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Kuo HC, Mahmood U, Kirov AS, Mechalakos J, Della Biancia C, Cerviño LI, Lim SB. An automated technique for global noise level measurement in CT image with a conjunction of image gradient. Phys Med Biol 2024; 69:09NT01. [PMID: 38537310 DOI: 10.1088/1361-6560/ad3883] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 03/27/2024] [Indexed: 04/16/2024]
Abstract
Automated assessment of noise level in clinical computed tomography (CT) images is a crucial technique for evaluating and ensuring the quality of these images. There are various factors that can impact CT image noise, such as statistical noise, electronic noise, structure noise, texture noise, artifact noise, etc. In this study, a method was developed to measure the global noise index (GNI) in clinical CT scans due to the fluctuation of x-ray quanta. Initially, a noise map is generated by sliding a 10 × 10 pixel for calculating Hounsfield unit (HU) standard deviation and the noise map is further combined with the gradient magnitude map. By employing Boolean operation, pixels with high gradients are excluded from the noise histogram generated with the noise map. By comparing the shape of the noise histogram from this method with Christianson's tissue-type global noise measurement algorithm, it was observed that the noise histogram computed in anthropomorphic phantoms had a similar shape with a close GNI value. In patient CT images, excluding the HU deviation due the structure change demonstrated to have consistent GNI values across the entire CT scan range with high heterogeneous tissue compared to the GNI values using Christianson's tissue-type method. The proposed GNI was evaluated in phantom scans and was found to be capable of comparing scan protocols between different scanners. The variation of GNI when using different reconstruction kernels in clinical CT images demonstrated a similar relationship between noise level and kernel sharpness as observed in uniform phantom: sharper kernel resulted in noisier images. This indicated that GNI was a suitable index for estimating the noise level in clinical CT images with either a smooth or grainy appearance. The study's results suggested that the algorithm can be effectively utilized to screen the noise level for a better CT image quality control.
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Affiliation(s)
- Hsiang-Chi Kuo
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, NY, United States of America
| | - Usman Mahmood
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, NY, United States of America
| | - Assen S Kirov
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, NY, United States of America
| | - James Mechalakos
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, NY, United States of America
| | - Cesar Della Biancia
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, NY, United States of America
| | - Laura I Cerviño
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, NY, United States of America
| | - Seng Boh Lim
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, NY, United States of America
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Wang J, Duan X, Mahmood U, McKenney SE, Brady SL. An adult and pediatric size-based contrast administration reduction phantom study for single and dual-energy CT through preservation of contrast-to-noise ratio. J Appl Clin Med Phys 2024:e14340. [PMID: 38605540 DOI: 10.1002/acm2.14340] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 01/29/2024] [Accepted: 02/24/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Global shortages of iodinated contrast media (ICM) during COVID-19 pandemic forced the imaging community to use ICM more strategically in CT exams. PURPOSE The purpose of this work is to provide a quantitative framework for preserving iodine CNR while reducing ICM dosage by either lowering kV in single-energy CT (SECT) or using lower energy virtual monochromatic images (VMI) from dual-energy CT (DECT) in a phantom study. MATERIALS AND METHODS In SECT study, phantoms with effective diameters of 9.7, 15.9, 21.1, and 28.5 cm were scanned on SECT scanners of two different manufacturers at a range of tube voltages. Statistical based iterative reconstruction and deep learning reconstruction were used. In DECT study, phantoms with effective diameters of 20, 29.5, 34.6, and 39.7 cm were scanned on DECT scanners from three different manufacturers. VMIs were created from 40 to 140 keV. ICM reduction by lowering kV levels for SECT or switching from SECT to DECT was calculated based on the linear relationship between iodine CNR and its concentration under different scanning conditions. RESULTS On SECT scanner A, while matching CNR at 120 kV, ICM reductions of 21%, 58%, and 72% were achieved at 100, 80, and 70 kV, respectively. On SECT scanner B, 27% and 80% ICM reduction was obtained at 80 and 100 kV. On the Fast-kV switch DECT, with CNR matched at 120 kV, ICM reductions were 35%, 30%, 23%, and 15% with VMIs at 40, 50, 60, and 68 keV, respectively. On the dual-source DECT, ICM reductions were 52%, 48%, 42%, 33%, and 22% with VMIs at 40, 50, 60, 70, and 80 keV. On the dual-layer DECT, ICM reductions were 74%, 62%, 45%, and 22% with VMIs at 40, 50, 60, and 70 keV. CONCLUSIONS Our work provided a quantitative baseline for other institutions to further optimize their scanning protocols to reduce the use of ICM.
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Affiliation(s)
- Jia Wang
- Department of Environmental Health & Safety, Stanford University, Stanford, California, USA
| | - Xinhui Duan
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Usman Mahmood
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Sarah Eva McKenney
- Department of Radiology, University of California, Davis Medical Center, Sacramento, California, USA
| | - Samuel Loren Brady
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
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Roemer G, Li A, Mahmood U, Dauer L, Bellamy M. Artificial intelligence model GPT4 narrowly fails simulated radiological protection exam. J Radiol Prot 2024; 44:013502. [PMID: 38232401 DOI: 10.1088/1361-6498/ad1fdf] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/17/2024] [Indexed: 01/19/2024]
Abstract
This study assesses the efficacy of Generative Pre-Trained Transformers (GPT) published by OpenAI in the specialised domains of radiological protection and health physics. Utilising a set of 1064 surrogate questions designed to mimic a health physics certification exam, we evaluated the models' ability to accurately respond to questions across five knowledge domains. Our results indicated that neither model met the 67% passing threshold, with GPT-3.5 achieving a 45.3% weighted average and GPT-4 attaining 61.7%. Despite GPT-4's significant parameter increase and multimodal capabilities, it demonstrated superior performance in all categories yet still fell short of a passing score. The study's methodology involved a simple, standardised prompting strategy without employing prompt engineering or in-context learning, which are known to potentially enhance performance. The analysis revealed that GPT-3.5 formatted answers more correctly, despite GPT-4's higher overall accuracy. The findings suggest that while GPT-3.5 and GPT-4 show promise in handling domain-specific content, their application in the field of radiological protection should be approached with caution, emphasising the need for human oversight and verification.
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Affiliation(s)
- G Roemer
- MSKCC, 1275 York Avenue, New York, NY 10065, United States of America
| | - A Li
- MSKCC, 1275 York Avenue, New York, NY 10065, United States of America
| | - U Mahmood
- MSKCC, 1275 York Avenue, New York, NY 10065, United States of America
| | - L Dauer
- MSKCC, 1275 York Avenue, New York, NY 10065, United States of America
| | - M Bellamy
- MSKCC, 1275 York Avenue, New York, NY 10065, United States of America
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Mahmood U, Shukla-Dave A, Chan HP, Drukker K, Samala RK, Chen Q, Vergara D, Greenspan H, Petrick N, Sahiner B, Huo Z, Summers RM, Cha KH, Tourassi G, Deserno TM, Grizzard KT, Näppi JJ, Yoshida H, Regge D, Mazurchuk R, Suzuki K, Morra L, Huisman H, Armato SG, Hadjiiski L. Artificial intelligence in medicine: mitigating risks and maximizing benefits via quality assurance, quality control, and acceptance testing. BJR Artif Intell 2024; 1:ubae003. [PMID: 38476957 PMCID: PMC10928809 DOI: 10.1093/bjrai/ubae003] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 03/14/2024]
Abstract
The adoption of artificial intelligence (AI) tools in medicine poses challenges to existing clinical workflows. This commentary discusses the necessity of context-specific quality assurance (QA), emphasizing the need for robust QA measures with quality control (QC) procedures that encompass (1) acceptance testing (AT) before clinical use, (2) continuous QC monitoring, and (3) adequate user training. The discussion also covers essential components of AT and QA, illustrated with real-world examples. We also highlight what we see as the shared responsibility of manufacturers or vendors, regulators, healthcare systems, medical physicists, and clinicians to enact appropriate testing and oversight to ensure a safe and equitable transformation of medicine through AI.
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Affiliation(s)
- Usman Mahmood
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, United States
| | - Amita Shukla-Dave
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, United States
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, United States
| | - Heang-Ping Chan
- Department of Radiology, University of Michigan, Ann Arbor, MI, 48109, United States
| | - Karen Drukker
- Department of Radiology, University of Chicago, Chicago, IL, 60637, United States
| | - Ravi K Samala
- Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, 20993, United States
| | - Quan Chen
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, 85054, United States
| | - Daniel Vergara
- Department of Radiology, University of Washington, Seattle, WA, 98195, United States
| | - Hayit Greenspan
- Biomedical Engineering and Imaging Institute, Department of Radiology, Icahn School of Medicine at Mt Sinai, New York, NY, 10029, United States
| | - Nicholas Petrick
- Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, 20993, United States
| | - Berkman Sahiner
- Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, 20993, United States
| | - Zhimin Huo
- Tencent America, Palo Alto, CA, 94306, United States
| | - Ronald M Summers
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, 20892, United States
| | - Kenny H Cha
- Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, 20993, United States
| | - Georgia Tourassi
- Computing and Computational Sciences Directorate, Oak Ridge National Laboratory, Oak Ridge, TN, 37830, United States
| | - Thomas M Deserno
- Peter L. Reichertz Institute for Medical Informatics, TU Braunschweig and Hannover Medical School, Braunschweig, Niedersachsen, 38106, Germany
| | - Kevin T Grizzard
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, 06510, United States
| | - Janne J Näppi
- 3D Imaging Research, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, United States
| | - Hiroyuki Yoshida
- 3D Imaging Research, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, United States
| | - Daniele Regge
- Radiology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060, Italy
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, 56126, Italy
| | - Richard Mazurchuk
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, United States
| | - Kenji Suzuki
- Institute of Innovative Research, Tokyo Institute of Technology, Midori-ku, Yokohama, Kanagawa, 226-8503, Japan
| | - Lia Morra
- Department of Control and Computer Engineering, Politecnico di Torino, Torino, Piemonte, 10129, Italy
| | - Henkjan Huisman
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Gelderland, 6525 GA, Netherlands
| | - Samuel G Armato
- Department of Radiology, University of Chicago, Chicago, IL, 60637, United States
| | - Lubomir Hadjiiski
- Department of Radiology, University of Michigan, Ann Arbor, MI, 48109, United States
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Mahmood U, Fu Z, Calhoun V, Plis S. GLACIER: GLASS-BOX TRANSFORMER FOR INTERPRETABLE DYNAMIC NEUROIMAGING. Proc IEEE Int Conf Acoust Speech Signal Process 2023; 2023:10.1109/icassp49357.2023.10097126. [PMID: 37266485 PMCID: PMC10231935 DOI: 10.1109/icassp49357.2023.10097126] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Deep learning models can perform as well or better than humans in many tasks, especially vision related. Almost exclusively, these models are used to perform classification or prediction. However, deep learning models are usually of black-box nature, and it is often difficult to interpret the model or the features. The lack of interpretability causes a restrain from applying deep learning to fields such as neuroimaging, where the results must be transparent, and interpretable. Therefore, we present a 'glass-box' deep learning model and apply it to the field of neuroimaging. Our model mixes spatial and temporal dimensions in succession to estimate dynamic connectivity between the brain's intrinsic networks. The interpretable connectivity matrices produced by our model result in beating state-of-the-art models on many tasks using multiple functional MRI datasets. More importantly, our model estimates task-based flexible connectivity matrices, unlike static methods such as Pearson's correlation coefficients.
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Affiliation(s)
- Usman Mahmood
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
- Georgia State University, Department of Computer Science, Atlanta, GA, USA
| | - Zening Fu
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
- Georgia State University, Department of Computer Science, Atlanta, GA, USA
| | - Vince Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
- Georgia Institute of Technology, Department of Electrical and Computer Engineering, Atlanta, GA, USA
| | - Sergey Plis
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
- Georgia State University, Department of Computer Science, Atlanta, GA, USA
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Paudyal R, Shah AD, Akin O, Do RKG, Konar AS, Hatzoglou V, Mahmood U, Lee N, Wong RJ, Banerjee S, Shin J, Veeraraghavan H, Shukla-Dave A. Artificial Intelligence in CT and MR Imaging for Oncological Applications. Cancers (Basel) 2023; 15:cancers15092573. [PMID: 37174039 PMCID: PMC10177423 DOI: 10.3390/cancers15092573] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023] Open
Abstract
Cancer care increasingly relies on imaging for patient management. The two most common cross-sectional imaging modalities in oncology are computed tomography (CT) and magnetic resonance imaging (MRI), which provide high-resolution anatomic and physiological imaging. Herewith is a summary of recent applications of rapidly advancing artificial intelligence (AI) in CT and MRI oncological imaging that addresses the benefits and challenges of the resultant opportunities with examples. Major challenges remain, such as how best to integrate AI developments into clinical radiology practice, the vigorous assessment of quantitative CT and MR imaging data accuracy, and reliability for clinical utility and research integrity in oncology. Such challenges necessitate an evaluation of the robustness of imaging biomarkers to be included in AI developments, a culture of data sharing, and the cooperation of knowledgeable academics with vendor scientists and companies operating in radiology and oncology fields. Herein, we will illustrate a few challenges and solutions of these efforts using novel methods for synthesizing different contrast modality images, auto-segmentation, and image reconstruction with examples from lung CT as well as abdome, pelvis, and head and neck MRI. The imaging community must embrace the need for quantitative CT and MRI metrics beyond lesion size measurement. AI methods for the extraction and longitudinal tracking of imaging metrics from registered lesions and understanding the tumor environment will be invaluable for interpreting disease status and treatment efficacy. This is an exciting time to work together to move the imaging field forward with narrow AI-specific tasks. New AI developments using CT and MRI datasets will be used to improve the personalized management of cancer patients.
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Affiliation(s)
- Ramesh Paudyal
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York City, NY 10065, USA
| | - Akash D Shah
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, NY 10065, USA
| | - Oguz Akin
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, NY 10065, USA
| | - Richard K G Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, NY 10065, USA
| | - Amaresha Shridhar Konar
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York City, NY 10065, USA
| | - Vaios Hatzoglou
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, NY 10065, USA
| | - Usman Mahmood
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York City, NY 10065, USA
| | - Nancy Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, NY 10065, USA
| | - Richard J Wong
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY 10065, USA
| | | | | | - Harini Veeraraghavan
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York City, NY 10065, USA
| | - Amita Shukla-Dave
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York City, NY 10065, USA
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, NY 10065, USA
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Jones AK, Wunderle KA, Fruscello T, Simanowith M, Cline B, Dharmadhikari S, Duan X, Durack JC, Hirschl D, Kim DS, Mahmood U, Mann SD, Martin C, Metwalli Z, Moirano JM, Neill RA, Newsome J, Padua H, Schoenfeld AH, Miller DL. Patient Radiation Doses in IR Procedures: The American College of Radiology Dose Index Registry-Fluoroscopy Pilot. J Vasc Interv Radiol 2023; 34:544-555.e11. [PMID: 36379286 DOI: 10.1016/j.jvir.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 10/14/2022] [Accepted: 11/06/2022] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To update normative data on fluoroscopy dose indices in the United States for the first time since the Radiation Doses in Interventional Radiology study in the late 1990s. MATERIALS AND METHODS The Dose Index Registry-Fluoroscopy pilot study collected data from March 2018 through December 2019, with 50 fluoroscopes from 10 sites submitting data. Primary radiation dose indices including fluoroscopy time (FT), cumulative air kerma (Ka,r), and kerma area product (PKA) were collected for interventional radiology fluoroscopically guided interventional (FGI) procedures. Clinical facility procedure names were mapped to the American College of Radiology (ACR) common procedure lexicon. Distribution parameters including the 10th, 25th, 50th, 75th, 95th, and 99th percentiles were computed. RESULTS Dose indices were collected for 70,377 FGI procedures, with 50,501 ultimately eligible for analysis. Distribution parameters are reported for 100 ACR Common IDs. FT in minutes, Ka,r in mGy, and PKA in Gy-cm2 are reported in this study as (n; median) for select ACR Common IDs: inferior vena cava filter insertion (1,726; FT: 2.9; Ka,r: 55.8; PKA: 14.19); inferior vena cava filter removal (464; FT: 5.7; Ka,r: 178.6; PKA: 34.73); nephrostomy placement (2,037; FT: 4.1; Ka,r: 39.2; PKA: 6.61); percutaneous biliary drainage (952; FT: 12.4; Ka,r: 160.5; PKA: 21.32); gastrostomy placement (1,643; FT: 3.2; Ka,r: 29.1; PKA: 7.29); and transjugular intrahepatic portosystemic shunt placement (327; FT: 34.8; Ka,r: 813.0; PKA: 181.47). CONCLUSIONS The ACR DIR-Fluoro pilot has provided state-of-the-practice statistics for radiation dose indices from IR FGI procedures. These data can be used to prioritize procedures for radiation optimization, as demonstrated in this work.
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Affiliation(s)
- A Kyle Jones
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Kevin A Wunderle
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Brendan Cline
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | | | - Xinhui Duan
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - David Hirschl
- Department of Radiology, Montefiore Medical Center, Bronx, New York
| | - Don-Soo Kim
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Usman Mahmood
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Steve D Mann
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Charles Martin
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, Ohio
| | - Zeyad Metwalli
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey M Moirano
- Department of Radiology, University of Washington, Seattle, Washington
| | - Rebecca A Neill
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Janice Newsome
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Horacio Padua
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | | | - Donald L Miller
- United States Food and Drug Administration, Silver Spring, Maryland
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Som A, Wehrenberg-Klee E, Rosenboom J, Chandler A, Ndakwah G, Kim J, Feig V, Marcos-Vidal A, Fintelmann F, Basu A, Langer R, Traverso G, Mahmood U. Abstract No. 4 ▪ FEATURED ABSTRACT Image-Guided Intratumoral Cancer Vaccine to Treat Metastatic Immunotherapy Resistant Cancer with and without Cryoablation. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.043] [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: 02/27/2023] Open
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Lumish MA, Tan G, Mahmood U, Dauer L, Cercek A, Bates D. Radiation exposure from diagnostic CT for young patients with colon cancer in the first 5 years after diagnosis. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.90] [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: 01/25/2023] Open
Abstract
90 Background: Given the rise in colorectal cancer (CRC) in younger patients, this study aims to analyze the radiation exposure received by early onset colorectal cancer patients from diagnostic imaging performed in the first 5-years from diagnosis. Methods: A retrospective review of all patients (age ≤ 50 y) with stage I-III CRC who received at least 5 surveillance or staging body computed tomography (CT) scans in the 5 years from diagnosis was performed beginning in October 2015. The volume CT dose index (CTDIvol) and dose length product (DLP) were extracted; a previously validated Monte Carlo (MC) based software, VirtualDose (Virtual Phantoms, Inc., Albany, NY), was used to estimate organ dose to 19 organs based on the imaging mode parameters. The effective doses were calculated based on methods set forth in the International Commission on Radiological Protection ICRP No. 103 Publication. Results: A total of 107 patients were included (age range 25-50 years, median 44 years). The average effective dose per CT scan was 15.0 mSv range: 11.6 to 22.6 mSv) for male (n = 62) and 13.4 mSv (8.04 to 17.5 mSv) for female (n = 45) patients. The cumulative effective dose was greater than 100 mSv for 9 (8.4%) of patients and between 50 to < 100 mSv for 28 (26.2%) of the patients in this study. Of the 107 patients, 23% (n = 25) of the patients recurred during the first 5 years. Conclusions: The majority of early-onset colorectal cancer patients in this study received a cumulative dose under 100 mSv, which is considered low risk according to a policy statement by the International Organization for Medical Physics. Since the majority of patients in this study received what is considered a low cumulative radiation dose from repeated CT imaging during the 5-year period after diagnosis, this may provide reassurance that repeated CT imaging, particularly for surveillance, is warranted. Individual risk will vary but the clinical benefits of clinical imaging outweigh the small, if any, risk of radiation-induced cancers in this patient cohort. [Table: see text]
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Affiliation(s)
| | - Gary Tan
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Usman Mahmood
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Andrea Cercek
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - David Bates
- Memorial Sloan Kettering Cancer Center, New York, NY
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Lygo-Frett F, Richard B, Mahmood U, Maqsud MA, Baker D. Objective measures of visual improvement following amblyopia therapy in children. J Vis 2022. [DOI: 10.1167/jov.22.14.4232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
| | - Bruno Richard
- Rutgers University, Newark, USA
- University of York, York, UK
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Mahmood U, Fu Z, Ghosh S, Calhoun V, Plis S. Through the looking glass: Deep interpretable dynamic directed connectivity in resting fMRI. Neuroimage 2022; 264:119737. [PMID: 36356823 PMCID: PMC9844250 DOI: 10.1016/j.neuroimage.2022.119737] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/01/2022] [Accepted: 11/06/2022] [Indexed: 11/09/2022] Open
Abstract
Brain network interactions are commonly assessed via functional (network) connectivity, captured as an undirected matrix of Pearson correlation coefficients. Functional connectivity can represent static and dynamic relations, but often these are modeled using a fixed choice for the data window Alternatively, deep learning models may flexibly learn various representations from the same data based on the model architecture and the training task. However, the representations produced by deep learning models are often difficult to interpret and require additional posthoc methods, e.g., saliency maps. In this work, we integrate the strengths of deep learning and functional connectivity methods while also mitigating their weaknesses. With interpretability in mind, we present a deep learning architecture that exposes a directed graph layer that represents what the model has learned about relevant brain connectivity. A surprising benefit of this architectural interpretability is significantly improved accuracy in discriminating controls and patients with schizophrenia, autism, and dementia, as well as age and gender prediction from functional MRI data. We also resolve the window size selection problem for dynamic directed connectivity estimation as we estimate windowing functions from the data, capturing what is needed to estimate the graph at each time-point. We demonstrate efficacy of our method in comparison with multiple existing models that focus on classification accuracy, unlike our interpretability-focused architecture. Using the same data but training different models on their own discriminative tasks we are able to estimate task-specific directed connectivity matrices for each subject. Results show that the proposed approach is also more robust to confounding factors compared to standard dynamic functional connectivity models. The dynamic patterns captured by our model are naturally interpretable since they highlight the intervals in the signal that are most important for the prediction. The proposed approach reveals that differences in connectivity among sensorimotor networks relative to default-mode networks are an important indicator of dementia and gender. Dysconnectivity between networks, specially sensorimotor and visual, is linked with schizophrenic patients, however schizophrenic patients show increased intra-network default-mode connectivity compared to healthy controls. Sensorimotor connectivity was important for both dementia and schizophrenia prediction, but schizophrenia is more related to dysconnectivity between networks whereas, dementia bio-markers were mostly intra-network connectivity.
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Affiliation(s)
- Usman Mahmood
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA; Georgia State University, Department of Computer Science, Atlanta, GA, USA.
| | - Zening Fu
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA; Georgia State University, Department of Computer Science, Atlanta, GA, USA
| | - Satrajit Ghosh
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA USA; Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA USA
| | - Vince Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA; Georgia State University, Department of Computer Science, Atlanta, GA, USA; Georgia Institute of Technology, Department of Electrical and Computer Engineering, Atlanta, GA, USA
| | - Sergey Plis
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA; Georgia State University, Department of Computer Science, Atlanta, GA, USA
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12
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Jones AK, Wunderle KA, Fruscello T, Simanowith M, Cline B, Dharmadhikari S, Duan X, Durack JC, Hirschl D, Kim DS, Mahmood U, Mann SD, Martin C, Metwalli Z, Moirano JM, Neill RA, Newsome J, Padua H, Schoenfeld AH, Miller DL. Patient Radiation Doses in Interventional Radiology Procedures: Comparison of fluoroscopy dose indices from the American College of Radiology Dose Index Registry-Fluoroscopy (DIR-Fluoro) Pilot to the RAD-IR study. J Vasc Interv Radiol 2022; 34:556-562.e3. [PMID: 36031041 DOI: 10.1016/j.jvir.2022.08.023] [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] [Received: 06/14/2022] [Revised: 08/08/2022] [Accepted: 08/14/2022] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To compare interventional radiology fluoroscopically-guided intervention (FGI) radiation dose index distributions from the American College of Radiology (ACR) Fluoroscopy Dose Index Registry (DIR-Fluoro) pilot to the Radiation Doses in Interventional Radiology (RAD-IR) study. MATERIALS AND METHODS Individual and grouped ACR Common IDs (procedure types) from the DIR-Fluoro pilot were matched to procedure types in the RAD-IR study. Fifteen comparisons were made. Distribution parameters including the 10th, 25th, 50th, 75th, and 95th percentiles were compared for fluoroscopy time (FT), cumulative air kerma (Ka,r), and kerma area product (PKA). Two derived indices were computed using median dose indices. The procedure-averaged reference air kerma rate (Ka,r¯) was computed as Ka,r / FT. The procedure-averaged X-ray field size at the reference point (Ar¯) was computed as PKA / (Ka,r * 1,000). RESULTS Median FT was equally likely to be higher or lower in the DIR-Fluoro pilot compared to RAD-IR, while maximum FT was almost twice as likely to be higher in DIR-Fluoro than RAD-IR. Median Ka,r was lower in the DIR-Fluoro pilot for all procedures, as was median PKA. The maximum Ka,r and PKA were more often higher in the DIR-Fluoro pilot compared to RAD-IR. Ka,r¯ followed the same pattern as Ka,r, while Ar¯ was often greater in DIR-Fluoro. CONCLUSIONS Median dose indices have decreased since the RAD-IR study. Typical Ka,r rates are lower, a result of the use of lower default dose rates. However, opportunities for quality improvement exist, including a renewed focus on tight collimation of the imaging field of view.
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Affiliation(s)
- A Kyle Jones
- The University of Texas MD Anderson Cancer Center, 1400 Pressler, Unit 1472, Houston, TX 77030.
| | | | | | | | | | | | - Xinhui Duan
- The University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | | | - Usman Mahmood
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Zeyad Metwalli
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | - Donald L Miller
- United States Food and Drug Administration, Silver Spring, MD
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13
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Jones A, Wunderle K, Fruscello T, Cline B, Dharmadhikari S, Duan X, Durack J, Hirschl D, Ingraham C, Kim D, Mahmood U, Mann S, Martin C, Metwalli Z, Moirano J, Neill R, Newsome J, Padua H, Schoenfeld A, Simanowith M, Miller D. Abstract No. 592 How far we’ve come: comparison of fluoroscopy dose indices from the DIR-Fluoro pilot to the RAD-IR study. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.574] [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] Open
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14
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Hayat A, Johnson DW, Hawley CM, Jaffrey LR, Mahmood U, Mon SSY, Cho Y. Associations, microbiology and outcomes of pre-training peritoneal dialysis-related peritonitis. Perit Dial Int 2022; 43:173-181. [PMID: 35220814 DOI: 10.1177/08968608221079183] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Pre-training peritonitis (PTP), defined as peritonitis that occurred after catheter insertion and before peritoneal dialysis (PD) training, is increasingly recognized as a risk factor for adverse patient outcomes, yet poorly understood with limited studies conducted to date. This study was conducted to identify the associations, microbiologic profiles and outcomes of PTP compared to post-training peritonitis. METHODS This single-centre, case-control study involved patients with kidney failure who had PD as their first kidney replacement therapy and had experienced an episode of PD peritonitis between 1 January 2005 and 31 December 2015. Individuals experiencing their first episode of peritonitis were included in the study and categorized according to whether it occurred pre- or post-training. The primary outcome was peritonitis cure rates and composite outcome of hemodialysis (HD) transfer for ≥30 days or death. The secondary outcomes included catheter removal and refractory peritonitis rates. RESULTS Among 683 patients who received PD for the first time, 121 (17.7%) had PTP while 265 (38.8%) had post-training peritonitis. PTP patients were more likely to have had exit-site infection (ESI) prior to peritonitis (24.8% compared to 17% in the post-training peritonitis group, p = 0.2). Culture-negative peritonitis was significantly more common in the PTP patients (53.7%) than in the post-training group (27.3%, p < 0.001). The cure was achieved in 68.9% of cases and was not significantly different between the PTP and post-training peritonitis groups (66.1% vs. 70.2%; OR 0.83, 95% CI 0.51-1.35). Lower odds of cure were associated with peritonitis caused by moderate and high severity organisms (OR 0.49, 95% CI 0.29-0.85; OR 0.18, 95% CI 0.08-0.43, respectively). Composite outcome of HD transfer or death was more commonly observed among patients with PTP (87.5% vs. 75.8%; OR 2.2, 95% CI 1.20-4.48) in whom significantly shorter median time to HD transfer was observed (PTP 10.7 months vs. post-training peritonitis 21.9 months, p < 0.0001). CONCLUSIONS PTP is a common condition that is highly associated with preceding ESI, is frequently culture-negative and is associated with worse composite outcome of HD transfer or death. PTP rates should be routinely monitored and reported by PD units for continuous quality improvement.
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Affiliation(s)
- Ashik Hayat
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,The University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,The University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Carmel M Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,The University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Lauren R Jaffrey
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | | | - Sarah Saw Yu Mon
- The University of Queensland, Brisbane, Australia.,Department of Nephrology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Yeoungjee Cho
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,The University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
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15
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Lin PJP, Goode AR, Corwin FD, Fisher RF, Balter S, Wunderle KA, Schueler BA, Kim DS, Zhang J, Zhou YJ, Jenkins PA, Mahmood U, Lin T, Zhao H, Park MA, Trianni A, Lendle M, Kuhls-Gilcrist A, Jans JC, Desponds L, Banasiak G, Backes S, Snyder C, Snyder A, Lu M, Gonzalez S. Report of AAPM Task Group 272: Comprehensive acceptance testing and evaluation of fluoroscopy imaging systems. Med Phys 2022; 49:e1-e49. [PMID: 35032394 DOI: 10.1002/mp.15429] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 12/07/2021] [Accepted: 12/13/2021] [Indexed: 11/06/2022] Open
Abstract
Modern fluoroscopes used for image guidance have become quite complex. Adding to this complexity are the many regulatory and accreditation requirements that must be fulfilled during acceptance testing of a new unit. Further, some of these acceptance tests have pass/fail criteria, while others do not, making acceptance testing a subjective and time consuming task. The AAPM Task Group 272 Report spells out the details of tests that are required and gives visibility to some of the tests that while not yet required, are recommended as good practice. The organization of the report begins with the most complicated fluoroscopes used in interventional radiology or cardiology, continues with general fluoroscopy and mobile C-arms. Finally, the Appendices of the report provide useful information, an example report form and topics that needed their own section due to the level of detail. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Pei-Jan Paul Lin
- Department of Radiology, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | - Allen R Goode
- Department of Radiology, University of Virginia, Charlottesville, VA, 22908, USA
| | - Frank D Corwin
- Department of Radiology, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | - Ryan F Fisher
- Department of Radiology, The MetroHealth System, Cleveland, OH, 44109, USA
| | - Stephen Balter
- Departments of Medicine and Radiology, Columbia University Medical Center, New York, NY, 10021, USA
| | - Kevin A Wunderle
- Department of Radiology, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Beth A Schueler
- Radiology Department, Mayo Clinic, Rochester, MN, 55905, USA
| | - Don-Soo Kim
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Jie Zhang
- Department of Radiology, University of Kentucky, Lexington, KY, 40536, USA
| | - Yifang Jimmy Zhou
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Peter A Jenkins
- Department of Radiology, University of Utah Health, Salt Lake City, UT, 84132, USA
| | - Usman Mahmood
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Teh Lin
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, 19111, USA
| | - Hui Zhao
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT, 84112, USA
| | - Mi-Ae Park
- Department of Radiology, University of Texas Southwestern, Dallas, TX, 75390, USA
| | - Annalisa Trianni
- Medical Physics Department, Udine University Hospital, Udine, 33100, Italy
| | | | | | - Jan C Jans
- Philips Healthcare, Best, 5680 DA, The Netherlands
| | | | | | - Steve Backes
- Atirix Medical Systems, Inc., Minneapolis, MN, 55305, USA
| | - Carl Snyder
- Atirix Medical Systems, Inc., Minneapolis, MN, 55305, USA
| | - Angela Snyder
- Atirix Medical Systems, Inc., Minneapolis, MN, 55305, USA
| | - Minghui Lu
- Varex Imaging Corporation, San Jose, CA, 95134, USA
| | - Scott Gonzalez
- Food and Drug Administration, Health and Human Services, Silver Spring, MD, 20993, USA
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16
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Mahmood U, Shrestha R, Bates DDB, Mannelli L, Corrias G, Erdi YE, Kanan C. Detecting Spurious Correlations With Sanity Tests for Artificial Intelligence Guided Radiology Systems. Front Digit Health 2021; 3:671015. [PMID: 34713144 PMCID: PMC8521929 DOI: 10.3389/fdgth.2021.671015] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/29/2021] [Indexed: 11/23/2022] Open
Abstract
Artificial intelligence (AI) has been successful at solving numerous problems in machine perception. In radiology, AI systems are rapidly evolving and show progress in guiding treatment decisions, diagnosing, localizing disease on medical images, and improving radiologists' efficiency. A critical component to deploying AI in radiology is to gain confidence in a developed system's efficacy and safety. The current gold standard approach is to conduct an analytical validation of performance on a generalization dataset from one or more institutions, followed by a clinical validation study of the system's efficacy during deployment. Clinical validation studies are time-consuming, and best practices dictate limited re-use of analytical validation data, so it is ideal to know ahead of time if a system is likely to fail analytical or clinical validation. In this paper, we describe a series of sanity tests to identify when a system performs well on development data for the wrong reasons. We illustrate the sanity tests' value by designing a deep learning system to classify pancreatic cancer seen in computed tomography scans.
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Affiliation(s)
- Usman Mahmood
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Robik Shrestha
- Chester F. Carlson Center for Imaging Science, Rochester Institute of Technology, Rochester, NY, United States
| | - David D. B. Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Lorenzo Mannelli
- Institute of Research and Medical Care (IRCCS) SDN, Institute of Diagnostic and Nuclear Research, Naples, Italy
| | - Giuseppe Corrias
- Department of Radiology, University of Cagliari, Cagliari, Italy
| | - Yusuf Emre Erdi
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Christopher Kanan
- Chester F. Carlson Center for Imaging Science, Rochester Institute of Technology, Rochester, NY, United States
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17
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Mahmood U, Apte A, Kanan C, Bates DDB, Corrias G, Manneli L, Oh JH, Erdi YE, Nguyen J, O'Deasy J, Shukla-Dave A. Quality control of radiomic features using 3D-printed CT phantoms. J Med Imaging (Bellingham) 2021; 8:033505. [PMID: 34222557 PMCID: PMC8240751 DOI: 10.1117/1.jmi.8.3.033505] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 06/04/2021] [Indexed: 01/01/2023] Open
Abstract
Purpose: The lack of standardization in quantitative radiomic measures of tumors seen on computed tomography (CT) scans is generally recognized as an unresolved issue. To develop reliable clinical applications, radiomics must be robust across different CT scan modes, protocols, software, and systems. We demonstrate how custom-designed phantoms, imprinted with human-derived patterns, can provide a straightforward approach to validating longitudinally stable radiomic signature values in a clinical setting. Approach: Described herein is a prototype process to design an anatomically informed 3D-printed radiomic phantom. We used a multimaterial, ultra-high-resolution 3D printer with voxel printing capabilities. Multiple tissue regions of interest (ROIs), from four pancreas tumors, one lung tumor, and a liver background, were extracted from digital imaging and communication in medicine (DICOM) CT exam files and were merged together to develop a multipurpose, circular radiomic phantom (18 cm diameter and 4 cm width). The phantom was scanned 30 times using standard clinical CT protocols to test repeatability. Features that have been found to be prognostic for various diseases were then investigated for their repeatability and reproducibility across different CT scan modes. Results: The structural similarity index between the segment used from the patients' DICOM image and the phantom CT scan was 0.71. The coefficient variation for all assessed radiomic features was < 1.0 % across 30 repeat scans of the phantom. The percent deviation (pDV) from the baseline value, which was the mean feature value determined from repeat scans, increased with the application of the lung convolution kernel, changes to the voxel size, and increases in the image noise. Gray level co-occurrence features, contrast, dissimilarity, and entropy were particularly affected by different scan modes, presenting with pDV > ± 15 % . Conclusions: Previously discovered prognostic and popular radiomic features are variable in practice and need to be interpreted with caution or excluded from clinical implementation. Voxel-based 3D printing can reproduce tissue morphology seen on CT exams. We believe that this is a flexible, yet practical, way to design custom phantoms to validate and compare radiomic metrics longitudinally, over time, and across systems.
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Affiliation(s)
- Usman Mahmood
- Memorial Sloan Kettering Cancer Center, Department of Medical Physics, New York, United States
| | - Aditya Apte
- Memorial Sloan Kettering Cancer Center, Department of Medical Physics, New York, United States
| | - Christopher Kanan
- Rochester Institute of Technology, Department of Imaging Science, Rochester, New York, United States
| | - David D B Bates
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, United States
| | - Giuseppe Corrias
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, United States
| | | | - Jung Hun Oh
- Memorial Sloan Kettering Cancer Center, Department of Medical Physics, New York, United States
| | - Yusuf Emre Erdi
- Memorial Sloan Kettering Cancer Center, Department of Medical Physics, New York, United States
| | | | - Joseph O'Deasy
- Memorial Sloan Kettering Cancer Center, Department of Medical Physics, New York, United States
| | - Amita Shukla-Dave
- Memorial Sloan Kettering Cancer Center, Department of Medical Physics, New York, United States.,Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, United States
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18
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Cruz-Hernández E, Mahmood U, Golia Pernicka JS, Paroder V, Petkovska I, Gollub MJ, Shia J, Ganesh K, Bates DDB. Initial evaluation of dual-energy computed tomography as an imaging biomarker for hepatic metastases from neuroendocrine tumor of the gastrointestinal tract. Quant Imaging Med Surg 2021; 11:2085-2092. [PMID: 33936989 DOI: 10.21037/qims-20-917] [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] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background To evaluate quantitative iodine parameters from the arterial phase dual-energy computed tomography (DECT) scans as an imaging biomarker for tumor grade (TG), mitotic index (MI), and Ki-67 proliferation index of hepatic metastases from neuroendocrine tumors (NETs) of the gastrointestinal (GI) tract. Imaging biomarkers have the potential to provide relevant clinical information about pathologic processes beyond lesion morphology. NETs are a group of rare, heterogeneous neoplasms classified by World Health Organization (WHO) TG, which is derived from MI and Ki-67 proliferation index. Imaging biomarkers for these pathologic features and TG may be useful. Methods Between January 2014 and April 2019, 73 unique patients with hepatic metastases from NET of the GI tract underwent DECT of the abdomen with an arterial phase were analyzed after exclusions. Using GSIViewer software (GE Healthcare, Madison, Wisconsin), elliptical regions of interest (ROIs) were placed over selected hepatic metastases by a fellowship trained abdominal radiologist. Quantitative iodine concentration (IC) data was extracted from the lesion ROIs, and the normalized IC (lesion IC/aorta IC) and relative IC (lesion IC/liver IC) for each liver were calculated. Spearman correlation was calculated for lesion mean IC, normalized IC, and relative IC to both Ki-67 proliferation and mitotic indices. Student's t-test was performed to compare lesion mean IC, normalized IC and relative IC between WHO TGs. Results There was very weak correlation between both normalized IC and relative IC for both Ki-67 proliferation and mitotic indices. A significant difference was not observed between normalized IC and relative IC to distinguish metastases from G1 and G2/3 tumors. Conclusions Our study finds limited potential for quantitative parameters from DECT to distinguish neuroendocrine hepatic metastases by WHO TG, as well as limited potential as an imaging biomarker for Ki-67 proliferation and mitotic indices in this setting. Our findings of a lack of correlation between Ki-67 and quantitative iodine parameters stands in contrast to existing literature that reports positive correlations for these parameters in the rectum and stomach.
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Affiliation(s)
| | - Usman Mahmood
- Department of Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Viktoriya Paroder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Iva Petkovska
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jinru Shia
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Karuna Ganesh
- Molecular Pharmacology Program and Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David D B Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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19
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Oh JH, Apte AP, Katsoulakis E, Riaz N, Hatzoglou V, Yu Y, Mahmood U, Veeraraghavan H, Pouryahya M, Iyer A, Shukla-Dave A, Tannenbaum A, Lee NY, Deasy JO. Reproducibility of radiomic features using network analysis and its application in Wasserstein k-means clustering. J Med Imaging (Bellingham) 2021; 8:031904. [PMID: 33954225 PMCID: PMC8085581 DOI: 10.1117/1.jmi.8.3.031904] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 04/02/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose: The goal of this study is to develop innovative methods for identifying radiomic features that are reproducible over varying image acquisition settings. Approach: We propose a regularized partial correlation network to identify reliable and reproducible radiomic features. This approach was tested on two radiomic feature sets generated using two different reconstruction methods on computed tomography (CT) scans from a cohort of 47 lung cancer patients. The largest common network component between the two networks was tested on phantom data consisting of five cancer samples. To further investigate whether radiomic features found can identify phenotypes, we propose a k -means clustering algorithm coupled with the optimal mass transport theory. This approach following the regularized partial correlation network analysis was tested on CT scans from 77 head and neck squamous cell carcinoma (HNSCC) patients in the Cancer Imaging Archive (TCIA) and validated using an independent dataset. Results: A set of common radiomic features was found in relatively large network components between the resultant two partial correlation networks resulting from a cohort of lung cancer patients. The reliability and reproducibility of those radiomic features were further validated on phantom data using the Wasserstein distance. Further analysis using the network-based Wasserstein k -means algorithm on the TCIA HNSCC data showed that the resulting clusters separate tumor subsites as well as HPV status, and this was validated on an independent dataset. Conclusion: We showed that a network-based analysis enables identifying reproducible radiomic features and use of the selected set of features can enhance clustering results.
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Affiliation(s)
- Jung Hun Oh
- Memorial Sloan Kettering Cancer Center, Department of Medical Physics, New York, United States
| | - Aditya P Apte
- Memorial Sloan Kettering Cancer Center, Department of Medical Physics, New York, United States
| | - Evangelia Katsoulakis
- Veterans Affairs, James A Haley, Department of Radiation Oncology, Tampa, Florida, United States
| | - Nadeem Riaz
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York, United States
| | - Vaios Hatzoglou
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, United States
| | - Yao Yu
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York, United States
| | - Usman Mahmood
- Memorial Sloan Kettering Cancer Center, Department of Medical Physics, New York, United States
| | - Harini Veeraraghavan
- Memorial Sloan Kettering Cancer Center, Department of Medical Physics, New York, United States
| | - Maryam Pouryahya
- Memorial Sloan Kettering Cancer Center, Department of Medical Physics, New York, United States
| | - Aditi Iyer
- Memorial Sloan Kettering Cancer Center, Department of Medical Physics, New York, United States
| | - Amita Shukla-Dave
- Memorial Sloan Kettering Cancer Center, Department of Medical Physics, New York, United States
| | - Allen Tannenbaum
- Stony Brook University, Department of Computer Science, Stony Brook, New York, United States.,Stony Brook University, Department of Applied Mathematics and Statistics, Stony Brook, New York, United States
| | - Nancy Y Lee
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York, United States
| | - Joseph O Deasy
- Memorial Sloan Kettering Cancer Center, Department of Medical Physics, New York, United States
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20
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Corrias G, Erta M, Sini M, Sardu C, Saba L, Mahmood U, Castellanos SH, Bates D, Mondanelli N, Thomsen B, Carollo G, Sawan P, Mannelli L. Comparison of Multimaterial Decomposition Fat Fraction with DECT and Proton Density Fat Fraction with IDEAL IQ MRI for Quantification of Liver Steatosis in a Population Exposed to Chemotherapy. Dose Response 2021; 19:1559325820984938. [PMID: 33958978 PMCID: PMC8060765 DOI: 10.1177/1559325820984938] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/20/2020] [Accepted: 12/07/2020] [Indexed: 12/25/2022] Open
Abstract
Introduction: Oncologic patients who develop chemotherapy-associated liver injury (CALI) secondary to chemotherapy treatment tend to have worse outcomes. Biopsy remains the gold standard for the diagnosis of hepatic steatosis. The purpose of this article is to compare 2 alternatives: Proton-Density-Fat-Fraction (PDFF) MRI and MultiMaterial-Decomposition (MMD) DECT. Materials and Methods: 49 consecutive oncologic patients treated with Chemotherapy underwent abdominal DECT and abdominal MRI within 2 weeks of each other. Two radiologists tracked Regions of Interest independently both in the PDFF fat maps and in the MMD DECT fat maps. Non-parametric exact Wilcoxon signed rank test and Cohen’s K were used to compare the 2 sequences and to evaluate the agreement. Results: There was no statistically significant difference in the fat fraction measured as a continuous value between PDFF and DECT between 2 readers. Within the same imaging method (PDFF) the degree of agreement based on the k coefficient between reader 1 and reader 2 is 0.88 (p-value < 0.05). Similarly, for single-source DECT(ssDECT) the degree of agreement based on the k coefficient between reader 1 and reader 2 is 0.97 (p-value < 0.05). Conclusions: The results of this study demonstrate that the hepatic fat fraction of ssDECT with MMD are not significantly different from PDFF. This could be an advantage in an oncological population that undergoes serial CT scans for follow up of chemotherapy response.
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Affiliation(s)
- Giuseppe Corrias
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Radiology, University of Cagliari, Italy
| | - Marco Erta
- Department of Radiology, University of Cagliari, Italy
| | - Marcello Sini
- Department of Radiology, University of Cagliari, Italy
| | - Claudia Sardu
- Department of Medical Science, University of Cagliari, Italy
| | - Luca Saba
- Department of Radiology, University of Cagliari, Italy
| | - Usman Mahmood
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - David Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Peter Sawan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Peter Sawan and Lorenzo Mannelli have contributed equally
| | - Lorenzo Mannelli
- IRCCS SDN, Napoli, Italy., Peter Sawan and Lorenzo Mannelli have contributed equally
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21
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Jones AK, Wunderle KA, Gress DA, Simanowith M, Zacharias-Andrews K, Dharmadhikari S, Duan X, Kim DS, Mahmood U, Mann SD, Moirano JM, Neill RA, Schoenfeld AH. A diagnostic medical physicist's guide to the American College of Radiology Fluoroscopy Dose Index Registry. J Appl Clin Med Phys 2021; 22:8-14. [PMID: 33764677 PMCID: PMC8035558 DOI: 10.1002/acm2.13227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/30/2020] [Accepted: 02/15/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- A Kyle Jones
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | | | | | - Xinhui Duan
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Usman Mahmood
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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22
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Kuht HJ, Han J, Maconachie GDE, Park SE, Lee ST, McLean R, Sheth V, Hisaund M, Dawar B, Sylvius N, Mahmood U, Proudlock FA, Gottlob I, Lim HT, Thomas MG. SLC38A8 mutations result in arrested retinal development with loss of cone photoreceptor specialization. Hum Mol Genet 2020; 29:2989-3002. [PMID: 32744312 PMCID: PMC7645707 DOI: 10.1093/hmg/ddaa166] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 01/09/2023] Open
Abstract
Foveal hypoplasia, optic nerve decussation defects and anterior segment dysgenesis is an autosomal recessive disorder arising from SLC38A8 mutations. SLC38A8 is a putative glutamine transporter with strong expression within the photoreceptor layer in the retina. Previous studies have been limited due to lack of quantitative data on retinal development and nystagmus characteristics. In this multi-centre study, a custom-targeted next generation sequencing (NGS) gene panel was used to identify SLC38A8 mutations from a cohort of 511 nystagmus patients. We report 16 novel SLC38A8 mutations. The sixth transmembrane domain is most frequently disrupted by missense SLC38A8 mutations. Ninety percent of our cases were initially misdiagnosed as PAX6-related phenotype or ocular albinism prior to NGS. We characterized the retinal development in vivo in patients with SLC38A8 mutations using high-resolution optical coherence tomography. All patients had severe grades of arrested retinal development with lack of a foveal pit and no cone photoreceptor outer segment lengthening. Loss of foveal specialization features such as outer segment lengthening implies reduced foveal cone density, which contributes to reduced visual acuity. Unlike other disorders (such as albinism or PAX6 mutations) which exhibit a spectrum of foveal hypoplasia, SLC38A8 mutations have arrest of retinal development at an earlier stage resulting in a more under-developed retina and severe phenotype.
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Affiliation(s)
- Helen J Kuht
- The University of Leicester Ulverscroft Eye Unit, Department of Neuroscience, Psychology and Behaviour, University of Leicester – RKCSB, PO Box 65, Leicester LE2 7LX, UK
| | - Jinu Han
- Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Gail D E Maconachie
- The University of Leicester Ulverscroft Eye Unit, Department of Neuroscience, Psychology and Behaviour, University of Leicester – RKCSB, PO Box 65, Leicester LE2 7LX, UK
- Academic Unit of Ophthalmology and Orthoptics, University of Sheffield, Sheffield S10 2RX, UK
| | - Sung Eun Park
- Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Seung-Tae Lee
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Rebecca McLean
- The University of Leicester Ulverscroft Eye Unit, Department of Neuroscience, Psychology and Behaviour, University of Leicester – RKCSB, PO Box 65, Leicester LE2 7LX, UK
| | - Viral Sheth
- The University of Leicester Ulverscroft Eye Unit, Department of Neuroscience, Psychology and Behaviour, University of Leicester – RKCSB, PO Box 65, Leicester LE2 7LX, UK
| | - Michael Hisaund
- The University of Leicester Ulverscroft Eye Unit, Department of Neuroscience, Psychology and Behaviour, University of Leicester – RKCSB, PO Box 65, Leicester LE2 7LX, UK
| | - Basu Dawar
- The University of Leicester Ulverscroft Eye Unit, Department of Neuroscience, Psychology and Behaviour, University of Leicester – RKCSB, PO Box 65, Leicester LE2 7LX, UK
| | - Nicolas Sylvius
- Department of Genetics and Genome Biology, University of Leicester, Leicester LE1 7RH, UK
| | - Usman Mahmood
- Department of Ophthalmology, Hull and East Yorkshire Hospitals NHS Trust, Hull HU3 2JZ, UK
| | - Frank A Proudlock
- The University of Leicester Ulverscroft Eye Unit, Department of Neuroscience, Psychology and Behaviour, University of Leicester – RKCSB, PO Box 65, Leicester LE2 7LX, UK
| | - Irene Gottlob
- The University of Leicester Ulverscroft Eye Unit, Department of Neuroscience, Psychology and Behaviour, University of Leicester – RKCSB, PO Box 65, Leicester LE2 7LX, UK
| | - Hyun Taek Lim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Mervyn G Thomas
- The University of Leicester Ulverscroft Eye Unit, Department of Neuroscience, Psychology and Behaviour, University of Leicester – RKCSB, PO Box 65, Leicester LE2 7LX, UK
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23
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Abstract
OBJECTIVE. Patient-specific organ and effective dose provides essential information for CT protocol optimization. However, such information is not readily available in the scan records. The purpose of this study was to develop a method to obtain accurate examination- and patient-specific organ and effective dose estimates by use of available scan data and patient body size information for a large cohort of patients. MATERIALS AND METHODS. The data were randomly collected for 1200 patients who underwent CT in a 2-year period. Physical characteristics of the patients and CT technique were processed as inputs for the dose estimator. Organ and effective doses were estimated by use of the inputs and computational human phantoms matched to patients on the basis of sex and effective diameter. Size-based ratios were applied to correct for patient-phantom body size differences. RESULTS. Patients received a mean of 59.9 mGy to the lens of the eye per brain scan, 10.1 mGy to the thyroid per chest scan, 17.5 mGy to the liver per abdomen and pelvis scan, and 19.0 mGy to the liver per body scan. A factor of 2 difference in dose estimates was observed between patients of various habitus. CONCLUSION. Examination- and patient-specific organ and effective doses were estimated for 1200 adult oncology patients undergoing CT. The dose conversion factors calculated facilitate rapid organ and effective dose estimation in clinics. Compared with nonspecific dose estimation methods, patient dose estimations with data specific to the patient and examination can differ by a factor of 2.
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Affiliation(s)
- Yiming Gao
- Department of Medical Physics, Box 84, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Usman Mahmood
- Department of Medical Physics, Box 84, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Tianyu Liu
- Department of Mechanical, Aerospace, and Nuclear Engineering, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
| | - Brian Quinn
- Department of Medical Physics, Box 84, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Marc J. Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - X. George Xu
- Department of Mechanical, Aerospace, and Nuclear Engineering, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
| | - Lawrence T. Dauer
- Department of Medical Physics, Box 84, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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24
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Quinn BM, Gao Y, Mahmood U, Pandit-Taskar N, Behr G, Zanzonico P, Dauer LT. Patient-adapted organ absorbed dose and effective dose estimates in pediatric 18F-FDG positron emission tomography/computed tomography studies. BMC Med Imaging 2020; 20:9. [PMID: 31996149 PMCID: PMC6988339 DOI: 10.1186/s12880-020-0415-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/21/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Organ absorbed doses and effective doses can be used to compare radiation exposure among medical imaging procedures, compare alternative imaging options, and guide dose optimization efforts. Individual dose estimates are important for relatively radiosensitive patient populations such as children and for radiosensitive organs such as the eye lens. Software-based dose calculation methods conveniently calculate organ dose using patient-adjusted and examination-specific inputs. METHODS Organ absorbed doses and effective doses were calculated for 429 pediatric 18F-FDG PET-CT patients. Patient-adjusted and scan-specific information was extracted from the electronic medical record and scanner dose-monitoring software. The VirtualDose and OLINDA/EXM (version 2.0) programs, respectively, were used to calculate the CT and the radiopharmaceutical organ absorbed doses and effective doses. Patients were grouped according to age at the time of the scan as follows: less than 1 year old, 1 to 5 years old, 6 to 10 years old, 11 to 15 years old, and 16 to 17 years old. RESULTS The mean (+/- standard deviation, range) total PET plus CT effective dose was 14.5 (1.9, 11.2-22.3) mSv. The mean (+/- standard deviation, range) PET effective dose was 8.1 (1.2, 5.7-16.5) mSv. The mean (+/- standard deviation, range) CT effective dose was 6.4 (1.8, 2.9-14.7) mSv. The five organs with highest PET dose were: Urinary bladder, heart, liver, lungs, and brain. The five organs with highest CT dose were: Thymus, thyroid, kidneys, eye lens, and gonads. CONCLUSIONS Organ and effective dose for both the CT and PET components can be estimated with actual patient and scan data using commercial software. Doses calculated using software generally agree with those calculated using dose conversion factors, although some organ doses were found to be appreciably different. Software-based dose calculation methods allow patient-adjusted dose factors. The effort to gather the needed patient data is justified by the resulting value of the characterization of patient-adjusted dosimetry.
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Affiliation(s)
- Brian M Quinn
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Yiming Gao
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Usman Mahmood
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Neeta Pandit-Taskar
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Gerald Behr
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Pat Zanzonico
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.,Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Lawrence T Dauer
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.,Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
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25
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Corrias G, Sawan P, Mahmood U, Zheng J, Capanu M, Salvatore M, Spinato G, Saba L, Mannelli L. Dual energy computed tomography analysis in cancer patients: What factors affect iodine concentration in contrast enhanced studies? Eur J Radiol 2019; 120:108698. [PMID: 31600640 DOI: 10.1016/j.ejrad.2019.108698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 03/06/2019] [Revised: 08/28/2019] [Accepted: 09/26/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE The aim of the study is to explore the patient's and scan's parameters that affect the iodine concentration in the abdomen using dual energy computed tomography (DECT) in an oncologic population. METHOD This is a retrospective study with consecutive patients with different cancers who underwent a single-source DECT (ssDECT) examinations at our institution between years 2015 and 2017. On axial IODINE images, the radiologist manually drew a circular ROI along the inner contour of the aorta. Mean iodine concentration and ROI areas were recorded. Body mass index for every patient was recorded. Descriptive statistics were summarized for iodine concentration and patient/scan characteristics. Linear regression was used to examine associations between iodine concentration in aorta and studied characteristics. Statistical significance was set at a p value < 0.05. RESULTS The univariate analysis, showed a statistically significant association between iodine concentration within the aorta and the area of ROI (Estimated Coefficient β: -0.013), the rate of injection (Estimated Coefficient β: 2.09), the acquisition time (Estimated Coefficient β: -0.195). In multivariable analysis iodine concentration in the aorta increased with higher rate of injection (4 ml/sec), smaller ROI area and lower BMI. CONCLUSION Our results showed how iodine concentration is highly dependent on some intrinsic and extrinsic parameters of the examination. These parameters should be taken into account since lower concentration of iodine decrease contrast-to-noise ratio, and in longitudinal follow up studies, they would affect iodine quantitive assessments in cancer patients with frequent chemotherapy-induced variations in BMI and cardiac function.
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Affiliation(s)
- Giuseppe Corrias
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA; Department of Radiology, University of Cagliari, Via Università, 40, 09124, Cagliari, CA, Italy
| | - Peter Sawan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Usman Mahmood
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Junting Zheng
- Department of Statistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Marinela Capanu
- Department of Statistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | | | - Giacomo Spinato
- Department of Neurosciences, Section of Otolaryngology and Regional Centre for Head and Neck Cancer, University of Padova, Treviso, Italy; Department of Surgery, Oncology and Gastroenterology, Section of Oncology and Immunology, University of Padova, Padova, Italy
| | - Luca Saba
- Department of Radiology, University of Cagliari, Via Università, 40, 09124, Cagliari, CA, Italy
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26
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Bang A, Mahmood U, Chen Y, Mak R, Lorch J, Hanna G, Sridharan V, Busse P, Willers H, Mamon H, Yoo H, Pai S, Wirth L, Haddad R, Chau N, Schoenfeld J. Local Control following Combination Hypofractionated Radiotherapy and Pembrolizumab in A Phase II Trial of Recurrent or Metastatic Adenoid Cystic Carcinoma Patients. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1700] [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: 11/17/2022]
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27
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Philip N, Pugh T, Ye R, Hwang H, Wang X, Shah S, Choi S, Mahmood U, Nguyen Q, Chun S, Mayo L, Lee A, Tang C, Anscher M, Hoffman K, Kuban D, Davis J, Troncoso P, Choi H, Frank S. A Phase II trial of Hypofractionated Proton Therapy in Prostate Cancer: 3-year Physician and Patient Reported Outcomes. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1857] [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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28
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Ahn S, Choi M, Kim H, Yang EJ, Mahmood U, Kang SI, Shin HW, Kim DW, Kim HS. Transient Anosmia Induces Depressive-like and Anxiolytic-like Behavior and Reduces Amygdalar Corticotropin-Releasing Hormone in a ZnSO4-Induced Mouse Model. Chem Senses 2019; 43:213-221. [PMID: 29438489 DOI: 10.1093/chemse/bjy008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Olfactory loss is known to affect both mood and quality of life. Transient anosmia was induced in mice to study the resulting changes in mood, behavior, and on a molecular level. Transient anosmia was induced by a single intranasal instillation of ZnSO4 in BALB/c mice. Hematoxylin and eosin (HE) staining, and potato chip finding test were performed to confirm olfactory loss. Tail suspension, forced swim, and splash tests were performed to evaluate depression-related behavior; while the open field, and elevated plus maze tests were used to evaluate anxiety-related behavior. The mRNA levels of amygdalar corticotropin-releasing hormone (CRH) and hypothalamic glucocorticoid receptor (GR) were quantified using real-time PCR to confirm relevant molecular change. Olfactory loss was confirmed 1-2.5 weeks after induction, and this loss was subsequently reversed over time. The results of the behavioral tests indicated increased depression-like and reduced anxiety-like behavior at week 1. Accordingly, PCR data identified decreased amygdalar CRH expression at week 1. These results suggest that transient anosmia induces both depressive and anxiolytic behavior as a result of decreased amygdalar CRH in a mouse model of anosmia.
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Affiliation(s)
- Sangzin Ahn
- Department of Pharmacology and Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Pharmacology, Inje University College of Medicine, Busan, Republic of Korea
| | - Mooseok Choi
- Department of Pharmacology and Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyunju Kim
- Department of Pharmacology and Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun-Jeong Yang
- Department of Pharmacology and Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Usman Mahmood
- Interdisciplinary Program in Brain Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
| | - Seong-Il Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Woo Shin
- Department of Pharmacology and Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dae Woo Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hye-Sun Kim
- Department of Pharmacology and Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Seoul National University Bundang Hospital, Seoul National University College of Medicine, Sungnam, Republic of Korea
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29
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Skourou C, Sherouse GW, Bahar N, Bauer LA, Fairobent L, Freedman DJ, Genovese LM, Halvorsen PH, Kirby NA, Mahmood U, Ozturk N, Osterman KS, Serago CF, Svatos MM, Wilson ML. Code of ethics for the American Association of Physicists in Medicine (Revised): Report of Task Group 109. Med Phys 2019; 46:e79-e93. [PMID: 30570754 DOI: 10.1002/mp.13351] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 08/10/2018] [Revised: 10/01/2018] [Accepted: 10/05/2018] [Indexed: 11/08/2022] Open
Abstract
The American Association of Physicists in Medicine (AAPM) has established a comprehensive Code of Ethics for its members. The Code is a formal part of AAPM governance, maintained as Professional Policy 24, and includes both principles of ethical practice and the rules by which a complaint will be adjudicated. The structure and content of the Code have been crafted to also serve the much broader purpose of giving practical ethical guidance to AAPM members for making sound decisions in their professional lives. The Code is structured in four major parts: a Preamble, a set of ten guiding Principles, Guidelines that elucidate the application of the Principles in various practice settings, and the formal Complaint process. Guidelines have been included to address evolving social and cultural norms, such as the use of social media and the broadening scope of considerations important in an evolving workplace. The document presented here is the first major revision of the AAPM Code of Ethics since 2008. This revision was approved by the Board of Directors to become effective 1 January 2019.
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Affiliation(s)
- Christina Skourou
- St. Luke's Radiation Oncology Centre, Beaumont Hospital, Beaumont, Dublin 9, Ireland
| | | | - Nina Bahar
- Landauer Medical Physics, Charlotte, NC, 28204, USA
| | - Linda A Bauer
- Greenville Hospital Systems, Greenville, SC, 29605, USA
| | | | | | - Lisa M Genovese
- Krueger-Gilbert Health Physics, Inc., Towson, MD, 21286, USA
| | | | - Neil A Kirby
- University of Texas Health Science Center San Antonio, San Antonio, TX, 78229, USA
| | - Usman Mahmood
- Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Naim Ozturk
- The University of Chicago, Chicago, IL, 60637, USA
| | | | | | | | - Melissa L Wilson
- MHP Radiation Oncology Institute, Farmington Hills, MI, 48334, USA
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30
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Yang EJ, Mahmood U, Kim H, Choi M, Choi Y, Lee JP, Cho JY, Hyun JW, Kim YS, Chang MJ, Kim HS. Phloroglucinol ameliorates cognitive impairments by reducing the amyloid β peptide burden and pro-inflammatory cytokines in the hippocampus of 5XFAD mice. Free Radic Biol Med 2018; 126:221-234. [PMID: 30118828 DOI: 10.1016/j.freeradbiomed.2018.08.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 08/10/2018] [Accepted: 08/13/2018] [Indexed: 01/29/2023]
Abstract
Among the various causative factors involved in the pathogenesis of Alzheimer's disease (AD), oxidative stress has emerged as an important factor. Phloroglucinol is a polyphenol component of phlorotannin, which is found at sufficient levels in Ecklonia cava (E. cava). Phloroglucinol has been reported to exert antioxidant activities in various tissues. Previously, we reported that the stereotaxic injection of phloroglucinol regulated synaptic plasticity in an AD mouse model. In this study, we aimed to investigate the effects of oral administration of phloroglucinol in AD. The oral administration of phloroglucinol for 2 months attenuated the impairments in cognitive function observed in 6-month-old 5X familial AD (5XFAD) mice, as assessed with the T-maze and Y-maze tests. The administration of phloroglucinol for 2 months in 5XFAD mice caused a reduction in the number of amyloid plaques and in the protein level of BACE1, a major amyloid precursor protein cleavage enzyme, together with γ-secretase. Phloroglucinol also restored the reduction in dendritic spine density and the number of mature spines in the hippocampi of 5XFAD mice. In addition, phloroglucinol-administered 5XFAD mice displayed lower protein levels of GFAP and Iba-1 and mRNA levels of TNF-α and IL-6 compared with vehicle-administered 5XFAD mice. These results demonstrated that phloroglucinol alleviated the neuropathological features and behavioral phenotypes in the 5XFAD mouse model. Taken together, our results suggest that phloroglucinol has therapeutic potential for AD treatment.
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Affiliation(s)
- Eun-Jeong Yang
- Department of Pharmacology, Seoul National University, College of Medicine, 103 Daehakro, Jongro-gu, Seoul 03080, Republic of Korea; Department of Biomedical Sciences, Seoul National University, College of Medicine, 103 Daehakro, Jongro-gu, Seoul 03080, Republic of Korea
| | - Usman Mahmood
- Department of Pharmacology, Seoul National University, College of Medicine, 103 Daehakro, Jongro-gu, Seoul 03080, Republic of Korea
| | - Hyunju Kim
- Department of Pharmacology, Seoul National University, College of Medicine, 103 Daehakro, Jongro-gu, Seoul 03080, Republic of Korea; Department of Biomedical Sciences, Seoul National University, College of Medicine, 103 Daehakro, Jongro-gu, Seoul 03080, Republic of Korea
| | - Moonseok Choi
- Department of Pharmacology, Seoul National University, College of Medicine, 103 Daehakro, Jongro-gu, Seoul 03080, Republic of Korea; Department of Biomedical Sciences, Seoul National University, College of Medicine, 103 Daehakro, Jongro-gu, Seoul 03080, Republic of Korea
| | - Yunjung Choi
- Department of Pharmacology, Seoul National University, College of Medicine, 103 Daehakro, Jongro-gu, Seoul 03080, Republic of Korea; Department of Biomedical Sciences, Seoul National University, College of Medicine, 103 Daehakro, Jongro-gu, Seoul 03080, Republic of Korea
| | - Jean-Pyo Lee
- Department of Physiology, Center for Stem Cell Research and Regenerative Medicine, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA 70112, USA
| | - Joo-Youn Cho
- Department of Clinical Pharmacology & Therapeutics, College of Medicine, Seoul National University and Hospital, 103 Daehakro, Jongro-gu, Seoul 03080, Republic of Korea
| | - Jin Won Hyun
- Department of Biochemistry, School of Medicine, Jeju National University, Jeju 63243, Republic of Korea
| | - Yong Sik Kim
- Department of Pharmacology, Seoul National University, College of Medicine, 103 Daehakro, Jongro-gu, Seoul 03080, Republic of Korea
| | - Moon-Jeong Chang
- Department of Foods and Nutrition, College of Natural Science, Kookmin University, Seoul 02707, Republic of Korea.
| | - Hye-Sun Kim
- Department of Pharmacology, Seoul National University, College of Medicine, 103 Daehakro, Jongro-gu, Seoul 03080, Republic of Korea; Department of Biomedical Sciences, Seoul National University, College of Medicine, 103 Daehakro, Jongro-gu, Seoul 03080, Republic of Korea; Seoul National University Bundang Hospital, Seongnam, Sungnam, Bundang-Gu 13620, Republic of Korea; Neuroscience Research Institute, Seoul National University, College of Medicine, 103 Daehakro, Jongro-gu, Seoul 03080, Republic of Korea.
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Hanna G, Supplee J, Kuang Y, Mahmood U, Lau C, Haddad R, Jänne P, Paweletz C. Plasma HPV cell-free DNA monitoring in advanced HPV-associated oropharyngeal cancer. Ann Oncol 2018; 29:1980-1986. [DOI: 10.1093/annonc/mdy251] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Amalou H, Xu S, Sajjadi A, Heidari P, Li M, Suh R, Mahmood U, Wood B. 3:18 PM Abstract No. 213 Real-time biopsy system for combined optical spectroscopy and electromagnetic tracking. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.239] [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] Open
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Mahmood U, Horvat N, Horvat JV, Ryan D, Gao Y, Carollo G, DeOcampo R, Do RK, Katz S, Gerst S, Schmidtlein CR, Dauer L, Erdi Y, Mannelli L. Rapid switching kVp dual energy CT: Value of reconstructed dual energy CT images and organ dose assessment in multiphasic liver CT exams. Eur J Radiol 2018; 102:102-108. [PMID: 29685522 DOI: 10.1016/j.ejrad.2018.02.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 06/30/2017] [Revised: 01/13/2018] [Accepted: 02/14/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE Clinical applications of dual energy computed tomography (DECT) have been widely reported; however, the importance of the different image reconstructions and radiation organ dose remains a relevant area of investigation, particularly considering the different commercially available DECT equipment. Therefore, the purpose of this study was to assess the image reliability and compare the information content between several image reconstructions in a rapid-switching DECT (rsDECT), and assess radiation organ dose between rsDECT and conventional single-energy computed tomography (SECT) exams. MATERIALS AND METHODS This Institutional Review Board-approved retrospective study included 98 consecutive patients who had a history of liver cancer and underwent multiphasic liver CT exams with rsDECT applied during the late arterial phase between June 2015 and December 2015. Virtual monochromatic 70 keV, material density images (MDI) iodine (-water) and virtual unenhanced (VUE) images were generated. Radiation dose analysis was performed in a subset of 44 patients who had also undergone a multiphasic SECT examination within 6 months of the rsDECT. Four board-certified abdominal radiologists reviewed 24-25 patients each, and a fifth radiologist re-evaluated all the scans to reach a consensus. The following imaging aspects were assessed by the radiologists: (a) attenuation measurements were made in the liver and spleen in VUE and true unenhanced (TUE) images; (b) subjective evaluation for lesion detection and conspicuity on MDI iodine (-water)/VUE images compared with the virtual monochromatic images/TUE images; and (c) overall image quality using a five-point Likert scale. The radiation dose analyses were evaluated in the subset of 44 patients regarding the following parameters: CTDIvol, dose length product, patient's effective diameter and organ dose using a Monte Carlo-based software, VirtualDose™ (Virtual Phantoms, Inc.) to 21 organs. RESULTS On average, image noise on the TUE images was 49% higher within the liver (p < 0.0001) and 48% higher within the spleen (p < 0.0001). CT numbers for the spleen were significantly higher on VUE images (p < 0.0001). Twenty-eight lesions in 24/98 (24.5%) patients were not observed on the VUE images. The conspicuity of vascular anatomy was considered better on MDI iodine (-water) Images 26.5% of patients. Using the Likert scale, the rsDECT image quality was considered to be satisfactory. Considering the subset of 44 patients with recent SECT, the organ dose was, on average, 37.4% less with rsDECT. As the patient's effective diameter decreased, the differences in dose between the rsDECT and SECT increased, with the total average organ dose being less by 65.1% when rsDECT was used. CONCLUSION VUE images in the population had lower image noise than TUE images; however, a few small and hyperdense findings were not characterized on VUE images. Delineation of vascular anatomy was considered better in around a quarter of patients on MDI iodine (-water) images. Finally, radiation dose, particularly organ dose, was found to be lower with rsDECT, especially in smaller patients.
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Affiliation(s)
- Usman Mahmood
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
| | - Natally Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
| | - Joao Vicente Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
| | - Davinia Ryan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
| | - Yiming Gao
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
| | - Gabriella Carollo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
| | - Rommel DeOcampo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
| | - Richard K Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
| | - Seth Katz
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
| | - Scott Gerst
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
| | - C Ross Schmidtlein
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
| | - Lawrence Dauer
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
| | - Yusuf Erdi
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
| | - Lorenzo Mannelli
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
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Gao Y, Quinn B, Pandit-Taskar N, Behr G, Mahmood U, Long D, Xu XG, St Germain J, Dauer LT. Patient-specific organ and effective dose estimates in pediatric oncology computed tomography. Phys Med 2018; 45:146-155. [PMID: 29472080 PMCID: PMC5828028 DOI: 10.1016/j.ejmp.2017.12.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/27/2017] [Accepted: 12/15/2017] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Estimate organ and effective doses from computed tomography scans of pediatric oncologic patients using patient-specific information. MATERIALS AND METHODS With IRB approval patient-specific scan parameters and patient size obtained from DICOM images and vendor-provided dose monitoring application were obtained for a cross-sectional study of 1250 pediatric patients from 0 through 20 y-olds who underwent head, chest, abdomen-pelvis, or chest-abdomen-pelvis CT scans. Patients were categorized by age. Organ doses and effective doses were estimated using VirtualDose™ CT based on patient-specific information, tube current modulation (TCM), and age-specific realistic phantoms. CTDIvol, DLP, and dose results were compared with those reported in the literature. RESULTS CTDIvol and DLP varied widely as patient size varied. The 75th percentiles of CTDIvol and DLP were no greater than in the literature with the exception of head scans of 16-20 y-olds and of abdomen-pelvis scans of larger patients. Eye lens dose from a head scan was up to 69 mGy. Mean organ doses agreed with other studies at maximal difference of 38% for chest and 41% for abdomen-pelvis scans. Mean effective dose was generally higher for older patients. The highest effective doses were estimated for the 16-20 y-olds as: head 3.3 mSv, chest 4.1 mSv, abdomen-pelvis 10.0 mSv, chest-abdomen-pelvis 14.0 mSv. CONCLUSION Patient-specific organ and effective doses have been estimated for pediatric oncologic patients from <1 through 20 y-olds. The effect of TCM was successfully accounted for in the estimates. Output parameters varied with patient size. CTDIvol and DLP results are useful for future protocol optimization.
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Affiliation(s)
- Yiming Gao
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Brian Quinn
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Neeta Pandit-Taskar
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Gerald Behr
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Usman Mahmood
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Daniel Long
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - X George Xu
- Department of Mechanical, Aerospace, and Nuclear Engineering, Rensselaer Polytechnic Institute, Troy, NY 12180, USA.
| | - Jean St Germain
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Lawrence T Dauer
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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Mahmood U, Healy HG, Kark A, Cameron A, Wang Z, Abeysekera R, Hoy WE. Spectrum (characteristics) of patients with chronic kidney disease (CKD) with increasing age in a major metropolitan renal service. BMC Nephrol 2017; 18:372. [PMID: 29282014 PMCID: PMC5745771 DOI: 10.1186/s12882-017-0781-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 03/12/2017] [Accepted: 12/07/2017] [Indexed: 11/26/2022] Open
Abstract
Background Aim of our study is to describe, in people with CKD, the demographic and clinical characteristics and outcomes with increasing age. The prevalence of CKD in Western populations, where longevity is the norm, is about 10–15%, but how age influence different characteristics of patients with CKD is largely not known. Methods One thousand two hundred sixty-five patients enrolled in the CKD.QLD registry at the Royal Brisbane and Women’s Hospital were grouped according to age at consent i.e. <35, 35–44, 45–54, 55–64, 65–74, 75–84, 85+ years age groups, and were followed till start of renal replacement therapy (RRT), death, discharge or the censor date of September 2015. Results Age ranged from 17.6 to 98.5 years with medians of 70.1 and 69.9 years for males and females respectively: 7% were <35 years of age, with the majority (63%) >65 years old. The leading renal diagnoses changed from genetic real disease (GRD) and glomerulonephritis (GN) in the younger patients to renovascular disease (RVD) and hypertension (HTN) in older patients. With increasing age, there were often multiple renal disease diagnoses, more advanced stages of CKD, greater number of comorbidities, more frequent and more costly hospitalizations, and higher death rates. The rates of initiation of renal replacement therapy (RRT) rose from 4.5 per 100 person years in those age < 35 years to a maximum of 5.5 per 100 person years in 45–54 years age group and were lowest, at 0.5 per 100 person years in those >85 years. Mortality rates increased by age group from 1.3 to 17.0 per 100 person years in 35–44 year and 85+ year age groups respectively. Rates of hospitalization, length of stay and cost progressively increased from the youngest to eldest groups. Patients with diabetic nephropathy had highest incidence rate of RRT and death. The proportion of patients who lost more than 5mls/min/1.73m2 of eGFR during at least 12 months follow up increased from 13.3% in the youngest age group to 29.2% in the eldest. Conclusion This is the first comprehensive view, with no exclusions, of CKD patients seen in a public renal specialty referral practice, in Australia. The age distribution of patients encompasses the whole of adult life, with a broader range and higher median value than patients receiving RRT. Health status ranged from a single system (renal) disease in young adults through, with advancing age, renal impairment as a component of, or accompanying multisystem diseases, to demands and complexities of support of frail or elderly people approaching end of life. This great spectrum demands a broad understanding and capacity of renal health care providers, and dictates a need for a wider scope of health services provision incorporating multiple models of care.
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Affiliation(s)
- Usman Mahmood
- Kidney Health Services, Metro North Hospital and Health Service, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia. .,NHMRC CKD.CRE & CKD.QLD, Brisbane, QLD, Australia. .,Toowoomba Hospital, Toowoomba, QLD, Australia.
| | - Helen G Healy
- Kidney Health Services, Metro North Hospital and Health Service, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia.,NHMRC CKD.CRE & CKD.QLD, Brisbane, QLD, Australia
| | - Adrian Kark
- Kidney Health Services, Metro North Hospital and Health Service, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia.,NHMRC CKD.CRE & CKD.QLD, Brisbane, QLD, Australia
| | - Anne Cameron
- Kidney Health Services, Metro North Hospital and Health Service, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia.,NHMRC CKD.CRE & CKD.QLD, Brisbane, QLD, Australia.,Centre for Chronic Disease, University of Queensland, Brisbane, Australia
| | - Zaimin Wang
- NHMRC CKD.CRE & CKD.QLD, Brisbane, QLD, Australia.,Centre for Chronic Disease, University of Queensland, Brisbane, Australia
| | - Rajitha Abeysekera
- Kidney Health Services, Metro North Hospital and Health Service, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia.,NHMRC CKD.CRE & CKD.QLD, Brisbane, QLD, Australia
| | - Wendy E Hoy
- NHMRC CKD.CRE & CKD.QLD, Brisbane, QLD, Australia.,Centre for Chronic Disease, University of Queensland, Brisbane, Australia
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Mahmood U, Ahn S, Yang EJ, Choi M, Kim H, Regan P, Cho K, Kim HS. Dendritic spine anomalies and PTEN alterations in a mouse model of VPA-induced autism spectrum disorder. Pharmacol Res 2017; 128:110-121. [PMID: 28823725 DOI: 10.1016/j.phrs.2017.08.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 08/08/2017] [Accepted: 08/12/2017] [Indexed: 11/18/2022]
Abstract
Mounting evidence suggests that the etiology of autism spectrum disorders (ASDs) is profoundly influenced by exposure to environmental factors, although the precise molecular and cellular links remain ill-defined. In this study, we examined how exposure to valproic acid (VPA) during pregnancy is associated with an increased incidence of ASD. A mouse model was established by injecting VPA at embryonic day 13, and its behavioral phenotypes including impaired social interaction, increased repetitive behaviors and decreased nociception were observed at postnatal days 21-42. VPA-treated mice showed dysregulation of synaptic structure in cortical neurons, including a reduced proportion of filopodium-type and stubby spines and increased proportions of thin and mushroom-type spines, along with a decreased spine head size. We also found that VPA-treatment led to decreased expression of phosphate and tensin homolog (PTEN) and increased levels of p-AKT protein in the hippocampus and cortex. Our data suggest that there is a correlation between VPA exposure and dysregulation of PTEN with ASD-like behavioral and neuroanatomical changes, and this may be a potential mechanism of VPA-induced ASD.
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Affiliation(s)
- Usman Mahmood
- Interdisciplinary Program in Brain Sciences, Seoul National University College of Natural Sciences, Seoul, 08826, Republic of Korea
| | - Sangzin Ahn
- Department of Pharmacology and Biomedical Sciences, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea; Present address: Department of Pharmacology, Inje University College of Medicine, Busan, 47392, Republic of Korea
| | - Eun-Jeong Yang
- Department of Pharmacology and Biomedical Sciences, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Moonseok Choi
- Department of Pharmacology and Biomedical Sciences, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Hyunju Kim
- Department of Pharmacology and Biomedical Sciences, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Philip Regan
- School of Clinical Sciences, Faculty of Health Sciences, University of Bristol, Whitson Street, Bristol BS1 3NY, United Kingdom
| | - Kwangwook Cho
- School of Clinical Sciences, Faculty of Health Sciences, University of Bristol, Whitson Street, Bristol BS1 3NY, United Kingdom
| | - Hye-Sun Kim
- Interdisciplinary Program in Brain Sciences, Seoul National University College of Natural Sciences, Seoul, 08826, Republic of Korea; Department of Pharmacology and Biomedical Sciences, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea; Seoul National University Bundang Hospital, Seoul National University College of Medicine, Sungnam, 13620, Republic of Korea.
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Lee J, Mott N, Mahmood U, Clouston J, Summers K, Nicholas P, Gois PHF, Ranganathan D. Radiological Tenckhoff catheter insertion for peritoneal dialysis: A cost-effective approach. J Med Imaging Radiat Oncol 2017; 62:174-178. [PMID: 28762670 DOI: 10.1111/1754-9485.12643] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 06/16/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Radiological insertion of Tenckhoff catheters can be an alternative option for peritoneal dialysis access creation, as compared to surgical catheter insertion. This study will review the outcomes and complications of radiological Tenckhoff catheter insertion in a metropolitan renal service and compare costs between surgical and radiological insertion. METHODS Data were collected prospectively for all patients who had a Tenckhoff catheter insertion for peritoneal dialysis (PD) under radiological guidance at our hospital from May 2014 to November 2016. The type of catheter used and complications, including peri-catheter leak, exit site infection and peritonitis were reviewed. Follow-up data were also collected at points 3, 6 and 12 months from catheter insertion. Costing data were obtained from Queensland Health Electronic Reporting System (QHERS) data, average staff salaries and consumable contract price lists. RESULTS In the 30-month evaluation period, 70 catheters were inserted. Two patients had an unsuccessful procedure due to the presence of abdominal adhesions. Seven patients had an episode of peri-catheter leak, and four patients had an exit site infection following catheter insertion. Peritonitis was observed in nine patients during the study period. The majority of patients (90%) remained on peritoneal dialysis at 3-month follow-up. The average costs of surgical and radiological insertion were noted to be AUD$7788.34 and AUD$1597.35, respectively. CONCLUSION Radiological Tenckhoff catheter insertion for peritoneal dialysis appears to be an attractive and cost-effective option given less waiting periods for the procedure, the relatively low cost of insertion and comparable rates of complications.
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Affiliation(s)
- James Lee
- Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Nigel Mott
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Usman Mahmood
- Toowoomba Health Service, Toowoomba, Queensland, Australia
| | - John Clouston
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Kara Summers
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Pauline Nicholas
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | | | - Dwarakanathan Ranganathan
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Griffith School of Medicine, Gold Coast, Queensland, Australia
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Holliday EB, Kuban DA, Levy LB, Bolukbasi Y, Master P, Choi S, Nguyen Q, McGuire SE, Mahmood U, Frank SJ, Hoffman KE. Select men benefit from androgen deprivation therapy delivered with salvage radiation therapy after prostatectomy. Prostate Cancer Prostatic Dis 2017; 20:389-394. [PMID: 28462945 DOI: 10.1038/pcan.2017.24] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 03/07/2017] [Accepted: 03/13/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND Which men benefit most from adding androgen deprivation therapy (ADT) to salvage radiation therapy (SRT) after prostatectomy has not clearly been defined; therefore, we evaluated the impact of ADT to SRT on failure-free survival (FFS) in men with a rising or persistent PSA after prostatectomy. METHODS We identified 332 men who received SRT after prostatectomy from 1987 to 2010. Recursive partitioning analysis (RPA) identified favorable, intermediate and unfavorable groups based on the risk of failure after SRT alone. Kaplan-Meier and log-rank tests compared FFS with and without ADT. RESULTS Forty-three percent received SRT alone and 57% received SRT with ADT (median 6.6 months (interquartile range (IQR) 5.8-18.1) ADT). Median SRT dose was 70 Gy (IQR 70-70), and median follow-up after SRT was 6.7 years (IQR 4.5-10.8). On Cox's proportional hazard regression, ADT improved FFS (adjusted hazard ratio 0.60, 95% confidence interval: 0.42-0.86; P=0.006). RPA classified unfavorable disease as negative surgical margins (SMs) and preradiation PSA of ⩾0.5 ng ml-1. Favorable disease had neither adverse factor, and intermediate disease had one adverse factor. The addition of ADT to SRT improved 5-year FFS for men with unfavorable disease (70.3% vs 23.4%; P<0.001) and intermediate disease (69.8% vs 48.0%; P=0.003), but not for men with favorable disease (81.2% vs 78.0%; P=0.971). CONCLUSIONS The addition of ADT to SRT appears to improve FFS for men with a preradiation PSA of ⩾0.5 ng ml-1 or with negative SM at prostatectomy. Men with involved surgical margins and PSA <0.5 ng ml-1 appear to be at a lower risk of failure after SRT alone and may not derive as much benefit from the administration of ADT with SRT. These results are hypothesis-generating only, and further prospective data are required to see if ADT can safely be omitted in this select group of men.
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Affiliation(s)
- E B Holliday
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - D A Kuban
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L B Levy
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - P Master
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S Choi
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Q Nguyen
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S E McGuire
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - U Mahmood
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S J Frank
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - K E Hoffman
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Gao Y, Quinn B, Mahmood U, Long D, Erdi Y, St. Germain J, Pandit-Taskar N, Xu XG, Bolch WE, Dauer LT. A comparison of pediatric and adult CT organ dose estimation methods. BMC Med Imaging 2017; 17:28. [PMID: 28446130 PMCID: PMC5406971 DOI: 10.1186/s12880-017-0199-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 04/11/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Computed Tomography (CT) contributes up to 50% of the medical exposure to the United States population. Children are considered to be at higher risk of developing radiation-induced tumors due to the young age of exposure and increased tissue radiosensitivity. Organ dose estimation is essential for pediatric and adult patient cancer risk assessment. The objective of this study is to validate the VirtualDose software in comparison to currently available software and methods for pediatric and adult CT organ dose estimation. METHODS Five age groups of pediatric patients and adult patients were simulated by three organ dose estimators. Head, chest, abdomen-pelvis, and chest-abdomen-pelvis CT scans were simulated, and doses to organs both inside and outside the scan range were compared. For adults, VirtualDose was compared against ImPACT and CT-Expo. For pediatric patients, VirtualDose was compared to CT-Expo and compared to size-based methods from literature. Pediatric to adult effective dose ratios were also calculated with VirtualDose, and were compared with the ranges of effective dose ratios provided in ImPACT. RESULTS In-field organs see less than 60% difference in dose between dose estimators. For organs outside scan range or distributed organs, a five times' difference can occur. VirtualDose agrees with the size-based methods within 20% difference for the organs investigated. Between VirtualDose and ImPACT, the pediatric to adult ratios for effective dose are compared, and less than 21% difference is observed for chest scan while more than 40% difference is observed for head-neck scan and abdomen-pelvis scan. For pediatric patients, 2 cm scan range change can lead to a five times dose difference in partially scanned organs. CONCLUSIONS VirtualDose is validated against CT-Expo and ImPACT with relatively small discrepancies in dose for organs inside scan range, while large discrepancies in dose are observed for organs outside scan range. Patient-specific organ dose estimation is possible using the size-based methods, and VirtualDose agrees with size-based method for the organs investigated. Careful range selection for CT protocols is necessary for organ dose optimization for pediatric and adult patients.
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Affiliation(s)
- Yiming Gao
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 84, New York, NY 10065 USA
| | - Brian Quinn
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 84, New York, NY 10065 USA
| | - Usman Mahmood
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 84, New York, NY 10065 USA
| | - Daniel Long
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 84, New York, NY 10065 USA
| | - Yusuf Erdi
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 84, New York, NY 10065 USA
| | - Jean St. Germain
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 84, New York, NY 10065 USA
| | - Neeta Pandit-Taskar
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - X. George Xu
- Department of Mechanical, Aerospace, and Nuclear Engineering, Rensselaer Polytechnic Institute, Troy, NY 12180 USA
| | - Wesley E. Bolch
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611 USA
| | - Lawrence T. Dauer
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 84, New York, NY 10065 USA
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
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Yang EJ, Mahmood U, Kim H, Choi M, Choi Y, Lee JP, Chang MJ, Kim HS. Alterations in protein phosphorylation in the amygdala of the 5XFamilial Alzheimer's disease animal model. J Pharmacol Sci 2017; 133:261-267. [PMID: 28408165 DOI: 10.1016/j.jphs.2017.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 01/26/2017] [Revised: 03/13/2017] [Accepted: 03/21/2017] [Indexed: 12/18/2022] Open
Abstract
Alzheimer's disease is the most common disease underlying dementia in humans. Two major neuropathological hallmarks of AD are neuritic plaques primarily composed of amyloid beta peptide and neurofibrillary tangles primarily composed of hyperphosphorylated tau. In addition to impaired memory function, AD patients often display neuropsychiatric symptoms and abnormal emotional states such as confusion, delusion, manic/depressive episodes and altered fear status. Brains from AD patients show atrophy of the amygdala which is involved in fear expression and emotional processing as well as hippocampal atrophy. However, which molecular changes are responsible for the altered emotional states observed in AD remains to be elucidated. Here, we observed that the fear response as assessed by evaluating fear memory via a cued fear conditioning test was impaired in 5XFamilial AD (5XFAD) mice, an animal model of AD. Compared to wild-type mice, 5XFAD mice showed changes in the phosphorylation of twelve proteins in the amygdala. Thus, our study provides twelve potential protein targets in the amygdala that may be responsible for the impairment in fear memory in AD.
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Affiliation(s)
- Eun-Jeong Yang
- Department of Pharmacology and Biomedical Sciences, College of Medicine, Seoul National University, 103 Daehakro, Jongro-gu, Seoul, Republic of Korea.
| | - Usman Mahmood
- Department of Pharmacology and Biomedical Sciences, College of Medicine, Seoul National University, 103 Daehakro, Jongro-gu, Seoul, Republic of Korea.
| | - Hyunju Kim
- Department of Pharmacology and Biomedical Sciences, College of Medicine, Seoul National University, 103 Daehakro, Jongro-gu, Seoul, Republic of Korea.
| | - Moonseok Choi
- Department of Pharmacology and Biomedical Sciences, College of Medicine, Seoul National University, 103 Daehakro, Jongro-gu, Seoul, Republic of Korea.
| | - Yunjung Choi
- Department of Pharmacology and Biomedical Sciences, College of Medicine, Seoul National University, 103 Daehakro, Jongro-gu, Seoul, Republic of Korea.
| | - Jean-Pyo Lee
- Center for Stem Cell Research and Regenerative Medicine, Tulane University School of Medicine, 1430 Tulane Ave, SL99, New Orleans, LA 70112, USA.
| | - Moon-Jeong Chang
- Department of Foods and Nutrition, College of Natural Science, Kookmin University, Seoul, Republic of Korea.
| | - Hye-Sun Kim
- Department of Pharmacology and Biomedical Sciences, College of Medicine, Seoul National University, 103 Daehakro, Jongro-gu, Seoul, Republic of Korea; Seoul National University College of Medicine, Bundang Hospital, Bundang-Gu, Sungnam, Republic of Korea; Neuroscience Research Institute, College of Medicine, Seoul National University, 103 Daehakro, Jongro-gu, Seoul, Republic of Korea.
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Mahmood U, Isbel N, Mollee P, Mallett A, Govindarajulu S, Francis R. Monoclonal gammopathy of renal significance triggering atypical haemolytic uraemic syndrome. Nephrology (Carlton) 2017; 22 Suppl 1:15-17. [PMID: 28176474 DOI: 10.1111/nep.12934] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Haemolytic uraemic syndrome is a rare condition with an overall incidence of one to two cases in a population of 100 000 and approximately 10% of these cases are classified as atypical. Atypical haemolytic uraemic syndrome (aHUS) is a thrombotic microangiopathy (TMA) characterized by microangiopathic haemolytic anaemia (MAHA), thrombocytopenia and acute kidney injury. aHUS can be genetic, acquired or idiopathic (negative genetic screening and no environmental triggers). We describe a case of aHUS triggered by monoclonal gammopathy of renal significance (MGRS) successfully treated with plasmapheresis and a bortezomib-based chemotherapy regimen, resulting in marked improvement in renal function and other markers of haemolysis. This patient has been in remission for more than 2 years currently.
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Affiliation(s)
- Usman Mahmood
- Department of Nephrology, Princess Alexandra Hospital, Queensland, Australia
| | - Nicole Isbel
- Department of Nephrology, Princess Alexandra Hospital, Queensland, Australia
| | - Peter Mollee
- Department of Haematology, Princess Alexandra Hospital, Queensland, Australia
| | - Andrew Mallett
- Royal Brisbane and Women's Hospital, Queensland, Australia
| | | | - Ross Francis
- Department of Nephrology, Princess Alexandra Hospital, Queensland, Australia
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Abstract
Cardiovascular disease is the major cause of death, accounting for approximately 40 percent of all-cause mortality in patients receiving either hemodialysis or peritoneal dialysis. Cardiovascular risk stratification is an important aspect of managing dialysis patients as it enables early identification of high-risk patients, so therapeutic interventions can be optimized to lower cardiovascular morbidity and mortality. Biomarkers can detect early stages of cardiac injury so timely intervention can be provided. The B-type natriuretic peptides (Brain Natriuretic peptide [BNP] and N-terminal pro-B-type natriuretic peptide [NT-proBNP]) and troponins have been shown to predict mortality in dialysis patients. Suppression of tumorigenicity 2 (ST2) and galectin-3 are new emerging biomarkers in the field of heart failure in both the general and dialysis populations. This article aims to discuss the current evidence regarding cardiac biomarker use to diagnose myocardial injury and monitor the risk of major adverse cardiovascular events in patients undergoing dialysis.
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Affiliation(s)
- Usman Mahmood
- Department of Nephrology, Princess Alexandra Hospital, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Australia.,Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Magid A Fahim
- Department of Nephrology, Princess Alexandra Hospital, Australia.,Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
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Ahn S, Shin H, Mahmood U, Khalmuratova R, Jeon S, Jin H, Choi J, Kim H, Kim D. Chronic anosmia induces depressive behavior and reduced anxiety via dysregulation of glucocorticoid receptor and corticotropin-releasing hormone in a mouse model. Rhinology 2016. [DOI: 10.4193/rhin15.209] [Citation(s) in RCA: 8] [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: 11/08/2022]
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Choi S, Levy L, Lee K, Nguyen Q, Lee A, McGuire S, Kudchadker R, Du W, Hoffman K, Mahmood U, Frank S, Kuban D. Identifying a Subgroup of High-Risk Prostate Cancer Patients With Worse Clinical Outcomes: Should There Be a “Very High-Risk” Group? Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1228] [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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45
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Frank S, Pugh T, Mahmood U, Blanchard P, Kudchadker R, Graber W, Kuban D, Choi S, Hoffman K, McGuire S, Chen H, Wang X, Thaker N, Bruno T, Henry T, Occena M, Kaplan R, Feeley T, Swanson D. The Value of Brachytherapy for Intermediate-Risk Localized Prostate Cancer Using Ichom Outcomes and Time-Driven Activity-Based Costing: Results From a Phase 2 Prospective Trial of 300 Patients. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1637] [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: 10/20/2022]
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Hoffman K, Voong K, Levy L, Pugh T, Choi S, Du W, Frank S, Johnson J, Kudchadker R, Nguyen Q, Lee A, Mahmood U, McGuire S, Kuban D. Randomized Trial of Hypofractionated Dose-Escalated Intensity Modulated Radiation Therapy Versus Conventionally Fractionated Intensity Modulated Radiation Therapy for Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.091] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Wang Y, Oh K, Loeffler J, Shih H, Mahmood U. C11 Methionine Positron Emission Tomography (MET-PET) Imaging of Glioblastoma for Detecting Postoperative Residual Disease and Response to Chemoradiation Therapy. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.825] [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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Gadh M, Fatmi S, Gadhi M, Mahmood U, Shakil M, Buzdar S. Variation of annual effective dose from external ionizing radiation among radiation workers of Bahawalpur Institute of Nuclear Medicine and Oncology (BINO), Pakistan. INT J RADIAT RES 2016. [DOI: 10.18869/acadpub.ijrr.14.3.229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Yang EJ, Ahn S, Lee K, Mahmood U, Kim HS. Correction: Early Behavioral Abnormalities and Perinatal Alterations of PTEN/AKT Pathway in Valproic Acid Autism Model Mice. PLoS One 2016; 11:e0157202. [PMID: 27258156 PMCID: PMC4892646 DOI: 10.1371/journal.pone.0157202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0153298.].
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Ruuge A, Erdi Y, Mahmood U. SU-F-I-61: Assessment and Characterization of the Built-in Internal Photometer of Primary Diagnostic Monitors. Med Phys 2016. [DOI: 10.1118/1.4955889] [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: 11/07/2022] Open
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