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Farrell R, Zaunders J, Poynten IM, Anderson L, Evans L. Concurrent nonavalent human papillomavirus (HPV) vaccination and immune stimulation with imiquimod to treat recalcitrant HPV-associated high grade vaginal intra-epithelial neoplasia. Gynecol Oncol Rep 2024; 52:101350. [PMID: 38445009 PMCID: PMC10912037 DOI: 10.1016/j.gore.2024.101350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 02/13/2024] [Accepted: 02/20/2024] [Indexed: 03/07/2024] Open
Abstract
This is the first report describing detailed T cell responses to viral-like proteins contained in an HPV specific vaccine given in combination with Imiquimod for treatment of persistent VAIN2/3. We postulate that stimulation of the innate immune system with Imiquimod and the specific CD4 and CD8T cell responses following HPV vaccination with Gardasil9@ combined to induce clinical remission in a woman with treatment-refractory disease.
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Affiliation(s)
- R. Farrell
- Chris O'Brien Lifehouse Hospital, Camperdown, Sydney, New South Wales 2050, Australia
- Sydney Medical School, University of Sydney, New South Wales 2006, Australia
| | - J. Zaunders
- NSW State Reference Labaoratory for HIV, Centre for Applied Medical Research, St Vincents Hospital, New South Wales, Australia
- HIV Epidemiology and Prevention Program, The Kirby Institute, University of NSW Kensington, Sydney, New South Wales 2052, Australia
| | - IM. Poynten
- HIV Epidemiology and Prevention Program, The Kirby Institute, University of NSW Kensington, Sydney, New South Wales 2052, Australia
| | - L. Anderson
- Sydney Medical School, University of Sydney, New South Wales 2006, Australia
- NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, Sydney, New South Wales 2050, Australia
| | - L. Evans
- University of NSW Kensington, Sydney, New South Wales 2052, Australia
- Department of Clinical Immunology, Allergy and HIV, Liverpool Hospital, South Western Sydney Local Health District, Liverpool Sydney, New South Wales 2170, Australia
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Veldkamp R, D'hooge M, Sandroff BM, DeLuca J, Kos D, Salter A, Feinstein A, Amato MP, Brichetto G, Chataway J, Farrell R, Chiaravalloti ND, Dalgas U, Filippi M, Freeman J, Motl RW, Meza C, Inglese M, Rocca MA, Cutter G, Feys P. Profiling cognitive-motor interference in a large sample of persons with progressive multiple sclerosis and impaired processing speed: results from the CogEx study. J Neurol 2023; 270:3120-3128. [PMID: 36881147 DOI: 10.1007/s00415-023-11636-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/15/2023] [Accepted: 02/19/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Performing cognitive-motor dual tasks (DTs) may result in reduced walking speed and cognitive performance. The effect in persons with progressive multiple sclerosis (pwPMS) having cognitive dysfunction is unknown. OBJECTIVE To profile DT-performance during walking in cognitively impaired pwPMS and examine DT-performance by disability level. METHODS Secondary analyses were conducted on baseline data from the CogEx-study. Participants, enrolled with Symbol Digit Modalities Test 1.282 standard deviations below normative value, performed a cognitive single task ([ST], alternating alphabet), motor ST (walking) and DT (both). Outcomes were number of correct answers on the alternating alphabet task, walking speed, and DT-cost (DTC: decline in performance relative to the ST). Outcomes were compared between EDSS subgroups (≤ 4, 4.5-5.5, ≥ 6). Spearman correlations were conducted between the DTCmotor with clinical measures. Adjusted significance level was 0.01. RESULTS Overall, participants (n = 307) walked slower and had fewer correct answers on the DT versus ST (both p < 0.001), with a DTCmotor of 15.8% and DTCcognitive of 2.7%. All three subgroups walked slower during the DT versus ST, with DTCmotor different from zero (p's < 0.001). Only the EDSS ≥ 6 group had fewer correct answers on the DT versus ST (p < 0.001), but the DTCcognitive did not differ from zero for any of the groups (p ≥ 0.039). CONCLUSION Dual tasking substantially affects walking performance in cognitively impaired pwPMS, to a similar degree for EDSS subgroups.
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Affiliation(s)
- R Veldkamp
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.
- UMSC, Hasselt-Pelt, Belgium.
| | - M D'hooge
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- UMSC, Hasselt-Pelt, Belgium
- National MS Center Melsbroek, Steenokkerzeel, Belgium
| | - B M Sandroff
- Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - J DeLuca
- Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - D Kos
- National MS Center Melsbroek, Steenokkerzeel, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - A Salter
- Department of Neurology, Section on Statistical Planning and Analysis, UT Southwestern Medical Center, Dallas, TX, USA
| | - A Feinstein
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, M5R 3B6, Canada
| | - M P Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - G Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Via Operai 40, 16149, Genoa, Italy
- AISM Rehabilitation Service, Italian Multiple Sclerosis Society (AISM), Via Operai 30, 16149, Genoa, Italy
| | - J Chataway
- Queen Square MS Centre, Department of Neuroinflammation, University College London (UCL) Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, UK
| | - R Farrell
- Queen Square MS Centre, Department of Neuroinflammation, University College London (UCL) Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, UK
| | - N D Chiaravalloti
- Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - U Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, 8000, Aarhus, Denmark
| | - M Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Neurology Unit, IRCCS, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - J Freeman
- School of Health Professions, Faculty of Health, University of Plymouth, Devon, UK
| | - R W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
| | - C Meza
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, M5R 3B6, Canada
| | - M Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - M A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Neurology Unit, IRCCS, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - G Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, USA
| | - P Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- UMSC, Hasselt-Pelt, Belgium
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3
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Farrell R, Liauw WS, Morris DL. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for ovarian cancer in an Australian institution: lessons from 20 years' experience. BMC Surg 2022; 22:338. [PMID: 36096791 PMCID: PMC9469563 DOI: 10.1186/s12893-022-01786-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/31/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives We report the 20-year experience of the largest Australian unit performing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for ovarian cancer and reflect on learning opportunities. Methods A retrospective review of all cases of CRS for ovarian cancer at St George Peritonectomy Unit from Jan 1998 to Jan 2018 was performed. Prospectively collected data include age, stage, histology, disease extent (PCI), completeness of cytoreduction (CC score), HIPEC regime, 30-day surgical morbidity, disease recurrence, and death. Survival was computed using Kaplan–Meier method and analysed using log-rank tests and Cox-proportional hazards models. Results Forty-one women with advanced ovarian cancer (11 primary stage III/IV, 30 recurrent) underwent CRS, 29 (71%) with HIPEC. Most (68%) had high-volume disease (PCI > 15). In 98%, CC0/CC1 (residual < 2.5 mm) was achieved. Fourteen (34%) had grade 3/4 complications, 1 patient (2%) died within 30 days and 2 patients (5%) died within 90 days. Progression-free and median overall survival was 30.0 and 67.0 months for primary cancer, and 6.7 and 18.1 months for recurrent cancer. Survival was associated with platinum-sensitivity, PCI ≤ 15, and CC score 0, but not HIPEC. Conclusion This study reports outcomes for patients with advanced ovarian cancer patients treated in an Australian centre offering CRS and HIPEC. Whilst survival and morbidity outcomes were good for primary disease, they were poorer than predicted from the literature for cases of recurrent disease. The incorporation of evidence-based predictors of survival and multidisciplinary input are essential to achieve the best survival outcomes.
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Affiliation(s)
- R Farrell
- Chris O'Brien Lifehouse Hospital, Camperdown, Sydney, NSW, 2050, Australia. .,The University of Sydney, Sydney, NSW, 2006, Australia. .,Department of Surgery, UNSW, Sydney, NSW, 2033, Australia. .,Prince of Wales Private Hospital, Suite 30, Level 7, Randwick Sydney, 2031, Australia.
| | - W S Liauw
- Department of Surgery, UNSW, Sydney, NSW, 2033, Australia.,Cancer Care Centre, St George Hospital, Kogarah, NSW, 2217, Australia
| | - D L Morris
- Department of Surgery, UNSW, Sydney, NSW, 2033, Australia.,Cancer Care Centre, St George Hospital, Kogarah, NSW, 2217, Australia
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Farrell R, Colglazier E, Parker C, Stevens L, Austin ED, Fineman JR. Case Report: Caveolin‐1 Associated with Severe (Pediatric‐onset) Presentation of Pulmonary Arterial Hypertension. Pulm Circ 2022; 12:e12100. [PMID: 35864912 PMCID: PMC9294289 DOI: 10.1002/pul2.12100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 11/10/2022] Open
Abstract
There has been a growing interest in the role that genetic factors influence pediatric pulmonary vascular disease. In fact, data suggests that genetic factors contribute to ~42% of pediatric‐onset pulmonary hypertension. Although animal and human studies suggest that aberrations in Caveolin1 (CAV1) signaling participate in the development of pulmonary vascular disorders, limited reports of CAV1‐associated heritable pulmonary arterial hypertension (HPAH) exist. This is a case report of a 2‐year‐old female with late recognition of HPAH due to a CAV1 pathogenic variant: c.474del, (p.Leu159Serfs*22)(NM_001753.5). The pedigree demonstrates autosomal dominant transmission with reduced penetrance of PAH, suggestive that additional genetic or environmental factors modify PAH development. Genetic testing and the discovery of rare genetic alterations in PAH during infancy and childhood may aid in identifying disease etiologies, guide therapeutic decisions, and ultimately identify novel therapeutic targets. Moreover, CAV1 genetics implicate variable expressivity and incomplete penetrance for HPAH and underscores the utility of predictive genetic testing for unaffected family members no matter their age.
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Affiliation(s)
- R Farrell
- Department of Pediatrics UCSF Benioff Children's Hospital, San Francisco California
| | - E Colglazier
- Department of Pediatrics UCSF Benioff Children's Hospital, San Francisco California
| | - C Parker
- Department of Pediatrics UCSF Benioff Children's Hospital, San Francisco California
| | - L Stevens
- Department of Pediatrics UCSF Benioff Children's Hospital, San Francisco California
| | - ED Austin
- Department of Pediatrics Vanderbilt University Medical Center
| | - JR Fineman
- Department of Pediatrics UCSF Benioff Children's Hospital, San Francisco California
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5
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Farrell R, Summers M, Doogan C, Mulhert N, Keenan E, Buchanan K, Lee H, Padilla H, Stevenson VL. Evaluation of the cognitive benefits of intrathecal baclofen pump implantation in people with intractable multiple sclerosis related spasticity. Mult Scler Relat Disord 2021; 50:102831. [PMID: 33618123 DOI: 10.1016/j.msard.2021.102831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Spasticity is a common problematic symptom in Multiple Sclerosis with over one third of patients failing first line therapies. Intrathecal baclofen is a safe and efficacious option for treatment resistant spasticity. Anecdotally patients report improved concentration/cognitive performance when switching to intrathecal baclofen (ITB) from systemic medications. AIM To explore whether subjects who proceed with ITB pump implantation for spasticity management and reduce oral anti-spasticity agents will have improved cognitive function. METHODS Subjects were admitted for trial of ITB via lumbar puncture and subsequent pump implantation. Spasticity and cognitive measures before ITB trial and 3 months post implant were recorded. Paired t-test or Wilcoxon Signed Ranks test was used for within subject change and effect sizes (Cohen's dz) were calculated. Subgroup analysis of those on ≥2, or ≤ 1 spasticity medications at baseline was performed. RESULTS 27 subjects with MS completed per protocol. Mean age 46 years [26 - 56], disease duration 15 years [6 - 26], RRMS = 3, SPMS = 17 and PPMS=7. The majority were on multiple spasticity medications. Spasticity scores significantly improved post pump implant. Mean ITB dose at 3 months was 143 mcg / day and 19 discontinued all other treatments for spasticity. There was no deterioration on any cognitive or mood measure. An improvement of moderate effect size was found in Backwards Digit Span (d=0.41, p=0.059) and HADS - anxiety (d=0.37, p=0.097). Fatigue Severity Scale score decreased substantially (d=0.81, p=0.005). Small improvements in Symbol Digit Modalities Test score (d=0.24) and Sustained Attention to Response Task response time (d=0.23) were non-significant. Performance on other measures did not change. Effect sizes were larger in subgroup on ≥2 oral spasticity medications at baseline, compared to the group on ≤1 medication (SDMT, d=0.42 vs d=0.07; Backwards digit span 0.45 vs 0.28; HADS-anxiety 0.39 vs 0.32; HADS-depression d=0.32 vs 0.05 and FSS, d= 1.14 vs 0.42). CONCLUSIONS In a pilot study exploring the impact of ITB on cognition, spasticity scores improved universally and beneficial effects on some measures of fatigue, anxiety, auditory attention and verbal working memory were found. Improvement of speed of processing in those withdrawing higher doses of oral medication was also demonstrated suggesting that switching to ITB has added cognitive and psychological benefits for people with MS.
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Affiliation(s)
- R Farrell
- Department of Rehabilitation, The National Hospital for Neurology & Neurosurgery, University College London Hospitals (UCLH), London; Department of Neuroinflammation, Queen Square, Institute of Neurology, University College London; NIHR University College London Hospitals, Biomedical Research Centre.
| | - M Summers
- Department of Clinical Neuropsychology, National Hospital for Neurology & Neurosurgery, London, United Kingdom
| | - C Doogan
- Department of Rehabilitation, The National Hospital for Neurology & Neurosurgery, University College London Hospitals (UCLH), London
| | - N Mulhert
- Division of Neuroscience and Experimental Psychology, University of Manchester, United Kingdom
| | - E Keenan
- Department of Rehabilitation, The National Hospital for Neurology & Neurosurgery, University College London Hospitals (UCLH), London
| | - K Buchanan
- Department of Rehabilitation, The National Hospital for Neurology & Neurosurgery, University College London Hospitals (UCLH), London
| | - H Lee
- Department of Rehabilitation, The National Hospital for Neurology & Neurosurgery, University College London Hospitals (UCLH), London
| | - H Padilla
- Department of Rehabilitation, The National Hospital for Neurology & Neurosurgery, University College London Hospitals (UCLH), London
| | - V L Stevenson
- Department of Rehabilitation, The National Hospital for Neurology & Neurosurgery, University College London Hospitals (UCLH), London
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Brant A, Batur P, Arrigain S, Lopez R, Farrell R. P55 Demographic and social factors associated with out-of-pocket expenditures for contraceptive prescriptions in the US during medicaid expansion. Contraception 2020. [DOI: 10.1016/j.contraception.2020.07.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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7
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Judge C, McGettigan N, Ryan T, Hazel K, Singh P, Parihar V, Stack R, O'Connor A, Dunne C, Cullen G, Egan L, Harewood G, MacCarthy F, McKiernan S, Mulcahy H, Murray F, Patchett S, Sheridan J, Cheriyan D, Farrell R, Keohane J, Kelly O, McNamara D, Ryan B, O'Morain C, Sengupta S, O'Toole A, Buckley M, McCarthy J, Doherty G, Kevans D, Slattery E. Irish data on the safety and efficacy of vedolizumab in the treatment of inflammatory bowel disease. Scand J Gastroenterol 2020; 55:786-794. [PMID: 32544012 DOI: 10.1080/00365521.2020.1779340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This study reviews the safety and efficacy of treatment with vedolizumab for patients with inflammatory bowel disease across 9 Irish hospitals. It generates valuable and timely real-world data on treatment outcomes to add to the existing evidence base. Our population represents a refractory cohort with most patients previously exposed to at least one anti-TNFa agent and expressing an inflammatory phenotype. Results are reassuringly similar to larger international studies with additional insights into potential predictors of treatment response. This study further supports the safety and efficacy of vedolizumab in the treatment of inflammatory bowel disease. Key SummaryVedolizumab has growing real world data on its safety and efficacy in the treatment of IBD. Data on predictors of response are lacking. Studies such as VARSITY require new real-world data to help identify the place VDZ will occupy in the treatment algorithm for IBDThis study provides national Irish data on the safety and efficacy of VDZ in the treatment of IBD. It gives insight into various predictors of response for both UC and CD. It strengthens the available body of evidence on the use of VDZ and helps us determine its position on the treatment algorithm.
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Affiliation(s)
- Ciaran Judge
- Department of Gastroenterology, St James' Hospital, Dublin, Ireland.,INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland
| | - Neasa McGettigan
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Galway University Hospital, Galway, Ireland
| | - Timothy Ryan
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology and Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Karl Hazel
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Connolly Hospital Blanchardstown, Dublin, Ireland
| | - Pamla Singh
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - Vikrant Parihar
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - Roisin Stack
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Beaumont Hospital, Dublin, Ireland
| | - Anthony O'Connor
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
| | - Cara Dunne
- Department of Gastroenterology, St James' Hospital, Dublin, Ireland.,INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland
| | - Garret Cullen
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology and Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Laurence Egan
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Galway University Hospital, Galway, Ireland
| | - Gavin Harewood
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Beaumont Hospital, Dublin, Ireland
| | - Finbar MacCarthy
- Department of Gastroenterology, St James' Hospital, Dublin, Ireland.,INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland
| | - Susan McKiernan
- Department of Gastroenterology, St James' Hospital, Dublin, Ireland.,INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland
| | - Hugh Mulcahy
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology and Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Frank Murray
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Beaumont Hospital, Dublin, Ireland
| | - Stephen Patchett
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Beaumont Hospital, Dublin, Ireland
| | - Juliette Sheridan
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology and Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Danny Cheriyan
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Beaumont Hospital, Dublin, Ireland
| | - Richard Farrell
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Connolly Hospital Blanchardstown, Dublin, Ireland
| | - John Keohane
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - Orlaith Kelly
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Connolly Hospital Blanchardstown, Dublin, Ireland
| | - Deirdre McNamara
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
| | - Barbara Ryan
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
| | - Colm O'Morain
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Beacon Hospital, Dublin, Ireland
| | - Subhasish Sengupta
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - Aoibhlinn O'Toole
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Beaumont Hospital, Dublin, Ireland
| | - Martin Buckley
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Mercy University Hospital, Cork, Ireland
| | - Jane McCarthy
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Mercy University Hospital, Cork, Ireland
| | - Glen Doherty
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology and Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - David Kevans
- Department of Gastroenterology, St James' Hospital, Dublin, Ireland.,INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland
| | - Eoin Slattery
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Galway University Hospital, Galway, Ireland
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Castro PD, Harkin G, Hussey M, Christopher B, Kiat C, Chin JL, Trimble V, McNamara D, MacMathuna P, Egan B, Ryan B, Kevans D, Abuzakouk M, Farrell R, Feighery C, Byrnes V, Mahmud N, McManus R. Prevalence of coexisting autoimmune thyroidal diseases in coeliac disease is decreasing. United European Gastroenterol J 2020; 8:148-156. [PMID: 32213077 DOI: 10.1177/2050640619899225] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Coeliac disease (CD) is associated with an increased risk of other immune-mediated conditions. Aim: To investigate the prevalence of coexistent immune-mediated diseases in CD patients, and changes in the prevalence of autoimmune thyroidal diseases over the last 50 years. METHODS Medical record data were collected retrospectively from 749 CD patients in Ireland. Prevalence of autoimmune diseases was compared with previously published results from general populations. Patients were divided into four groups based on the year of diagnosis to analyse changes in the prevalence of autoimmune thyroidal disease over time. RESULTS Median age at the time of CD diagnosis was 56 years (range 18-91 years). A total of 233 (31.1%) patients had a coexistent immune-mediated condition (IMC). Autoimmune thyroidal diseases were seen in 149 (19.9%) patients, hypothyroidism in 110 (14.7%), type 1 diabetes in 27 (3.6%), psoriasis in 20 (2.7%), inflammatory bowel disease in 14 (1.9%) and rheumatoid arthritis in 12 (1.6%). All conditions were more common in CD patients than in the general population. Type 1 diabetes was diagnosed mainly before CD, whereas there was no such trend in other conditions. Autoimmune thyroidal diseases became less common in female CD patients over time. CONCLUSIONS Prevalence of autoimmune diseases is increased in adult CD patients compared with the general population. However, concomitant autoimmune thyroidal diseases became less common over time in women.
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Affiliation(s)
- Patricia Dominguez Castro
- Trinity Translational Medicine Institute and Department of Clinical Medicine, Trinity Centre for Health Science, St James's Hospital, Dublin, Ireland
| | - Grace Harkin
- Department of Clinical Medicine, University College Hospital Galway, Ireland
| | - Mary Hussey
- Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
| | | | - Clifford Kiat
- Department of Clinical Medicine, University College Hospital Galway, Ireland
| | - Jun Liong Chin
- Trinity Translational Medicine Institute and Department of Clinical Medicine, Trinity Centre for Health Science, St James's Hospital, Dublin, Ireland
| | - Valerie Trimble
- Trinity Translational Medicine Institute and Department of Clinical Medicine, Trinity Centre for Health Science, St James's Hospital, Dublin, Ireland
| | - Deirdre McNamara
- Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
| | - Padraic MacMathuna
- Gastrointestinal Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Brian Egan
- Department of Clinical Medicine, Mayo General Hospital, Castlebar, Ireland
| | - Barbara Ryan
- Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
| | - David Kevans
- Trinity Translational Medicine Institute and Department of Clinical Medicine, Trinity Centre for Health Science, St James's Hospital, Dublin, Ireland
| | | | | | - Con Feighery
- Departments of Immunology and Histopathology, St James's Hospital and Trinity College Dublin, Ireland
| | - Valerie Byrnes
- Department of Clinical Medicine, University College Hospital Galway, Ireland
| | - Nasir Mahmud
- Trinity Translational Medicine Institute and Department of Clinical Medicine, Trinity Centre for Health Science, St James's Hospital, Dublin, Ireland
| | - Ross McManus
- Trinity Translational Medicine Institute and Department of Clinical Medicine, Trinity Centre for Health Science, St James's Hospital, Dublin, Ireland
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Farrell R, Jain S, Shiels P, Workman G, Crowther K, Mitchell D. EP-2155 Optimising HDR Prostate Implant, Planning and delivery. A new centre experience. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32575-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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Donnelly A, Balaratnam M, Murphy M, Bahadur S, Padilla H, Keenan E, Farrell R, Stevenson V. WP1-12 Reducing infection rates in an intrathecal baclofen service; closing the audit cycle. J Neurol Neurosurg Psychiatry 2019. [DOI: 10.1136/jnnp-2019-abn.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
ObjectivesIntrathecal baclofen (ITB) is a recognised treatment strategy for the management of spasticity. We have 30 years of experience, and 160 patients currently receiving treatment.DesignAn audit (Jan 13 – Jul 15) demonstrated complication rates of 4.4% (infection) and 4.92% (catheter). After this we recommended 1 vancomycin wash of the pump pocket, 2 occlusive dressing of pressure sores, 3 timely MRSA pre-screening, and this was introduced June-August 2016. We present a re-audit of the service.SubjectsAll patients admitted for ITB pump surgery between June 2016 and June 2018.MethodsThe database of patients was used, from which the patient notes were reviewed with information relating to each surgical procedure recorded.ResultsThere were 92 surgical procedures and 78 patients (M 30, F 48). 12 patients had complications, requiring 18 surgical procedures. Out of 18 surgical procedures, 10 were catheter- and 7 pump-related). Our infection rate was lower at 1% of all surgeries (compared with 4.4%), or 0.6% of all ITB pump patients per year (compared with 3.4%), and our catheter complication rate was 6.25% of all patients per year. Our annual incidence rate of all complications was 5.6% in both groups.ConclusionsThe infection risk is lower and complication rate remains stable. We will discuss factors which may influence the risk of complication, and consider recommendations for the future.
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Barr M, Farrell R, Singh S, Foley E, He Y, Brady L, Young V, Ryan R, Nicholson S, Leonard N, Cuffe S, Finn S. MA06.09 XRCC6BP1: A DNA Repair Gene in Cisplatin Resistant Lung Cancer Stem Cells That May Predict Survival Outcomes in Patients. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Fitzgerald S, O'Reilly JA, Wilson E, Joyce A, Farrell R, Kenny D, Kay EW, Fitzgerald J, Byrne B, Kijanka GS, O'Kennedy R. Measurement of the IgM and IgG Autoantibody Immune Responses in Human Serum has High Predictive Value for the Presence of Colorectal Cancer. Clin Colorectal Cancer 2018; 18:e53-e60. [PMID: 30366678 DOI: 10.1016/j.clcc.2018.09.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/10/2018] [Accepted: 09/22/2018] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Colorectal cancer is a major public health issue, with incidences continuing to rise owing to the growing and aging world population. Current screening strategies for colorectal cancer diagnosis suffer from various limitations, including invasiveness and poor uptake. Consequently, there is an unmet clinical need for a minimally invasive, sensitive, and specific method for detecting the presence of colorectal cancer and pre-malignant lesions. PATIENTS AND METHODS An indirect enzyme-linked immunosorbent assay was used to measure the primary (IgM) and secondary (IgG) adaptive humoral immune responses to a panel of previously identified cancer antigens in the sera of normal and adenoma samples, and sera from patients with colorectal cancer. RESULTS An optimal panel of 7 biomarkers capable of identifying patients with colorectal cancer as distinct from both normal and adenoma samples is identified. The cumulative sensitivity and specificity of the assay are 70.8% and 86.5%, respectively. The positive and negative predictive values of the cohort are 77.3% and 82.1%. This assay was not able to accurately discriminate between normal and adenoma samples. Patients whose serum was positive for the presence of anti-ICLN IgM autoantibodies had a significantly poorer 5-year survival than patients whose serum was negative (P = .004). CONCLUSION This study describes a novel minimally invasive enzyme-linked immunosorbent assay-based method, capable of identifying patients with colorectal cancer as distinct from both normal and adenoma samples. Patients are likely to be far more amenable to a blood-based test such as the one described herein, rather than a fecal-based test, likely leading to increased patient uptake.
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Affiliation(s)
- Seán Fitzgerald
- Biomedical Diagnostics Institute, Dublin City University, Dublin, Ireland; CÚRAM-Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Julie-Ann O'Reilly
- Biomedical Diagnostics Institute, Dublin City University, Dublin, Ireland; Applied Biochemistry Group, School of Biotechnology, Dublin City University, Dublin, Ireland
| | - Erin Wilson
- Biomedical Diagnostics Institute, Dublin City University, Dublin, Ireland
| | - Ann Joyce
- Department of Gastroenterology, Connolly Hospital, Dublin, Ireland
| | - Richard Farrell
- Department of Gastroenterology, Connolly Hospital, Dublin, Ireland
| | - Dermot Kenny
- Biomedical Diagnostics Institute, Dublin City University, Dublin, Ireland; The Irish Centre for Vascular Biology, The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Elaine Williamson Kay
- Biomedical Diagnostics Institute, Dublin City University, Dublin, Ireland; Department of Pathology, Royal College of Surgeons in Ireland and Beaumont Hospital, Dublin 9, Ireland
| | - Jenny Fitzgerald
- Applied Biochemistry Group, School of Biotechnology, Dublin City University, Dublin, Ireland
| | - Barry Byrne
- Biomedical Diagnostics Institute, Dublin City University, Dublin, Ireland
| | - Gregor Stefan Kijanka
- Translational Research Institute, Immune Profiling and Cancer Group, Mater Research Institute - The University of Queensland, Woolloongabba, Queensland, Australia
| | - Richard O'Kennedy
- Applied Biochemistry Group, School of Biotechnology, Dublin City University, Dublin, Ireland; Research Complex, Hamad Bin Khalifa University, Education City, Doha, Qatar.
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Barr M, Singh S, Farrell R, Foley E, He Y, Nicholson S, Leonard N, Brady L, Cuffe S, Finn S. PO-510 XRCC6BP1: a novel role in the DNA repair of platinum resistant NSCLC cells. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.1011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Baird V, Drake A, Corrigan K, Clarke J, McGivern U, Byrne M, Workman G, Farrell R. Image guided high dose rate brachytherapy in cervical cancer. Clin Oncol (R Coll Radiol) 2017. [DOI: 10.1016/j.clon.2017.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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15
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Dominguez Castro P, Harkin G, Hussey M, Christopher B, Kiat C, Liong Chin J, Trimble V, McNamara D, MacMathuna P, Egan B, Ryan B, Kevans D, Farrell R, Byrnes V, Mahmud N, McManus R. Changes in Presentation of Celiac Disease in Ireland From the 1960s to 2015. Clin Gastroenterol Hepatol 2017; 15:864-871.e3. [PMID: 28043932 DOI: 10.1016/j.cgh.2016.11.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 11/08/2016] [Accepted: 11/13/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Celiac disease is an immune-mediated enteropathy characterized with high heterogeneity in presentation among genetically predisposed individuals. In recent years, a change in the phenotypic presentation of celiac disease has been reported. We studied clinical presentation, from 1960 through 2015, in Ireland, which has a high incidence of celiac disease. METHODS We performed a retrospective analysis of medical charts from patients diagnosed with celiac disease at 5 secondary referral centers in Ireland from 1960 through 2015 (n = 749; median age, 56 years; age range, 18-91 years). The cohort was divided into 5 groups based on year of diagnosis (≤1985, 1986-1995, 1996-2005, 2006-2010, or 2011 and later). We collected findings from clinical presentation at diagnosis; serology tests; small intestinal biopsy analyses; and patients' demographic, clinical, and family data. Presentations at diagnosis were classified according to the Oslo criteria as follows: classical (patients presenting with malabsorption), nonclassical (no signs or symptoms of malabsorption at presentation), or subclinical (below the threshold of clinical detection). The primary outcome was change in clinical presentation of celiac disease over time. RESULTS Of the 749 patients studied, 512 were female and 237 were male (ratio of 2.2:1). Female patients were diagnosed at younger ages than male patients (42 vs 47 years, respectively; P = .004), and had more immune-mediated conditions than male patients (35.7% for female patients vs 21.5% for male patients; P < .001). For patients diagnosed as adults (after the age of 18 years), the median age of diagnosis increased from 34.0 years during the period ≤1985 to median ages of 44-46 years after 1985 (P < .002). A smaller proportion of patients presented with classical features of celiac disease after 2010 (48.4%) than ≤1985 (85.2%); the proportion of patients with nonclassical or subclinical celiac disease increased from 14.8% ≤1985 to 51.6% after 2010 (P = .006 for each). Biopsies categorized as Marsh 3c decreased, from 52.2% in the period 1996-2005 to 22.5% in the period after 2010 (P = .003). The prevalence of associated thyroid disease has decreased during the study period, from 36.6% ≤1985 to 17.1% after 2010 (P = .039), whereas body mass index at diagnosis increased from 21.5 kg/m2 ≤1985 to 24.8 kg/m2 after 2010 (P < .001). CONCLUSIONS We found the clinical presentation of celiac disease changed significantly in Ireland from 1960 through 2015. The age of presentation in adulthood increased over this time period, as did the proportions of patients with nonclassical or subclinical disease.
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Affiliation(s)
- Patricia Dominguez Castro
- Trinity Translational Medicine Institute & Department of Clinical Medicine, Trinity Centre for Health Science, St James's Hospital, Dublin, Republic of Ireland.
| | - Grace Harkin
- Department of Clinical Medicine, University College Hospital Galway, Galway, Republic of Ireland
| | - Mary Hussey
- Department of Clinical Medicine, The Adelaide and Meath Hospital, Dublin, Republic of Ireland
| | - Brian Christopher
- Connolly Hospital Blanchardstown, Blanchardstown, Dublin, Republic of Ireland
| | - Clifford Kiat
- Department of Clinical Medicine, University College Hospital Galway, Galway, Republic of Ireland
| | - Jun Liong Chin
- Trinity Translational Medicine Institute & Department of Clinical Medicine, Trinity Centre for Health Science, St James's Hospital, Dublin, Republic of Ireland
| | - Valerie Trimble
- Trinity Translational Medicine Institute & Department of Clinical Medicine, Trinity Centre for Health Science, St James's Hospital, Dublin, Republic of Ireland
| | - Deirdre McNamara
- Department of Clinical Medicine, The Adelaide and Meath Hospital, Dublin, Republic of Ireland
| | - Padraic MacMathuna
- Gastrointestinal Unit, Mater Misericordiae University Hospital, Eccles Street, Dublin, Republic of Ireland
| | - Brian Egan
- Department of Clinical Medicine, Mayo General Hospital, Castlebar, County Mayo, Republic of Ireland
| | - Barbara Ryan
- Department of Clinical Medicine, The Adelaide and Meath Hospital, Dublin, Republic of Ireland
| | - David Kevans
- Trinity Translational Medicine Institute & Department of Clinical Medicine, Trinity Centre for Health Science, St James's Hospital, Dublin, Republic of Ireland
| | - Richard Farrell
- Connolly Hospital Blanchardstown, Blanchardstown, Dublin, Republic of Ireland
| | - Valerie Byrnes
- Department of Clinical Medicine, University College Hospital Galway, Galway, Republic of Ireland
| | - Nasir Mahmud
- Trinity Translational Medicine Institute & Department of Clinical Medicine, Trinity Centre for Health Science, St James's Hospital, Dublin, Republic of Ireland
| | - Ross McManus
- Trinity Translational Medicine Institute & Department of Clinical Medicine, Trinity Centre for Health Science, St James's Hospital, Dublin, Republic of Ireland
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Affiliation(s)
- R. Scott Willms
- Los Alamos National Laboratory, Mail Stop J964, Los Alamos, NM 87544, USA
| | - David Dogruel
- Los Alamos National Laboratory, Mail Stop J964, Los Alamos, NM 87544, USA
| | - Richard Myers
- Radiation Monitoring Devices, Inc., 44 Hunt Street, Watertown, MA 02472 USA
| | - Richard Farrell
- Radiation Monitoring Devices, Inc., 44 Hunt Street, Watertown, MA 02472 USA
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Yang Y, Bec J, Zhou J, Zhang M, Judenhofer MS, Bai X, Di K, Wu Y, Rodriguez M, Dokhale P, Shah KS, Farrell R, Qi J, Cherry SR. A Prototype High-Resolution Small-Animal PET Scanner Dedicated to Mouse Brain Imaging. J Nucl Med 2016; 57:1130-5. [PMID: 27013696 DOI: 10.2967/jnumed.115.165886] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 02/25/2016] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED We developed a prototype small-animal PET scanner based on depth-encoding detectors using dual-ended readout of small scintillator elements to produce high and uniform spatial resolution suitable for imaging the mouse brain. METHODS The scanner consists of 16 tapered dual-ended-readout detectors arranged in a 61-mm-diameter ring. The axial field of view (FOV) is 7 mm, and the transaxial FOV is 30 mm. The scintillator arrays consist of 14 × 14 lutetium oxyorthosilicate elements, with a crystal size of 0.43 × 0.43 mm at the front end and 0.80 × 0.43 mm at the back end, and the crystal elements are 13 mm long. The arrays are read out by 8 × 8 mm and 13 × 8 mm position-sensitive avalanche photodiodes (PSAPDs) placed at opposite ends of the array. Standard nuclear-instrumentation-module electronics and a custom-designed multiplexer are used for signal processing. RESULTS The detector performance was measured, and all but the crystals at the very edge could be clearly resolved. The average intrinsic spatial resolution in the axial direction was 0.61 mm. A depth-of-interaction resolution of 1.7 mm was achieved. The sensitivity of the scanner at the center of the FOV was 1.02% for a lower energy threshold of 150 keV and 0.68% for a lower energy threshold of 250 keV. The spatial resolution within a FOV that can accommodate the entire mouse brain was approximately 0.6 mm using a 3-dimensional maximum-likelihood expectation maximization reconstruction. Images of a hot-rod microphantom showed that rods with a diameter of as low as 0.5 mm could be resolved. The first in vivo studies were performed using (18)F-fluoride and confirmed that a 0.6-mm resolution can be achieved in the mouse head in vivo. Brain imaging studies with (18)F-FDG were also performed. CONCLUSION We developed a prototype PET scanner that can achieve a spatial resolution approaching the physical limits of a small-bore PET scanner set by positron range and detector interaction. We plan to add more detector rings to extend the axial FOV of the scanner and increase sensitivity.
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Affiliation(s)
- Yongfeng Yang
- Department of Biomedical Engineering, University of California-Davis, Davis, California Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Julien Bec
- Department of Biomedical Engineering, University of California-Davis, Davis, California
| | - Jian Zhou
- Department of Biomedical Engineering, University of California-Davis, Davis, California
| | - Mengxi Zhang
- Department of Biomedical Engineering, University of California-Davis, Davis, California
| | - Martin S Judenhofer
- Department of Biomedical Engineering, University of California-Davis, Davis, California
| | - Xiaowei Bai
- Department of Biomedical Engineering, University of California-Davis, Davis, California
| | - Kun Di
- Department of Biomedical Engineering, University of California-Davis, Davis, California
| | - Yibao Wu
- Department of Biomedical Engineering, University of California-Davis, Davis, California
| | - Mercedes Rodriguez
- Department of Biomedical Engineering, University of California-Davis, Davis, California Instituto de Física, Universidad Nacional Autónoma de México, Mexico City, Mexico; and
| | | | - Kanai S Shah
- Radiation Monitoring Devices Inc., Watertown, Massachusetts
| | | | - Jinyi Qi
- Department of Biomedical Engineering, University of California-Davis, Davis, California
| | - Simon R Cherry
- Department of Biomedical Engineering, University of California-Davis, Davis, California
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Murphy A, Parihar V, Shahin A, Farrell R. Imitation, The Greatest Form of Flattery? Ir Med J 2016; 109:322. [PMID: 26904782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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19
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Komath D, Jabbar S, Farrell R, Gilhooly M, Messiha A, Shorafa M, Visavadia B, McCaul J. Primary and metastatic Merkel cell carcinoma of parotid. Br J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.bjoms.2015.08.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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20
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Wong G, Awad Z, Wong P, Wood S, Farrell R. Clinical applicability of the Thy3a cytological category in thyroid nodules aspirates. Our experience in one hundred and fifty-seven patients with Thy3 cytology. Clin Otolaryngol 2014; 39:393-6. [DOI: 10.1111/coa.12307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2014] [Indexed: 11/29/2022]
Affiliation(s)
- G. Wong
- Department of Otolaryngology, Head and Neck Surgery; Northwick Park Hospital; Middlesex UK
| | - Z. Awad
- Department of Otolaryngology, Head and Neck Surgery; Northwick Park Hospital; Middlesex UK
| | - P.Y. Wong
- Department of Otolaryngology, Head and Neck Surgery; Northwick Park Hospital; Middlesex UK
| | - S. Wood
- Department of Otolaryngology, Head and Neck Surgery; Wexham Park Hospital; Slough Berkshire UK
| | - R. Farrell
- Department of Otolaryngology, Head and Neck Surgery; Northwick Park Hospital; Middlesex UK
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Hoenk ME, Nikzad S, Carver AG, Jones TJ, Hennessy J, Jewell AD, Sgro J, Tsur S, McClish M, Farrell R. Superlattice-doped silicon detectors: progress and prospects. ACTA ACUST UNITED AC 2014. [DOI: 10.1117/12.2057678] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Gunderson C, Farrell R, Slaughter K, Ding K, Lauer J, Perry L, McMeekin D, Moore K. The influence of obesity on disease characteristics and survival among patients with epithelial ovarian cancer. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.03.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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23
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Slaughter K, Gunderson C, Perry L, Thomas E, Farrell R, Lauer J, Ding K, McMeekin D, Moore K. Acquired platinum resistance among women with high-grade serous epithelial ovarian cancer. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.03.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gunderson C, Thomas E, Slaughter K, Farrell R, Ding K, Lauer J, Perry L, McMeekin D, Moore K. Venous thromboembolism carries a particularly grave prognosis with epithelial ovarian cancer. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.03.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Shakil J, Piracha N, Prasad N, Kopacz J, Tarasuk A, Farrell R, Urban C, Mariano N, Wang G, Segal-Maurer S. Use of outpatient parenteral antimicrobial therapy for transrectal ultrasound-guided prostate biopsy prophylaxis in the setting of community-associated multidrug-resistant Escherichia coli rectal colonization. Urology 2014; 83:710-3. [PMID: 24680441 DOI: 10.1016/j.urology.2013.12.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 12/19/2013] [Accepted: 12/20/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To study the use of ertapenem delivered in an outpatient parenteral antimicrobial therapy (OPAT) hospital-based unit setting for targeted transrectal ultrasound-guided prostate biopsy (TRUSPBx) prophylaxis in the setting of multidrug-resistant (MDR) Escherichia coli rectal colonization. E coli is the pathogen most commonly associated with post-TRUSPBx complications, and there is increasing prevalence of community-associated MDR E coli. METHODS Prospective data analysis of all patients admitted to the OPAT unit for administration of intravenous antibiotics for prophylaxis for TRUSPBx over 18-month period was performed. Patients had identification of MDR E coli in rectal swab cultures and/or intolerance to available oral agents. Microbiologic data and tolerability of administered antibiotics and outcome after TRUSPBx were tabulated. RESULTS Nine patients (median age 74 years) were referred because of antibiotic-resistant E coli from rectal swabs (all fluoroquinolone resistant, 7 MDR). All patients received ertapenem 1 g intravenously 1 day before TRUSPBx and the day of the procedure before TRUSPBx. None of the patients experienced infectious complications immediately after TRUSPBx or several weeks or months later, and no patient was lost to urologic follow-up. CONCLUSION Increasing worldwide reports of prostatitis, urinary tract infections, and septicemia after TRUSPBx because of MDR E coli suggest rectal screening before procedure may be useful in decreasing complications. Targeted prophylaxis in these instances is necessary. Although carbapenems are used for treatment, they are not routinely used for prophylaxis. We report successful use of ertapenem delivered in a hospital-based OPAT unit for TRUSPBx prophylaxis.
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Affiliation(s)
- J Shakil
- The Dr. James J. Rahal Jr. Division of Infectious Diseases, Department of Medicine, New York Hospital Queens, Flushing, NY
| | - N Piracha
- The Dr. James J. Rahal Jr. Division of Infectious Diseases, Department of Medicine, New York Hospital Queens, Flushing, NY
| | - N Prasad
- The Dr. James J. Rahal Jr. Division of Infectious Diseases, Department of Medicine, New York Hospital Queens, Flushing, NY
| | - J Kopacz
- The Dr. James J. Rahal Jr. Division of Infectious Diseases, Department of Medicine, New York Hospital Queens, Flushing, NY
| | - A Tarasuk
- Urology Division, Department of Surgery, New York Hospital Queens, Flushing, NY
| | - R Farrell
- Urology Division, Department of Surgery, New York Hospital Queens, Flushing, NY
| | - C Urban
- The Dr. James J. Rahal Jr. Division of Infectious Diseases, Department of Medicine, New York Hospital Queens, Flushing, NY; Department of Medicine, Weill Cornell Medical College, New York, NY
| | - N Mariano
- The Dr. James J. Rahal Jr. Division of Infectious Diseases, Department of Medicine, New York Hospital Queens, Flushing, NY; Department of Patient Care Services, New York Hospital Queens, Flushing, NY
| | - G Wang
- Urology Division, Department of Surgery, New York Hospital Queens, Flushing, NY
| | - S Segal-Maurer
- The Dr. James J. Rahal Jr. Division of Infectious Diseases, Department of Medicine, New York Hospital Queens, Flushing, NY; Department of Medicine, Weill Cornell Medical College, New York, NY.
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Thomas E, Slaughter K, Gunderson C, Perry L, Lauer J, Farrell R, Ding K, McMeekin D, Moore K. The use of biologic agents and clinical trials may prolong survival for women with primary platinum resistant ovarian carcinoma. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Gunderson C, Slaughter K, Thomas E, Farrell R, Ding K, Lauer J, Perry L, McMeekin D, Moore K. Timing of venous thromboembolism: Does it impact survival with serous carcinoma of the ovary? Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gunderson C, Slaughter K, Thomas E, Farrell R, Ding K, Lauer J, Perry L, McMeekin D, Moore K. Is leukocytosis a harbinger of poor prognosis in ovarian cancer akin to thrombocytosis? Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Gunderson C, Dinh B, Farrell R, Thomas E, Vesely S, Chopra S, McMeekin D, Moore K. Inpatient versus outpatient management of neutropenic fever in gynecologic oncology patients: Does cost really matter? Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Dooraghi AA, Vu NT, Silverman RW, Farrell R, Shah KS, Wang J, Heath JR, Chatziioannou AF. Betabox: a beta particle imaging system based on a position sensitive avalanche photodiode. Phys Med Biol 2013; 58:3739-53. [PMID: 23656911 PMCID: PMC3706465 DOI: 10.1088/0031-9155/58/11/3739] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A beta camera has been developed that allows planar imaging of the spatial and temporal distribution of beta particles using a 14 × 14 mm(2) position sensitive avalanche photodiode (PSAPD). This camera system, which we call Betabox, can be directly coupled to microfluidic chips designed for cell incubation or other biological applications. Betabox allows for imaging the cellular uptake of molecular imaging probes labeled with charged particle emitters such as (18)F inside these chips. In this work, we investigate the quantitative imaging capabilities of Betabox for (18)F beta particles, in terms of background rate, efficiency, spatial resolution, and count rate. Measurements of background and spatial resolution are considered both at room temperature (21 °C ± 1 °C) and at an elevated operating temperature (37 °C ± 1 °C), as is often required for biological assays. The background rate measured with a 4 keV energy cutoff is below 2 cph mm(-2) at both 21 and 37 °C. The absolute efficiency of Betabox for the detection of (18)F positron sources in contact with a PSAPD with the surface passivated from ambient light and damage is 46% ± 1%. The lower detection limit is estimated using the Rose Criterion to be 0.2 cps mm(-2) for 1 min acquisitions and a 62 × 62 µm(2) pixel size. The upper detection limit is approximately 21 000 cps. The spatial resolution at both 21 and 37 °C ranges from 0.4 mm FWHM at the center of the field of view (FOV), and degrades to 1 mm at a distance of 5 mm away from center yielding a useful FOV of approximately 10 × 10 mm(2). We also investigate the effects on spatial resolution and sensitivity that result from the use of a polymer based microfluidic chip. For these studies we place varying layers of low-density polyethylene (LDPE) between the detector and the source and find that the spatial resolution degrades by ∼180 µm for every 100 µm of LDPE film. Sensitivity is reduced by half with the inclusion of ∼200 µm of additional LDPE film. Lastly, we demonstrate the practical utilization of Betabox, with an imaging test of its linearity, when coupled to a polydimethylsiloxane microfluidic chip designed for cell based assays.
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Affiliation(s)
- A A Dooraghi
- Crump Institute for Molecular Imaging, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
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Abstract
INTRODUCTION Floseal® (Baxter, Hayward, CA, US) can be of value in reducing blood loss and haematoma rates. The manufacturer’s warnings include allergic reaction, poor wound healing and intravascular thrombosis. We aimed to determine whether Floseal® is safe to use in various head and neck surgery (HNS) procedures. METHODS A prospective trial was conducted using Floseal® in 42 various consecutive head and neck surgery procedures. Adverse incidents were used as the main outcome measure, including allergic reaction, wound breakdown, wound infection and thrombosis. Secondary outcome measures included haematoma formation, hospital stay, drain times and output. RESULTS No adverse incidents were recorded in the trial period. Two patients developed haematomas and required surgical exploration where a bleeding vessel was identified and dealt with. CONCLUSIONS Floseal® is safe to be used in head and neck surgery with no adverse effects. A larger number and a control group are required to ascertain its value in reducing blood loss, haematoma formation, drain usage and hospital stay.
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Affiliation(s)
- A Ujam
- North West London Hospitals NHS Trust, UK.
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Bishop E, Nugent E, Mathews C, Farrell R, Landrum L, McMeekin D. Prognostic factors in stage 2B–3B cervical cancer in an era of chemoradiation. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2012.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Farrell R, Nugent E, Mathews C, Bishop E, Perry L, Landrum L, Lee S, Kim Y, Nam J, Kim Y, McMeekin D. Outcomes and disease progression after cervical excisional procedures (EPS), loop electroexcisional procedure (LEEP) or cone biopsy specimens (CKC), and radical hysterectomy (RH) for early stage invasive cervical cancer. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2012.07.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Nugent E, Bishop E, Mathews C, Perry L, Farrell R, Landrum L, Moxley K. The prognostic impact of isolated pelvic lymph node metastasis in a contemporary population of early stage and loco-regionally advanced carcinoma of the uterine cervix. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2012.07.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Perry L, Mathews C, Nugent E, Farrell R, Moore K. Para-aortic nodal metastases in the modern era: still a dismal prognosis. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2012.07.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Godinez F, Chaudhari AJ, Yang Y, Farrell R, Badawi RD. Characterization of a high-resolution hybrid DOI detector for a dedicated breast PET/CT scanner. Phys Med Biol 2012; 57:3435-49. [PMID: 22581109 DOI: 10.1088/0031-9155/57/11/3435] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The aim of this study is to design and test a new high-resolution hybrid depth of interaction (DOI) detector for a dedicated breast PET/CT scanner. Two detectors have been designed and built. The completed detectors are based on a 14 × 14 array of 1.5 × 1.5 × 20 mm(3) unpolished lutetium orthosilicate scintillation crystals, with each element coated in a 50 μm layer of reflective material. The detector is read out from both ends using a position-sensitive photomultiplier tube (PSPMT) and a large active area (20 × 20 mm(2)) avalanche photodiode (APD) to enable acquisition of DOI information. Nuclear instrumentation modules were used to characterize the detectors' performances in terms of timing, intrinsic spatial resolution (ISR) and energy resolution, as well as DOI resolution with a dual-ended readout configuration. Measurements with the APD were performed at a temperature of 10 °C. All crystals were identified at all depths, even though the signal amplitude from the PSPMT decreases with depth away from it. We measured a timing resolution of 2.4 ns, and an average energy resolution of 19%. The mean ISR was measured to be 1.2 mm for crystals in the central row of the array for detectors in the face-to-face position. Two off-center positions were measured corresponding to 26° and 51° oblique photon incidence, and the mean ISR at these positions was 1.5 and 1.7 mm, respectively. The average DOI resolution across all crystals and depths was measured to be 2.9 mm (including the beam width of 0.6 mm). This detector design shows good promise as a high-resolution detector for a dedicated breast PET/CT scanner.
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Affiliation(s)
- Felipe Godinez
- Department of Biomedical Engineering, University of California Davis, Davis, CA 95616, USA.
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37
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Gentile TR, Bales M, Arp U, Dong B, Farrell R. Response of large area avalanche photodiodes to low energy x rays. Rev Sci Instrum 2012; 83:053105. [PMID: 22667600 DOI: 10.1063/1.4714348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
For an experiment to study neutron radiative beta-decay, we operated large area avalanche photodiodes (APDs) near liquid nitrogen temperature to detect x rays with energies between 0.2 keV and 20 keV. Whereas there are numerous reports of x ray spectrometry using APDs at energies above 1 keV, operation near liquid nitrogen temperature allowed us to reach a nominal threshold of 0.1 keV. However, due to the short penetration depth of x rays below 1 keV, the pulse height spectrum of the APD become complex. We studied the response using monochromatic x ray beams and employed phenomenological fits of the pulse height spectrum to model the measurement of a continuum spectrum from a synchrotron. In addition, the measured pulse height spectrum was modelled using a profile for the variation in efficiency of collection of photoelectrons with depth into the APD. The best results are obtained with the collection efficiency model.
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Affiliation(s)
- T R Gentile
- Stop 8461, National Institute of Standards and Technology, Gaithersburg, Maryland 20899, USA
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38
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Backes F, Farrell R, Brudie L, Ahmad S, Salani R, Eisenhauer E, Cohn D, Holloway R, Fowler J, O'Malley D. Endometrial cancer staging in the elderly: Robotic or open? Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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39
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Wong WL, Sonoda LI, Gharpurhy A, Gollub F, Wellsted D, Goodchild K, Lemon C, Farrell R, Saunders M. 18F-fluorodeoxyglucose positron emission tomography/computed tomography in the assessment of occult primary head and neck cancers--an audit and review of published studies. Clin Oncol (R Coll Radiol) 2011; 24:190-5. [PMID: 22183080 DOI: 10.1016/j.clon.2011.11.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Revised: 10/05/2011] [Accepted: 11/04/2011] [Indexed: 02/07/2023]
Abstract
AIMS To assess the value of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in patients with squamous cell and undifferentiated cancer neck nodes and no primary site on conventional assessment. MATERIALS AND METHODS Seventy-eight patients with neck nodal metastases from an unknown primary cancer were studied. PET/CT was carried out in all patients, 1h after FDG injection. RESULTS Uptake suspicious of an occult primary cancer was found in 46/78 (59.0%) patients. Subsequent investigations confirmed a primary site in the base of the tongue in 14, pharyngeal palatine tonsil in 14, post cricoid in one, lung in one. PET/CT diagnosed primary cancers in 30/78 patients (38.5%); sensitivity, specificity, positive predictive value, negative predictive value: 30/30 (100.0%), 32/48 (66.7%), 30/46 (65.2%), 32/32 (100.0%), respectively. PET/CT detected additional disease in four patients: contralateral nodal disease in two, mediastinal nodal disease in one and liver metastases in one. CONCLUSIONS FDG PET/CT is of value in the assessment of patients with occult head and neck primary cancers. However, false-positive results remain a limitation of the investigation.
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Affiliation(s)
- W L Wong
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, UK.
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40
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Beattie MS, Ganschow P, Gabram-Mendola S, Wilson A, Joseph G, Lee R, Loranger K, Stanislaw C, Seelaus C, Farrell R, Trim L, DelPozo S, Luce J. P2-13-03: Comparative Assessment of 636 Women at Risk for Hereditary Breast Cancer within 3 Public Hospitals: The Consortium of Underserved BRCA Testers. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p2-13-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Underserved women at risk for Hereditary Breast and Ovarian Cancer (HBOC) are confronted with many unique challenges, such as barriers to accessing appropriate genetic testing and counseling services and decreased resources, that place them at increased cancer risk. It is unclear whether these high-risk women are appropriately referred for genetic counseling and what their genetic test results demonstrate due to minimal practice-based evidence. To study this population, and to establish an infrastructure to further explore long-term outcomes, we formed the Consortium of Underserved BRCA testers in October 2010 from: San Francisco General Hospital (SF), Stroger Hospital of Cook County (Chicago), and Grady Memorial Hospital (Atlanta).
Methods: Using common clinical and research protocols and mixed methods analysis, we examined and compared referral patterns, demographics, and BRCA test results between sites. We used chart reviews and common data collection instruments to gather and pool data. Using descriptive and comparative statistics, we examined similarities and differences between Consortium sites.
Results: SF's program began 9 years ago, Chicago's began 6 years ago, and Atlanta's began 3 years ago. Medicaid funding for BRCA testing has been available in SF since 2011, in Chicago since 2009, and is not yet available in Atlanta. P values were all <0.05 for comparing referral sources between sites. Each site uses unique referral tools and systems. For example, in SF, a family history screening questionnaire is administered during mammography; in Chicago, an extensive primary care network has been educated to provide appropriate referrals; in Atlanta, a pedigree assessment tool is employed by referring clinics.
Conclusions: Despite differences in referral patterns and Medicaid funding, underserved women at all 3 public hospital sites had similar BRCA positive rates, which are in line with positive rates from University Cancer Centers. We believe this relates to the availability of genetic counseling services and a similar testing threshold at each site. The large and ethnically diverse population of this Consortium can serve as a valuable resource for researchers and clinicians. We plan to follow this cohort prospectively to study clinical outcomes and medical decisions after BRCA testing in underserved families at risk of HBOC.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-13-03.
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Affiliation(s)
- MS Beattie
- 1University of California, San Francisco, CA; San Francisco General Hospital, San Francisco, CA; Stroger Hospital of Cook County, Chicago, IL; Rush University Medical Center, Chicago, IL; Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - P Ganschow
- 1University of California, San Francisco, CA; San Francisco General Hospital, San Francisco, CA; Stroger Hospital of Cook County, Chicago, IL; Rush University Medical Center, Chicago, IL; Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - S Gabram-Mendola
- 1University of California, San Francisco, CA; San Francisco General Hospital, San Francisco, CA; Stroger Hospital of Cook County, Chicago, IL; Rush University Medical Center, Chicago, IL; Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - A Wilson
- 1University of California, San Francisco, CA; San Francisco General Hospital, San Francisco, CA; Stroger Hospital of Cook County, Chicago, IL; Rush University Medical Center, Chicago, IL; Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - G Joseph
- 1University of California, San Francisco, CA; San Francisco General Hospital, San Francisco, CA; Stroger Hospital of Cook County, Chicago, IL; Rush University Medical Center, Chicago, IL; Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - R Lee
- 1University of California, San Francisco, CA; San Francisco General Hospital, San Francisco, CA; Stroger Hospital of Cook County, Chicago, IL; Rush University Medical Center, Chicago, IL; Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - K Loranger
- 1University of California, San Francisco, CA; San Francisco General Hospital, San Francisco, CA; Stroger Hospital of Cook County, Chicago, IL; Rush University Medical Center, Chicago, IL; Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - C Stanislaw
- 1University of California, San Francisco, CA; San Francisco General Hospital, San Francisco, CA; Stroger Hospital of Cook County, Chicago, IL; Rush University Medical Center, Chicago, IL; Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - C Seelaus
- 1University of California, San Francisco, CA; San Francisco General Hospital, San Francisco, CA; Stroger Hospital of Cook County, Chicago, IL; Rush University Medical Center, Chicago, IL; Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - R Farrell
- 1University of California, San Francisco, CA; San Francisco General Hospital, San Francisco, CA; Stroger Hospital of Cook County, Chicago, IL; Rush University Medical Center, Chicago, IL; Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - L Trim
- 1University of California, San Francisco, CA; San Francisco General Hospital, San Francisco, CA; Stroger Hospital of Cook County, Chicago, IL; Rush University Medical Center, Chicago, IL; Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - S DelPozo
- 1University of California, San Francisco, CA; San Francisco General Hospital, San Francisco, CA; Stroger Hospital of Cook County, Chicago, IL; Rush University Medical Center, Chicago, IL; Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - J Luce
- 1University of California, San Francisco, CA; San Francisco General Hospital, San Francisco, CA; Stroger Hospital of Cook County, Chicago, IL; Rush University Medical Center, Chicago, IL; Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
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Farrell R, Mathews C, Walker J, Landrum L. Cervical adenocarcinoma in the elderly. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2011.07.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
After many years of development, position-sensitive avalanche photodiodes (PSAPDs) are now being incorporated into a range of scintillation detector systems, including those used in high-resolution small-animal PET and PET/MR scanners. In this work, the signal, noise, signal-to-noise ratio (SNR), flood histogram and timing resolution were measured for lutetium oxyorthosilicate (LSO) scintillator arrays coupled to PSAPDs ranging in size from 10 to 20 mm, and the optimum bias voltage and working temperature were determined. Variations in the SNR performance of PSAPDs with the same dimensions were small, but the SNR decreased significantly with increasing PSAPD size and increasing temperature. Smaller PSAPDs (10 mm and 15 mm in width) produced acceptable flood histograms at 24 °C, and cooling lower than 16 °C produced little improvement. The optimum bias voltage was about 25 V below the break down voltage. The larger 20 mm PSAPDs have lower SNR and require cooling to 0-7 °C for acceptable performance. The optimum bias voltage is also lower (35 V or more below the break down voltage depending on the temperature). Significant changes in the timing resolution were observed as the bias voltage and temperature varied. Higher bias voltages provided better timing resolution. The best timing resolution obtained for individual crystals was 2.8 ns and 3.3 ns for the 10 mm and 15 mm PSAPDs, respectively. The results of this work provide useful guidance for selecting the bias voltage and working temperature for scintillation detectors that incorporate PSAPDs as the photodetector.
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Affiliation(s)
- Yongfeng Yang
- Department of Biomedical Engineering, University of California-Davis, One Shields Avenue, CA 95616, USA.
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Mathews C, Goodrich S, Farrell R, DeSimone C, Seamon L, Landrum L. Adenocarcinoma as an independent risk factor for early-stage intermediate-risk cervical carcinoma. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Carotid body tumours cause characteristic splaying of the internal and external carotid arteries, known as ‘Lyre Sign’. Vagal paragangliomas are rare tumours that arise from glomus cells along the length of the vagus nerve. We present a case in which a vagal paraganglioma has arisen from the vagus nerve at the carotid bifurcation, and has mimicked the ‘Lyre Sign’ of a carotid body tumour.
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Affiliation(s)
- R Nash
- Northwick Park Hospital, London, UK
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45
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Abstract
By using detectors with good depth encoding accuracy (∼2 mm), an animal PET scanner can be built with a small ring diameter and thick crystals to simultaneously obtain high spatial resolution and high sensitivity. However, there will be large wedge-shaped gaps between detector modules in such a scanner if traditional cuboid crystal arrays are used in a polygonal arrangement. The gaps can be minimized by using tapered scintillator arrays enabling the sensitivity of the scanner to be further improved. In this work, tapered lutetium oxyorthosilicate (LSO) arrays with different crystal dimensions and different combinations of inter-crystal reflector and crystal surface treatments were manufactured and their performance was evaluated. Arrays were read out from both ends by position-sensitive avalanche photodiodes (PSAPDs). In the optimal configuration, arrays consisting of 0.5 mm LSO elements could be clearly resolved and a depth of interaction resolution of 2.6 mm was obtained for a 20 mm thick array. For this tapered array, the intrinsic spatial is degraded from 0.67 to 0.75 mm compared to a standard cuboidal array with similar dimensions, while the increase in efficiency is 41%. Tapered scintillator arrays offer the prospect of improvements in sensitivity and sampling for small-bore scanners, without large increases in manufacturing complexity.
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Affiliation(s)
- Yongfeng Yang
- Department of Biomedical Engineering, University of California-Davis, One Shields Avenue, CA 95616, USA
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Sangster A, Knight D, Farrell R, Bedard-Haughn A. Repeat-pulse 13CO2 labeling of canola and field pea: implications for soil organic matter studies. Rapid Commun Mass Spectrom 2010; 24:2791-8. [PMID: 20857436 DOI: 10.1002/rcm.4699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Both the quantity and quality of plant residues can impact soil properties and processes. Isotopic tracers can be used to trace plant residue decomposition if the tracer is homogeneously distributed throughout the plant. Continuous labeling will homogeneously label plants but is not widely accessible because elaborate equipment is needed. In order to determine if the more accessible repeat-pulse labeling method could be used to trace plant residue decomposition, this labeling procedure was employed using (13)CO(2) to enrich field pea and canola plants in a controlled environment. Plants were exposed weekly to pulses of 33 atom% (13)CO(2) and grown to maturity. The distribution of the label throughout the plant parts (roots, stem, leaves, and pod) and biochemical fractions (ADF and ADL) was determined. The label was not homogeneously distributed throughout the plant; in particular, the pod fractions were less enriched than other fractions indicating the importance of continuing labeling well into plant maturity for pod-producing plants. The ADL fraction was also less enriched than the ADF fraction. Because of the heterogeneity of the label throughout the plant, caution should be applied when using the repeat-pulse method to trace the fate of (13)C-labeled residues in the soil. However, root contributions to below-ground C were successfully determined from the repeat-pulse labeled root material, as was (13)C enrichment of soil within the top 15 cm. Canola contributed more above- and below-ground residue C than field pea; however, canola was also higher in ADF and ADL fractions indicating a more recalcitrant residue.
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Affiliation(s)
- Amy Sangster
- AgraPoint, 199 Innovation Drive, Truro, Nova Scotia B6L2H5, Canada
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Naik R, Galaal K, Godfrey K, Edmondson R, Kucukmetin A, Fisher A, Katory M, Mercer-Jones M, Farrell R. Surgical training in gastrointestinal procedures within a UK gynaecological oncology subspecialty programme. BJOG 2010. [DOI: 10.1111/j.1471-0528.2010.02658.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
In this paper, we study position-dependent timing shifts and timing resolution in position sensitive avalanche photodiodes (PSAPDs) and their effects on the coincidence window used in positron emission tomography (PET) systems using these devices. There is a delay in PSAPD signals that increases as the excitation position moves from the corner to the center of the device and the timing resolution concurrently worsens. The difference in timing between the center and the corner can be up to 30.7 ns for a 14 x 14 mm(2) area PSAPD. This means that a PSAPD-based PET system could require a very wide coincidence timing window (>60 ns) if this effect is not corrected, although the individual crystal pairs still have full-width half-maximum (FWHM) timing resolutions better than 7.4 ns. In addition to characterizing the timing properties of PSAPDs, two correction methods were developed and applied to data from a pair of PSAPD detectors. These two timing offset corrections reduced the timing shift of a crystal pair from 52.4 ns to 9.7 ns or 1.3 ns, improved the FWHM timing resolution of the detector pair from 24.6 ns to 9.5 ns or 6.0 ns and reduced the timing window (sufficient to cover at least twice the FWHM for all crystal pairs) from 65.1 ns to 22.0 ns or 15.2 ns, respectively. A two-step timing alignment method is proposed for a PET system consisting of multiple PSAPDs. Lastly, the effect of PSAPD size on the timing performance was also evaluated.
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Affiliation(s)
- Yibao Wu
- Department of Biomedical Engineering, University of California, Davis, CA 95616, USA.
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James SS, Yang Y, Wu Y, Farrell R, Dokhale P, Shah KS, Cherry SR. Experimental characterization and system simulations of depth of interaction PET detectors using 0.5 mm and 0.7 mm LSO arrays. Phys Med Biol 2009; 54:4605-19. [PMID: 19567945 DOI: 10.1088/0031-9155/54/14/015] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Small animal PET scanners may be improved by increasing the sensitivity, improving the spatial resolution and improving the uniformity of the spatial resolution across the field of view. This may be achieved by using PET detectors based on crystal elements that are thin in the axial and transaxial directions and long in the radial direction, and by employing depth of interaction (DOI) encoding to minimize the parallax error. With DOI detectors, the diameter of the ring of the PET scanner may also be decreased. This minimizes the number of detectors required to achieve the same solid angle coverage as a scanner with a larger ring diameter and minimizes errors due to non-collinearity of the annihilation photons. In this study, we characterize prototype PET detectors that are finely pixelated with individual LSO crystal element sizes of 0.5 mm x 0.5 mm x 20 mm and 0.7 mm x 0.7 mm x 20 mm, read out at both ends by position sensitive avalanche photodiodes (PSAPDs). Both a specular reflector and a diffuse reflector were evaluated. The detectors were characterized based on the ability to clearly resolve the individual crystal elements, the DOI resolution and the energy resolution. Our results indicate that a scanner based on any of the four detector designs would offer improved spatial resolution and more uniform spatial resolution compared to present day small animal PET scanners. The greatest improvements to spatial resolution will be achieved when the detectors employing the 0.5 mm x 0.5 mm x 20 mm crystals are used. Monte Carlo simulations were performed to demonstrate that 2 mm DOI resolution is adequate to ensure uniform spatial resolution for a small animal PET scanner geometry using these detectors. The sensitivity of such a scanner was also simulated using Monte Carlo simulations and was shown to be greater than 10% for a four ring scanner with an inner diameter of 6 cm, employing 20 detectors per scanner ring.
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Affiliation(s)
- Sara St James
- Department of Biomedical Engineering, University of California-Davis, One Shields Avenue, Davis, CA 95616, USA
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50
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Abstract
A magnetic resonance (MR) compatible positron emission tomography (PET) insert has been developed in our laboratory for simultaneous small animal PET/MR imaging. This system is based on lutetium oxyorthosilicate (LSO) scintillator arrays with position-sensitive avalanche photodiode (PSAPD) photodetectors. The PET performance of this insert has been measured. The average reconstructed image spatial resolution was 1.51 mm. The sensitivity at the center of the field of view (CFOV) was 0.35%, which is comparable to the simulation predictions of 0.40%. The average photopeak energy resolution was 25%. The scatter fraction inside the MRI scanner with a line source was 12% (with a mouse-sized phantom and standard 35 mm Bruker 1H RF coil), 7% (with RF coil only) and 5% (without phantom or RF coil) for an energy window of 350-650 keV. The front-end electronics had a dead time of 390 ns, and a trigger extension dead time of 7.32 μs that degraded counting rate performance for injected doses above ~0.75 mCi (28 MBq). The peak noise-equivalent count rate (NECR) of 1.27 kcps was achieved at 290 μCi (10.7 MBq). The system showed good imaging performance inside a 7-T animal MRI system; however improvements in data acquisition electronics and reduction of the coincidence timing window are needed to realize improved NECR performance.
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Affiliation(s)
- Yibao Wu
- Department of Biomedical Engineering, UC Davis, Davis, CA 95616 USA (telephone: 530-752-2809)
| | - Ciprian Catana
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129 USA
| | | | | | - Kanai S. Shah
- Radiation Monitoring Devices Inc., Watertown, MA 02472 USA
| | - Jinyi Qi
- Department of Biomedical Engineering, UC Davis, Davis, CA 95616 USA
| | - Simon R. Cherry
- Department of Biomedical Engineering, UC Davis, Davis, CA 95616 USA
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