22,584 research outputs found
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Design of a randomized superiority trial of a brief couple treatment for PTSD.
Interpersonal difficulties are common among veterans with posttraumatic stress disorder (PTSD) and are associated with poorer treatment response. Treatment outcomes for PTSD, including relationship functioning, improve when partners are included and engaged in the therapy process. Cognitive-behavioral conjoint therapy for PTSD (CBCT) is a manualized 15-session intervention designed for couples in which one partner has PTSD. CBCT was developed specifically to treat PTSD, engage a partner in treatment, and improve interpersonal functioning. However, recent research suggests that an abbreviated CBCT protocol may lead to sufficient gains in PTSD and relationship functioning, and yield lower dropout rates. Likewise, many veterans report a preference for receiving psychological treatments through clinical videoteleconferencing (CVT) rather than traditional face-to-face modalities that require travel to VA clinics. This manuscript describes the development and implementation of a novel randomized controlled trial (RCT) that examines the efficacy of an abbreviated 8-session version of CBCT ("brief CBCT," or B-CBCT), and compares the efficacy of this intervention delivered via CVT to traditional in-person platforms. Veterans and their partners were randomized to receive B-CBCT in a traditional Veterans Affairs office-based setting (B-CBCT-Office), CBCT through CVT with the veteran and partner at home (B-CBCT-Home), or an in office-delivered, couple-based psychoeducation control condition (PTSD Family Education). This study is the first RCT designed to investigate the delivery of B-CBCT specifically to veterans with PTSD and their partners, as well as to examine the delivery of B-CBCT over a CVT modality; findings could increase access to care to veterans with PTSD and their partners
Cone beam CT of the musculoskeletal system : clinical applications
Objectives: The aim of this pictorial review is to illustrate the use of CBCT in a broad spectrum of musculoskeletal disorders and to compare its diagnostic merit with other imaging modalities, such as conventional radiography (CR), Multidetector Computed Tomography (MDCT) and Magnetic Resonance Imaging.
Background: Cone Beam Computed Tomography (CBCT) has been widely used for dental imaging for over two decades.
Discussion: Current CBCT equipment allows use for imaging of various musculoskeletal applications. Because of its low cost and relatively low irradiation, CBCT may have an emergent role in making a more precise diagnosis, assessment of local extent and follow-up of fractures and dislocations of small bones and joints. Due to its exquisite high spatial resolution, CBCT in combination with arthrography may be the preferred technique for detection and local staging of cartilage lesions in small joints. Evaluation of degenerative joint disorders may be facilitated by CBCT compared to CR, particularly in those anatomical areas in which there is much superposition of adjacent bony structures. The use of CBCT in evaluation of osteomyelitis is restricted to detection of sequestrum formation in chronic osteomyelitis. Miscellaneous applications include assessment of (symptomatic) variants, detection and characterization of tumour and tumour-like conditions of bone.
Teaching Points:
Review the spectrum of MSK disorders in which CBCT may be complementary to other imaging techniques.
Compare the advantages and drawbacks of CBCT compared to other imaging techniques.
Define the present and future role of CBCT in musculoskeletal imaging
Feasibility of MV CBCT-based treatment planning for urgent radiation therapy: dosimetric accuracy of MV CBCT-based dose calculations.
Unlike scheduled radiotherapy treatments, treatment planning time and resources are limited for emergency treatments. Consequently, plans are often simple 2D image-based treatments that lag behind technical capabilities available for nonurgent radiotherapy. We have developed a novel integrated urgent workflow that uses onboard MV CBCT imaging for patient simulation to improve planning accuracy and reduce the total time for urgent treatments. This study evaluates both MV CBCT dose planning accuracy and novel urgent workflow feasibility for a variety of anatomic sites. We sought to limit local mean dose differences to less than 5% compared to conventional CT simulation. To improve dose calculation accuracy, we created separate Hounsfield unit-to-density calibration curves for regular and extended field-of-view (FOV) MV CBCTs. We evaluated dose calculation accuracy on phantoms and four clinical anatomical sites (brain, thorax/spine, pelvis, and extremities). Plans were created for each case and dose was calculated on both the CT and MV CBCT. All steps (simulation, planning, setup verification, QA, and dose delivery) were performed in one 30 min session using phantoms. The monitor units (MU) for each plan were compared and dose distribution agreement was evaluated using mean dose difference over the entire volume and gamma index on the central 2D axial plane. All whole-brain dose distributions gave gamma passing rates higher than 95% for 2%/2 mm criteria, and pelvic sites ranged between 90% and 98% for 3%/3 mm criteria. However, thoracic spine treatments produced gamma passing rates as low as 47% for 3%/3 mm criteria. Our novel MV CBCT-based dose planning and delivery approach was feasible and time-efficient for the majority of cases. Limited MV CBCT FOV precluded workflow use for pelvic sites of larger patients and resulted in image clearance issues when tumor position was far off midline. The agreement of calculated MU on CT and MV CBCT was acceptable for all treatment sites
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Assessment of image quality and dose calculation accuracy on kV CBCT, MV CBCT, and MV CT images for urgent palliative radiotherapy treatments.
A clinical workflow was developed for urgent palliative radiotherapy treatments that integrates patient simulation, planning, quality assurance, and treatment in one 30-minute session. This has been successfully tested and implemented clinically on a linac with MV CBCT capabilities. To make this approach available to all clinics equipped with common imaging systems, dose calculation accuracy based on treatment sites was assessed for other imaging units. We evaluated the feasibility of palliative treatment planning using on-board imaging with respect to image quality and technical challenges. The purpose was to test multiple systems using their commercial setup, disregarding any additional in-house development. kV CT, kV CBCT, MV CBCT, and MV CT images of water and anthropomorphic phantoms were acquired on five different imaging units (Philips MX8000 CT Scanner, and Varian TrueBeam, Elekta VersaHD, Siemens Artiste, and Accuray Tomotherapy linacs). Image quality (noise, contrast, uniformity, spatial resolution) was evaluated and compared across all machines. Using individual image value to density calibrations, dose calculation accuracies for simple treatment plans were assessed for the same phantom images. Finally, image artifacts on clinical patient images were evaluated and compared among the machines. Image contrast to visualize bony anatomy was sufficient on all machines. Despite a high noise level and low contrast, MV CT images provided the most accurate treatment plans relative to kV CT-based planning. Spatial resolution was poorest for MV CBCT, but did not limit the visualization of small anatomical structures. A comparison of treatment plans showed that monitor units calculated based on a prescription point were within 5% difference relative to kV CT-based plans for all machines and all studied treatment sites (brain, neck, and pelvis). Local dose differences >5% were found near the phantom edges. The gamma index for 3%/3 mm criteria was ≥95% in most cases. Best dose calculation results were obtained when the treatment isocenter was near the image isocenter for all machines. A large field of view and immediate image export to the treatment planning system were essential for a smooth workflow and were not provided on all devices. Based on this phantom study, image quality of the studied kV CBCT, MV CBCT, and MV CT on-board imaging devices was sufficient for treatment planning in all tested cases. Treatment plans provided dose calculation accuracies within an acceptable range for simple, urgently planned palliative treatments. However, dose calculation accuracy was compromised towards the edges of an image. Feasibility for clinical implementation should be assessed separately and may be complicated by machine specific features. Image artifacts in patient images and the effect on dose calculation accuracy should be assessed in a separate, machine-specific study. PACS number(s): 87.55.D-, 87.57.C-, 87.57.Q
Four-dimensional Cone Beam CT Reconstruction and Enhancement using a Temporal Non-Local Means Method
Four-dimensional Cone Beam Computed Tomography (4D-CBCT) has been developed
to provide respiratory phase resolved volumetric imaging in image guided
radiation therapy (IGRT). Inadequate number of projections in each phase bin
results in low quality 4D-CBCT images with obvious streaking artifacts. In this
work, we propose two novel 4D-CBCT algorithms: an iterative reconstruction
algorithm and an enhancement algorithm, utilizing a temporal nonlocal means
(TNLM) method. We define a TNLM energy term for a given set of 4D-CBCT images.
Minimization of this term favors those 4D-CBCT images such that any anatomical
features at one spatial point at one phase can be found in a nearby spatial
point at neighboring phases. 4D-CBCT reconstruction is achieved by minimizing a
total energy containing a data fidelity term and the TNLM energy term. As for
the image enhancement, 4D-CBCT images generated by the FDK algorithm are
enhanced by minimizing the TNLM function while keeping the enhanced images
close to the FDK results. A forward-backward splitting algorithm and a
Gauss-Jacobi iteration method are employed to solve the problems. The
algorithms are implemented on GPU to achieve a high computational efficiency.
The reconstruction algorithm and the enhancement algorithm generate visually
similar 4D-CBCT images, both better than the FDK results. Quantitative
evaluations indicate that, compared with the FDK results, our reconstruction
method improves contrast-to-noise-ratio (CNR) by a factor of 2.56~3.13 and our
enhancement method increases the CNR by 2.75~3.33 times. The enhancement method
also removes over 80% of the streak artifacts from the FDK results. The total
computation time is ~460 sec for the reconstruction algorithm and ~610 sec for
the enhancement algorithm on an NVIDIA Tesla C1060 GPU card.Comment: 20 pages, 3 figures, 2 table
Comparison of Online 6 Degree-of-Freedom Image Registration of Varian TrueBeam Cone-Beam CT and BrainLab ExacTrac X-Ray for Intracranial Radiosurgery.
PURPOSE: The study was aimed to compare online 6 degree-of-freedom image registrations of TrueBeam cone-beam computed tomography and BrainLab ExacTrac X-ray imaging systems for intracranial radiosurgery.
METHODS: Phantom and patient studies were performed on a Varian TrueBeam STx linear accelerator (version 2.5), which is integrated with a BrainLab ExacTrac imaging system (version 6.1.1). The phantom study was based on a Rando head phantom and was designed to evaluate isocenter location dependence of the image registrations. Ten isocenters at various locations representing clinical treatment sites were selected in the phantom. Cone-beam computed tomography and ExacTrac X-ray images were taken when the phantom was located at each isocenter. The patient study included 34 patients. Cone-beam computed tomography and ExacTrac X-ray images were taken at each patient\u27s treatment position. The 6 degree-of-freedom image registrations were performed on cone-beam computed tomography and ExacTrac, and residual errors calculated from cone-beam computed tomography and ExacTrac were compared.
RESULTS: In the phantom study, the average residual error differences (absolute values) between cone-beam computed tomography and ExacTrac image registrations were 0.17 ± 0.11 mm, 0.36 ± 0.20 mm, and 0.25 ± 0.11 mm in the vertical, longitudinal, and lateral directions, respectively. The average residual error differences in the rotation, roll, and pitch were 0.34° ± 0.08°, 0.13° ± 0.09°, and 0.12° ± 0.10°, respectively. In the patient study, the average residual error differences in the vertical, longitudinal, and lateral directions were 0.20 ± 0.16 mm, 0.30 ± 0.18 mm, 0.21 ± 0.18 mm, respectively. The average residual error differences in the rotation, roll, and pitch were 0.40°± 0.16°, 0.17° ± 0.13°, and 0.20° ± 0.14°, respectively. Overall, the average residual error differences wer
Effect of time lapse on the diagnostic accuracy of cone beam computed tomography for detection of vertical root fractures
Accurate and early diagnosis of vertical root fractures (VRFs) is imperative to prevent extensive bone loss and unnecessary endodontic and prosthodontic treatments. The aim of this study was to assess the effect of time lapse on the diagnostic accuracy of cone beam computed tomography (CBCT) for VRFs in endodontically treated dog’s teeth. Forty-eight incisors and premolars of three adult male dogs underwent root canal therapy. The teeth were assigned to two groups: VRFs were artificially induced in the first group (n=24) while the teeth in the second group remained intact (n=24). The CBCT scans were obtained by NewTom 3G unit immediately after inducing VRFs and after one, two, three, four, eight, 12 and 16 weeks. Three oral and maxillofacial radiologists blinded to the date of radiographs assessed the presence/absence of VRFs on CBCT scans. The sensitivity, specificity and accuracy values were calculated and data were analyzed using SPSS v.16 software and ANOVA. The total accuracy of detection of VRFs immediately after surgery, one, two, three, four, eight, 12 and 16 weeks was 67.3%, 68.7%, 66.6%, 64.6%, 64.5%, 69.4%, 68.7%, 68% respectively. The effect of time lapse on detection of VRFs was not significant (p>0.05). Overall sensitivity, specificity and accuracy of CBCT for detection of VRFs were 74.3%, 62.2%, 67.2% respectively. Cone beam computed tomography is a valuable tool for detection of VRFs. Time lapse (four months) had no effect on detection of VRFs on CBCT scans. © 2016, Associacao Brasileira de Divulgacao Cientifica. All rights reserved
The assessment of maxillofacial soft tissue and intracranial calcifications via cone-beam computed tomography
Abstract: Background: Cone-beam Computed Tomography (CBCT) scans obtained with larger
field of view let us see various incidental findings, anatomical variations and pathologies, like intracranial
and soft tissue calcifications.
Objective: The purpose of this retrospective study was to determine the prevalence of intracranial
and soft tissue calcifications via CBCT.
Methods: Full volume (maxillofacial region) scans of 290 patients achieved for various reasons
were investigated by blinded two dentomaxillofacial radiologists. Demographic data of the patients
were saved. The findings were categorized and statistically analyzed with descriptive statistics,
crosstabs and chi-square tests.
Results: Totally 290 patients aged between 24 and 81 years old (mean age ± standard deviation:
49±14) consisting of 155 females (53.4%) and 135 males (46.6%) were examined in the study. The
most common calcifications were pineal gland calcification (64.5%), followed by tonsillolith
(34.1%), petroclinoid ligament calcification (33.4%), Intracranial Internal Carotid Artery Calcifications
(IICAC) (18.3%), Extracranial Internal Carotid Artery Calcifications (EICAC) (8.3%) and the
others (1.7%, equally sialolith, antrolith and choroid plexus calcification), respectively.
Conclusion: Tonsillolith, EICAC and IICAC showed an increase with age. EICAC was seen more
in females, conversely petroclinoid ligament calcification was seen more in males. There was a statistically
significant correlation between EICAC and IICAC
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