Using a Clinically Interpretable End Point Composed of Multiple Outcomes to Evaluate Totality of Treatment Effect in Comparative Oncology Studies

No abstrac

Multi-organ segmentation of abdominal structures from non-contrast and contrast enhanced CT images

Manually delineating upper abdominal organs at risk (OARs) is a time-consuming task. To develop a deep-learning-based tool for accurate and robust auto-segmentation of these OARs, forty pancreatic cancer patients with contrast-enhanced breath-hold computed tomographic (CT) images were selected. We trained a three-dimensional (3D) U-Net ensemble that automatically segments all organ contours concurrently with the self-configuring nnU-Net framework. Our tool's performance was assessed on a held-out test set of 30 patients quantitatively. Five radiation oncologists from three different institutions assessed the performance of the tool using a 5-point Likert scale on an additional 75 randomly selected test patients. The mean (± std. dev.) Dice similarity coefficient values between the automatic segmentation and the ground truth on contrast-enhanced CT images were 0.80 ± 0.08, 0.89 ± 0.05, 0.90 ± 0.06, 0.92 ± 0.03, 0.96 ± 0.01, 0.97 ± 0.01, 0.96 ± 0.01, and 0.96 ± 0.01 for the duodenum, small bowel, large bowel, stomach, liver, spleen, right kidney, and left kidney, respectively. 89.3% (contrast-enhanced) and 85.3% (non-contrast-enhanced) of duodenum contours were scored as a 3 or above, which required only minor edits. More than 90% of the other organs' contours were scored as a 3 or above. Our tool achieved a high level of clinical acceptability with a small training dataset and provides accurate contours for treatment planning

Frequency-domain near-infrared spectroscopy of the uterine cervix during regular pregnancies

Preterm labor is a common obstetric complication. Clinical evaluation of cervical ripening to predict preterm labor is very inaccurate. We used frequency-domain near-infrared spectroscopy (FD-NIRS) to non-invasively investigate the changes of the optical properties (i.e., absorption and scattering of light) in the uterine cervix during regular pregnancies. Optical properties of uterine cervices were measured in 13 patients at various time points of regular pregnancies. For each gestational trimester, mean values with 95% confidence intervals were calculated for oxy-, deoxy-, and total hemoglobin concentration (O(2)Hb, HHb, tHb), tissue oxygen saturation and water content and statistically significant differences between the trimesters were determined. The wavelength-dependent scattering (scatter power) was calculated by an exponential fit. O(2)Hb, and tHb and the scatter power showed an increase as a function of the gestational age. Differences between the second and the third trimester were statistically significant. HHb and the water content showed no significant change over time. Our results show that FD-NIRS is a promising diagnostic tool for providing information about cervical content of hemoglobin, water, and extracellular matrix proteins. We propose this technology to assess the cervical ripening and eventually to predict preterm labor