
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Madhuri Are
- Division of Pain Medicine, Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Charles Balch
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, Global Cancer Surgery: pragmatic solutions to improve USA
| | - David Bartlett
- Department of Surgery, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Murray Brennan
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lydia Cairncross
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Matthew Clark
- University of Auckland School of Medicine, Auckland, New Zealand
| | - S V S Deo
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Vikas Dudeja
- Division of Surgical Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Domenico D'Ugo
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | | | - Armando Giuliano
- Cedars-Sinai Medical Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Satish Gopal
- Center for Global Health, National Cancer Institute, Washington DC, USA
| | - Lily Gutnik
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andre Ilbawi
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Pankaj Jani
- Department of Surgery, University of Nairobi, Nairobi, Kenya
| | | | - Laura Lorenzon
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | - Premila Leiphrakpam
- Division of Surgical Oncology, Department of Surgery, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Augusto Leon
- Department of Surgical Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Kelly McMasters
- Division of Surgical Oncology, Hiram C Polk, Jr MD Department of Surgery, University of Louisville, Louisville, KY, USA
| | - David O Meltzer
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University Hospital, Nairobi, Kenya
| | - Syed Nabeel Zafar
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, WI, USA
| | - Vibhavari Naik
- Department of Anesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | - Lisa Newman
- Department of Surgery, New York-Presbyterian, Weill Cornell Medicine, New York, NY, USA
| | | | - Do Joong Park
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - C S Pramesh
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Centre, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Saieesh Rao
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - T Subramanyeshwar Rao
- Department of Surgical Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | | | - Anya Romanoff
- Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Isabel T Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | | | - Eman Sbaity
- Division of General Surgery, Department of Surgery, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Maheswari Senthil
- Division of Surgical Oncology, Department of Surgery, University of California, Irvine, Irvine, CA, USA
| | - Lynette Smith
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Masakazi Toi
- Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Tokyo, Japan
| | - Kiran Turaga
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Ujwal Yanala
- Surgical Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Cheng-Har Yip
- Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
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Vlegels N, Gonzalez-Ortiz F, Knuth NL, Khalifeh N, Gesierich B, Müller F, Müller P, Klein M, Dimitriadis K, Franzmeier N, Liebig T, Duering M, Reidler P, Dichgans M, Karikari TK, Blennow K, Tiedt S. Brain-derived Tau for Monitoring Brain Injury in Acute Ischemic Stroke. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.18.23298728. [PMID: 38014197 PMCID: PMC10680879 DOI: 10.1101/2023.11.18.23298728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
The evolution of infarcts varies widely among patients with acute ischemic stroke (IS) and influences treatment decisions. Neuroimaging is not applicable for frequent monitoring and there is no blood-based biomarker to track ongoing brain injury in acute IS. Here, we examined the utility of plasma brain-derived tau (BD-tau) as a biomarker for brain injury in acute IS. We conducted the prospective, observational Precision Medicine in Stroke [PROMISE] study with serial blood sampling upon hospital admission and at days 2, 3, and 7 in patients with acute ischemic stroke (IS) and for comparison, in patients with stroke mimics (SM). We determined the temporal course of plasma BD-tau, its relation to infarct size and admission imaging-based metrics of brain injury, and its value to predict functional outcome. Upon admission (median time-from-onset, 4.4h), BD-tau levels in IS patients correlated with ASPECTS (ρ=-0.21, P<.0001) and were predictive of final infarct volume (ρ=0.26, P<.0001). In contrast to SM patients, BD-tau levels in IS patients increased from admission (median, 2.9 pg/ml [IQR, 1.8-4.8]) to day 2 (median time-from-onset, 22.7h; median BD-tau, 5.0 pg/ml [IQR, 2.6-10.3]; P<.0001). The rate of change of BD-tau from admission to day 2 was significantly associated with collateral supply (R2=0.10, P<.0001) and infarct progression (ρ=0.58, P<.0001). At day 2, BD-tau was predictive of final infarct volume (ρ=0.59, P<.0001) and showed superior value for predicting the 90-day mRS score compared with final infarct volume. In conclusion, in 502 patients with acute IS, plasma BD-tau was associated with imaging-based metrics of brain injury upon admission, increased within the first 24 hours in correlation with infarct progression, and at 24 hours was superior to final infarct volume in predicting 90-day functional outcome. Further research is needed to determine whether BD-tau assessments can inform decision-making in stroke care.
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Affiliation(s)
- Naomi Vlegels
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Germany
| | - Fernando Gonzalez-Ortiz
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Nicoló Luca Knuth
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Germany
| | - Nada Khalifeh
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Germany
| | - Benno Gesierich
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Germany
- Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Franziska Müller
- Department of Radiology, LMU University Hospital, LMU Munich, Germany
| | - Philipp Müller
- Department of Radiology, LMU University Hospital, LMU Munich, Germany
| | - Matthias Klein
- Department of Neurology, LMU University Hospital, LMU Munich, Germany
| | | | - Nicolai Franzmeier
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Germany
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Thomas Liebig
- Institute of Neuroradiology, LMU University Hospital, LMU Munich, Germany
| | - Marco Duering
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Germany
- Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Paul Reidler
- Department of Radiology, LMU University Hospital, LMU Munich, Germany
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE, Munich), Munich, Germany
- German Centre for Cardiovascular Research (DZHK, Munich), Munich, Germany
| | - Thomas K Karikari
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Steffen Tiedt
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Germany
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42
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Jaraczewski TJ, SenthilKumar G, Ramamurthi A, Nimmer K, Yang X, Kothari AN. Teaming with artificial intelligence to support global cancer surgical care. J Surg Oncol 2023; 128:943-946. [PMID: 37818910 DOI: 10.1002/jso.27442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 09/02/2023] [Indexed: 10/13/2023]
Affiliation(s)
- Taylor J Jaraczewski
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Gopika SenthilKumar
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Physiology and Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Adhitya Ramamurthi
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kaitlyn Nimmer
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Xin Yang
- Clinical and Translational Science Institute of Southeast Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Anai N Kothari
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Clinical and Translational Science Institute of Southeast Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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43
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Krishnan M, Agarwal P, Pinninti R, Rajappa S. Global inequalities in availability of systemic therapies for cancer care and strategies to address them. J Surg Oncol 2023; 128:1038-1044. [PMID: 37818905 DOI: 10.1002/jso.27439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/27/2023] [Indexed: 10/13/2023]
Abstract
Many Low and middle-income countries face challenges in delivering chemotherapy services due to limitations in infrastructure, inadequate healthcare facilities, and a shortage of trained medical professionals. High-income countries often have well-developed healthcare systems and advanced technology.
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Affiliation(s)
- Mridula Krishnan
- Division of Hematology and Oncology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Priyal Agarwal
- Division of Hematology and Oncology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Rakesh Pinninti
- Basavatarakam Indo American Cancer Hospital & RI, Hyderabad, Telangana, India
| | - Senthil Rajappa
- Basavatarakam Indo American Cancer Hospital & RI, Hyderabad, Telangana, India
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de Moraes FCA, Dal Moro L, Pessoa FR, Passos ESDR, Campos RALS, de Souza DDSM, Feio D, Rodríguez Burbano RM, Fernandes MR, dos Santos NPC. Malignant Neoplasms Arising in the Cardiac Pacemaker Cavity: A Systematic Review. Cancers (Basel) 2023; 15:5206. [PMID: 37958380 PMCID: PMC10647525 DOI: 10.3390/cancers15215206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/20/2023] [Accepted: 09/27/2023] [Indexed: 11/15/2023] Open
Abstract
Cancer is the abnormal proliferation of physiologically inadequate cells. Studies have identified the cardiac pacemaker pocket as a site of rare neoplasms. To evaluate the clinical outcomes, treatment, prognosis, and individualized management of tumors originating in the cardiac pacemaker pocket, a systematic review was conducted using case reports and case series available in the PubMed/Medline, Science Direct, Cochrane Central, LILACS, and Scientific Electronic Library Online (Scielo) databases. Pacemaker pocket tumors affected patients with a mean age of 72.9 years, with a higher incidence in males (76.9%, n = 10). The average time for neoplasm development was 4.4 years (54.07 months). The most prevalent model was Medtronic (38.4%, n = 5), with titanium (83.3%) being the most common metal composition. Chemotherapy was the most performed procedure among patients (38.4%), followed by radiation therapy (38.4%) and surgical tumor resection (30.7%). Six analyzed cases (46.1%) resulted in death, and four patients (30.7%) achieved a cure. Patients with pacemakers should be routinely evaluated for the occurrence of malignant tumors at the site of device implantation.
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Affiliation(s)
- Francisco Cezar Aquino de Moraes
- Oncology Research Center, University Hospital João de Barros Barreto, Belém 66073-005, PA, Brazil; (D.F.); (M.R.F.); (N.P.C.d.S.)
| | - Lucca Dal Moro
- Department of Medicine, Federal University of Pará, Belém 66075-110, PA, Brazil; (L.D.M.); (F.R.P.); (E.S.d.R.P.); (R.A.L.S.C.); (D.d.S.M.d.S.)
| | - Fernando Rocha Pessoa
- Department of Medicine, Federal University of Pará, Belém 66075-110, PA, Brazil; (L.D.M.); (F.R.P.); (E.S.d.R.P.); (R.A.L.S.C.); (D.d.S.M.d.S.)
| | - Ellen Sabrinna dos Remédios Passos
- Department of Medicine, Federal University of Pará, Belém 66075-110, PA, Brazil; (L.D.M.); (F.R.P.); (E.S.d.R.P.); (R.A.L.S.C.); (D.d.S.M.d.S.)
| | - Raul Antônio Lopes Silva Campos
- Department of Medicine, Federal University of Pará, Belém 66075-110, PA, Brazil; (L.D.M.); (F.R.P.); (E.S.d.R.P.); (R.A.L.S.C.); (D.d.S.M.d.S.)
| | - Dilma do Socorro Moraes de Souza
- Department of Medicine, Federal University of Pará, Belém 66075-110, PA, Brazil; (L.D.M.); (F.R.P.); (E.S.d.R.P.); (R.A.L.S.C.); (D.d.S.M.d.S.)
- Gaspar Vianna State Public Hospital of Clinical Foundation, Belém 66083-106, PA, Brazil
| | - Danielle Feio
- Oncology Research Center, University Hospital João de Barros Barreto, Belém 66073-005, PA, Brazil; (D.F.); (M.R.F.); (N.P.C.d.S.)
| | | | - Marianne Rodrigues Fernandes
- Oncology Research Center, University Hospital João de Barros Barreto, Belém 66073-005, PA, Brazil; (D.F.); (M.R.F.); (N.P.C.d.S.)
| | - Ney Pereira Carneiro dos Santos
- Oncology Research Center, University Hospital João de Barros Barreto, Belém 66073-005, PA, Brazil; (D.F.); (M.R.F.); (N.P.C.d.S.)
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Cobo M, Menéndez Fernández-Miranda P, Bastarrika G, Lloret Iglesias L. Enhancing radiomics and Deep Learning systems through the standardization of medical imaging workflows. Sci Data 2023; 10:732. [PMID: 37865635 PMCID: PMC10590396 DOI: 10.1038/s41597-023-02641-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 10/12/2023] [Indexed: 10/23/2023] Open
Affiliation(s)
- Miriam Cobo
- Advanced Computing and e-Science Group, Institute of Physics of Cantabria (IFCA), CSIC - UC, Santander, Spain.
| | | | - Gorka Bastarrika
- Clínica Universidad de Navarra, Department of Radiology, Pamplona, Spain
| | - Lara Lloret Iglesias
- Advanced Computing and e-Science Group, Institute of Physics of Cantabria (IFCA), CSIC - UC, Santander, Spain
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Sakafu L, Kiango V, Khasim Z, Shoo A, Ndossa M, Kagaruki G, Manyama D, Magandi J, Lee AY. Radiation safety in an era of diagnostic radiology growth in Africa: Lessons learned from Tanzania. Clin Imaging 2023; 102:65-70. [PMID: 37625349 DOI: 10.1016/j.clinimag.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/07/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
PURPOSE As radiology continues to grow in low- and middle-income countries (LMICs), radiation exposure and risk to patients and staff will concurrently increase. This study aims to assess the knowledge of radiation safety among medical staff in Tanzania. METHODS A survey was distributed to 350 staff members at a national referral hospital in Tanzania over a 7-month period (February-August 2021). This consisted of a structured questionnaire evaluating participants' knowledge and awareness ionizing radiation and radiation safety. Chi-square and Fisher's exact tests were used to determine the association between independent and dependent categorical variables. RESULTS A total of 300 surveys were completed (86% response rate). Mean age was 31 and 53% of participants were female. The majority (89%) were clinical staff employed in direct patient care. Most reported having heard of radiation protection (85%) but only 61% reported receiving training in radiation protection. Regarding radiation knowledge, 73% correctly answered how to protect oneself from radiation and 74% knew which medical staff were at greater risk of radiation exposure. However, only 32% correctly answered which imaging tests emit more radiation and only 53% correctly answered which age group was at greatest risk of radiation effects. Non-clinical staff had a significantly lower radiation awareness than clinical staff, with 69.7% reporting having heard about radiation protection, compared to 88.3% of clinical staff (p = 0.004). Female participants were more knowledgeable of radiation risks in pregnancy (p = 0.002). More early career staff reported receiving radiation protection training (64.5%) compared to those with >5 years work experience (53.9%), though this difference was not statistically significant (p = 0.09). When stratifying radiation knowledge by high (score of 80-100%), moderate (60-79.9%) and low (<60%), 20% of participants scored high, 47% moderate, and 33% low. CONCLUSION Most staff had low to moderate knowledge on radiation safety. Our findings highlight the importance of education on ionizing radiation as medical imaging continues to rise in Africa.
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Affiliation(s)
- Lulu Sakafu
- Department of Radiology, Muhimbili National Hospital-Mloganzila, Dar es Salaam, Tanzania.
| | - Violet Kiango
- Department of Radiology, Muhimbili National Hospital-Mloganzila, Dar es Salaam, Tanzania
| | - Zuwena Khasim
- Department of Radiology, Muhimbili National Hospital-Mloganzila, Dar es Salaam, Tanzania
| | - Aikankira Shoo
- Department of Radiology, Muhimbili National Hospital-Mloganzila, Dar es Salaam, Tanzania
| | - Mariam Ndossa
- Department of Radiology, Muhimbili National Hospital-Mloganzila, Dar es Salaam, Tanzania
| | - Gibson Kagaruki
- National Institute of Medical Research (NIMR), Mbeya, Tanzania
| | - Deogratius Manyama
- Department of Surgery, Muhimbili National Hospital-Mloganzila, Dar es Salaam, Tanzania
| | - Julieth Magandi
- Department of Surgery, Muhimbili National Hospital-Mloganzila, Dar es Salaam, Tanzania
| | - Amie Y Lee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, United States of America
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Wegrzyniak O, Zhang B, Rokka J, Rosestedt M, Mitran B, Cheung P, Puuvuori E, Ingvast S, Persson J, Nordström H, Löfblom J, Pontén F, Frejd FY, Korsgren O, Eriksson J, Eriksson O. Imaging of fibrogenesis in the liver by [ 18F]TZ-Z09591, an Affibody molecule targeting platelet derived growth factor receptor β. EJNMMI Radiopharm Chem 2023; 8:23. [PMID: 37733133 PMCID: PMC10513984 DOI: 10.1186/s41181-023-00210-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/04/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Platelet-derived growth factor receptor beta (PDGFRβ) is a receptor overexpressed on activated hepatic stellate cells (aHSCs). Positron emission tomography (PET) imaging of PDGFRβ could potentially allow the quantification of fibrogenesis in fibrotic livers. This study aims to evaluate a fluorine-18 radiolabeled Affibody molecule ([18F]TZ-Z09591) as a PET tracer for imaging liver fibrogenesis. RESULTS In vitro specificity studies demonstrated that the trans-Cyclooctenes (TCO) conjugated Z09591 Affibody molecule had a picomolar affinity for human PDGFRβ. Biodistribution performed on healthy rats showed rapid clearance of [18F]TZ-Z09591 through the kidneys and low liver background uptake. Autoradiography (ARG) studies on fibrotic livers from mice or humans correlated with histopathology results. Ex vivo biodistribution and ARG revealed that [18F]TZ-Z09591 binding in the liver was increased in fibrotic livers (p = 0.02) and corresponded to binding in fibrotic scars. CONCLUSIONS Our study highlights [18F]TZ-Z09591 as a specific tracer for fibrogenic cells in the fibrotic liver, thus offering the potential to assess fibrogenesis clearly.
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Affiliation(s)
- Olivia Wegrzyniak
- Science for Life Laboratory, Department of Medicinal Chemistry, Uppsala University, Dag Hammarskjölds Väg 14C, 3tr, 751 83, Uppsala, Sweden
| | - Bo Zhang
- Science for Life Laboratory, Department of Medicinal Chemistry, Uppsala University, Dag Hammarskjölds Väg 14C, 3tr, 751 83, Uppsala, Sweden
| | - Johanna Rokka
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Maria Rosestedt
- Science for Life Laboratory, Department of Medicinal Chemistry, Uppsala University, Dag Hammarskjölds Väg 14C, 3tr, 751 83, Uppsala, Sweden
| | - Bogdan Mitran
- Science for Life Laboratory, Department of Medicinal Chemistry, Uppsala University, Dag Hammarskjölds Väg 14C, 3tr, 751 83, Uppsala, Sweden
- Antaros Medical AB, Uppsala, Sweden
| | - Pierre Cheung
- Science for Life Laboratory, Department of Medicinal Chemistry, Uppsala University, Dag Hammarskjölds Väg 14C, 3tr, 751 83, Uppsala, Sweden
| | - Emmi Puuvuori
- Science for Life Laboratory, Department of Medicinal Chemistry, Uppsala University, Dag Hammarskjölds Väg 14C, 3tr, 751 83, Uppsala, Sweden
| | - Sofie Ingvast
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Jonas Persson
- Science for Life Laboratory, Department of Medicinal Chemistry, Uppsala University, Dag Hammarskjölds Väg 14C, 3tr, 751 83, Uppsala, Sweden
- Department of Protein Science, Division of Protein Engineering, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Helena Nordström
- Science for Life Laboratory, Drug Discovery and Development Platform, Department of Chemistry-BMC, Uppsala University, Uppsala, Sweden
| | - John Löfblom
- Department of Protein Science, Division of Protein Engineering, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Fredrik Pontén
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Fredrik Y Frejd
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
- Affibody AB, Solna, Sweden
| | - Olle Korsgren
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Jonas Eriksson
- Science for Life Laboratory, Department of Medicinal Chemistry, Uppsala University, Dag Hammarskjölds Väg 14C, 3tr, 751 83, Uppsala, Sweden.
- Uppsala University Hospital PET Center, Entrance 85, Dag Hammarskjölds Väg 21, 752 37, Uppsala, Sweden.
| | - Olof Eriksson
- Science for Life Laboratory, Department of Medicinal Chemistry, Uppsala University, Dag Hammarskjölds Väg 14C, 3tr, 751 83, Uppsala, Sweden.
- Antaros Medical AB, Uppsala, Sweden.
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Bragina O, Chernov V, Larkina M, Rybina A, Zelchan R, Garbukov E, Oroujeni M, Loftenius A, Orlova A, Sörensen J, Frejd FY, Tolmachev V. Phase I clinical evaluation of 99mTc-labeled Affibody molecule for imaging HER2 expression in breast cancer. Theranostics 2023; 13:4858-4871. [PMID: 37771776 PMCID: PMC10526658 DOI: 10.7150/thno.86770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/27/2023] [Indexed: 09/30/2023] Open
Abstract
The determination of tumor human epidermal growth factor receptor type 2 (HER2) status is of increasing importance with the recent approval of more efficacious HER2-targeted treatments. There is a lack of suitable methods for clinical in vivo HER2 expression assessment. Affibody molecules are small affinity proteins ideal for imaging detection of receptors, which are engineered using a small (molecular weight 6.5 kDa) nonimmunoglobulin scaffold. Labeling of Affibody molecules with positron emitters enabled the development of sensitive and specific agents for molecular imaging. The development of probes for SPECT would permit the use of Affibody-based imaging in regions where PET is not available. In this first-in-human study, we evaluated the safety, biodistribution, and dosimetry of the 99mTc-ZHER2:41071 Affibody molecule developed for SPECT/CT imaging of HER2 expression. Methods: Thirty-one patients with primary breast cancer were enrolled and divided into three cohorts (injected with 500, 1000, or 1500 µg ZHER2:41071) comprising at least five patients with high (positive) HER2 tumor expression (IHC score 3+ or 2+ and ISH positive) and five patients with low (IHC score 2+ or 1+ and ISH negative) or absent HER2 tumor expression. Patients were injected with 451 ± 71 MBq 99mTc-ZHER2:4107. Planar scintigraphy was performed after 2, 4, 6 and 24 h, and SPECT/CT imaging followed planar imaging 2, 4 and 6 h after injection. Results: Injections of 99mTc-ZHER2:41071 were well tolerated and not associated with adverse events. Normal organs with the highest accumulation were the kidney and liver. The effective dose was 0.019 ± 0.004 mSv/MBq. Injection of 1000 µg provided the best standard discrimination between HER2-positive and HER2-low or HER2-negative tumors 2 h after injection (SUVmax 16.9 ± 7.6 vs. 3.6 ± 1.4, p < 0.005). The 99mTc-ZHER2:41071 uptake in HER2-positive lymph node metastases (SUVmax 6.9 ± 2.4, n = 5) was significantly (p < 0.05) higher than that in HER2-low/negative lymph nodes (SUVmax 3.5 ± 1.2, n = 4). 99mTc-ZHER2:41071 visualized hepatic metastases in a patient with liver involvement. Conclusions: Injections of 99mTc-ZHER2:41071 appear safe and exhibit favorable dosimetry. The protein dose of 1000 µg provides the best discrimination between HER2-positive and HER2-low/negative expression of HER2 according to the definition used for current HER2-targeting drugs.
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Affiliation(s)
- Olga Bragina
- Department of Nuclear Therapy and Diagnostic, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
- Research Centrum for Oncotheranostics, Research School of Chemistry and Applied Biomedical Sciences, Tomsk Polytechnic University, Tomsk, Russia
| | - Vladimir Chernov
- Department of Nuclear Therapy and Diagnostic, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
- Research Centrum for Oncotheranostics, Research School of Chemistry and Applied Biomedical Sciences, Tomsk Polytechnic University, Tomsk, Russia
| | - Mariia Larkina
- Research Centrum for Oncotheranostics, Research School of Chemistry and Applied Biomedical Sciences, Tomsk Polytechnic University, Tomsk, Russia
- Department of Pharmaceutical Analysis, Siberian State Medical University, 634050 Tomsk, Russia
| | - Anstasiya Rybina
- Department of Nuclear Therapy and Diagnostic, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Roman Zelchan
- Department of Nuclear Therapy and Diagnostic, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
- Research Centrum for Oncotheranostics, Research School of Chemistry and Applied Biomedical Sciences, Tomsk Polytechnic University, Tomsk, Russia
| | - Eugeniy Garbukov
- Department of Nuclear Therapy and Diagnostic, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Maryam Oroujeni
- Department of Immunology, Genetics and Pathology, Uppsala University, 752 37 Uppsala, Sweden
- Affibody AB, Solna, Sweden
| | | | - Anna Orlova
- Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden
| | - Jens Sörensen
- Radiology and Nuclear Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Fredrik Y. Frejd
- Department of Immunology, Genetics and Pathology, Uppsala University, 752 37 Uppsala, Sweden
- Affibody AB, Solna, Sweden
| | - Vladimir Tolmachev
- Department of Immunology, Genetics and Pathology, Uppsala University, 752 37 Uppsala, Sweden
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49
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Wilson BE, Sullivan R, Peto R, Abubakar B, Booth C, Werutsky G, Adams C, Saint-Raymond A, Fleming TR, Lyerly K, Gralow JR. Global Cancer Drug Development-A Report From the 2022 Accelerating Anticancer Agent Development and Validation Meeting. JCO Glob Oncol 2023; 9:e2300294. [PMID: 37944089 PMCID: PMC10645408 DOI: 10.1200/go.23.00294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/18/2023] [Indexed: 11/12/2023] Open
Abstract
Rapidly expanding systemic treatment options, combined with improved screening, diagnostic, surgical, and radiotherapy techniques, have led to improved survival outcomes for many cancers over time. However, these overall survival gains have disproportionately benefited patients in high-income countries, whereas patients in low- and middle-income countries (LMICs) continue to experience challenges in accessing timely and guideline concordant care. In September 2022, the Accelerating Anticancer Agent Development and Validation workshop was held, focusing on global cancer drug development. Panelists discussed key barriers such as the lack of diagnostic services and human resources, drug accessibility and affordability, lack of research infrastructure, and regulatory and authorization challenges, with a particular focus on Africa and Latin America. Potential opportunities to improve access and affordability were reviewed, such as the importance of prioritizing investments in diagnostics, investing health infrastructure and work force planning, coordinated drug procurement efforts and streamlined regulatory processing, incentivized pricing through regulatory change, and the importance of developing and promoting clinical trials that can answer relevant clinical questions for patients in LMICs. As a cancer community, we must continue to advocate for and work toward equitable access to high-quality interventions for patients, regardless of their geographical location.
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Affiliation(s)
- Brooke E. Wilson
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Canada
- Department of Oncology, Queen's University, Kingston, Canada
| | - Richard Sullivan
- Institute of Cancer Policy, King's College London, London, United Kingdom
- Department of Oncology, Guy's & St Thomas' NHS Trust, London, United Kingdom
| | - Richard Peto
- Department of Medical Statistics and Epidemiology, University of Oxford, Oxford, United Kingdom
| | - Bello Abubakar
- Department of Radiotherapy and Oncology, National Hospital Abuja, Abuja, Nigeria
| | - Christopher Booth
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Canada
- Department of Oncology, Queen's University, Kingston, Canada
| | - Gustavo Werutsky
- Department of Medical Oncology, Hospital São Lucas, Porto Alegre, Brazil
| | - Cary Adams
- Union for International Cancer Control, Geneva, Switzerland
| | - Agnes Saint-Raymond
- International Affairs Division, European Medicines Agency, Amsterdam, the Netherlands
| | | | - Kim Lyerly
- Departments of Surgery, Pathology, and Immunology, Duke University School of Medicine, Durham, NC
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50
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Alves N, Bosma JS, Venkadesh KV, Jacobs C, Saghir Z, de Rooij M, Hermans J, Huisman H. Prediction Variability to Identify Reduced AI Performance in Cancer Diagnosis at MRI and CT. Radiology 2023; 308:e230275. [PMID: 37724961 DOI: 10.1148/radiol.230275] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Background A priori identification of patients at risk of artificial intelligence (AI) failure in diagnosing cancer would contribute to the safer clinical integration of diagnostic algorithms. Purpose To evaluate AI prediction variability as an uncertainty quantification (UQ) metric for identifying cases at risk of AI failure in diagnosing cancer at MRI and CT across different cancer types, data sets, and algorithms. Materials and Methods Multicenter data sets and publicly available AI algorithms from three previous studies that evaluated detection of pancreatic cancer on contrast-enhanced CT images, detection of prostate cancer on MRI scans, and prediction of pulmonary nodule malignancy on low-dose CT images were analyzed retrospectively. Each task's algorithm was extended to generate an uncertainty score based on ensemble prediction variability. AI accuracy percentage and partial area under the receiver operating characteristic curve (pAUC) were compared between certain and uncertain patient groups in a range of percentile thresholds (10%-90%) for the uncertainty score using permutation tests for statistical significance. The pulmonary nodule malignancy prediction algorithm was compared with 11 clinical readers for the certain group (CG) and uncertain group (UG). Results In total, 18 022 images were used for training and 838 images were used for testing. AI diagnostic accuracy was higher for the cases in the CG across all tasks (P < .001). At an 80% threshold of certain predictions, accuracy in the CG was 21%-29% higher than in the UG and 4%-6% higher than in the overall test data sets. The lesion-level pAUC in the CG was 0.25-0.39 higher than in the UG and 0.05-0.08 higher than in the overall test data sets (P < .001). For pulmonary nodule malignancy prediction, accuracy of AI was on par with clinicians for cases in the CG (AI results vs clinician results, 80% [95% CI: 76, 85] vs 78% [95% CI: 70, 87]; P = .07) but worse for cases in the UG (AI results vs clinician results, 50% [95% CI: 37, 64] vs 68% [95% CI: 60, 76]; P < .001). Conclusion An AI-prediction UQ metric consistently identified reduced performance of AI in cancer diagnosis. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Babyn in this issue.
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Affiliation(s)
- Natália Alves
- From the Department of Medical Imaging, Radboudumc, Route 767, Room 2.30, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands (N.A., J.S.B., K.V.V., C.J., M.d.R., J.H., H.H.); Department of Medicine, Section of Pulmonary Medicine, Herlev-Gentofte Hospital, Herlev, Denmark (Z.S.); and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Z.S.)
| | - Joeran S Bosma
- From the Department of Medical Imaging, Radboudumc, Route 767, Room 2.30, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands (N.A., J.S.B., K.V.V., C.J., M.d.R., J.H., H.H.); Department of Medicine, Section of Pulmonary Medicine, Herlev-Gentofte Hospital, Herlev, Denmark (Z.S.); and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Z.S.)
| | - Kiran V Venkadesh
- From the Department of Medical Imaging, Radboudumc, Route 767, Room 2.30, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands (N.A., J.S.B., K.V.V., C.J., M.d.R., J.H., H.H.); Department of Medicine, Section of Pulmonary Medicine, Herlev-Gentofte Hospital, Herlev, Denmark (Z.S.); and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Z.S.)
| | - Colin Jacobs
- From the Department of Medical Imaging, Radboudumc, Route 767, Room 2.30, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands (N.A., J.S.B., K.V.V., C.J., M.d.R., J.H., H.H.); Department of Medicine, Section of Pulmonary Medicine, Herlev-Gentofte Hospital, Herlev, Denmark (Z.S.); and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Z.S.)
| | - Zaigham Saghir
- From the Department of Medical Imaging, Radboudumc, Route 767, Room 2.30, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands (N.A., J.S.B., K.V.V., C.J., M.d.R., J.H., H.H.); Department of Medicine, Section of Pulmonary Medicine, Herlev-Gentofte Hospital, Herlev, Denmark (Z.S.); and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Z.S.)
| | - Maarten de Rooij
- From the Department of Medical Imaging, Radboudumc, Route 767, Room 2.30, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands (N.A., J.S.B., K.V.V., C.J., M.d.R., J.H., H.H.); Department of Medicine, Section of Pulmonary Medicine, Herlev-Gentofte Hospital, Herlev, Denmark (Z.S.); and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Z.S.)
| | - John Hermans
- From the Department of Medical Imaging, Radboudumc, Route 767, Room 2.30, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands (N.A., J.S.B., K.V.V., C.J., M.d.R., J.H., H.H.); Department of Medicine, Section of Pulmonary Medicine, Herlev-Gentofte Hospital, Herlev, Denmark (Z.S.); and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Z.S.)
| | - Henkjan Huisman
- From the Department of Medical Imaging, Radboudumc, Route 767, Room 2.30, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands (N.A., J.S.B., K.V.V., C.J., M.d.R., J.H., H.H.); Department of Medicine, Section of Pulmonary Medicine, Herlev-Gentofte Hospital, Herlev, Denmark (Z.S.); and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Z.S.)
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