What happens when we have data?

Background: Treatment recommendations (guidelines) are commonly represented in text form. Based on parameters (questions) recommendations are defined (answers). Objectives: To improve handling, alternative forms of representation are required. Methods: The concept of Dodes (diagnostic nodes) has been developed. Dodes contain answers and questions. Dodes are based on linked nodes and additionally contain descriptive information and recommendations. Dodes are organized hierarchically into Dode trees. Dode categories must be defined to prevent redundancy. Results: A centralized and neutral Dode database can provide standardization, which is a requirement for the comparison of recommendations. Centralized administration of Dode categories can provide information about diagnostic criteria (Dode categories) underutilized in existing recommendations (Dode trees). Conclusions: Representing clinical recommendations in Dode trees improves their manageability, handling and updateability

PROsaiq: A Smart Device-Based and EMR-Integrated System for Patient-Reported Outcome Measurement in Routine Cancer Care

The PROsaiq prototype, which is based on the use of smart devices, was developed to show the technical feasibility of a lean, low-cost ePRO system that integrated with the oncology information system MOSAIQ to provide the potential for benefits in routine patient care, and improved data for clinical research. The system was built with Free & Open Source Software and trialled for a limited number of assessments. The report describes the components used, the decisions made and the hurdles met during the project. An on-line demonstration system is available to showcase PROsaiqs functionality

The Informatics of the Planning Target Volume -- why it cannot and should not be changed

The ICRU defined the Planning Target Volume (PTV) as a static and geometrical volume in 1993. Radiation oncologists continue to manually alter PTVs in their daily practice when critical organs at risk (OAR) are too close to high dose PTVs. This practice is examined and shown to be non-standard (defies the ICRU definitions), inaccurate (all DVHs look perfect when the plan is manifestly NOT perfect), and useless for outcomes research (automatically analysed DVHs will find situations where the PTV_unaltered overlaps the OAR_unaltered, but will fail to find situations where an OAR_unaltered would be overlapped by a PTV_unaltered, but is not overlapped by a PTV_altered

Development of a specialist medical vocabulary for radiation oncology

Controlled medical terminologies that have been developed to describe terms utilized in the field of Radiation Oncology, include SNOMED-CT and DICOM-RT. However, a literature review has failed to provide evidence that the coverage and the level of granularity of these nomenclatures have satisfied the needs of radiation oncologists. Indeed most investigations conclude that the coverage is generally unsatisfactory. Fur-thermore, there is no evidence that an objective specification of the specialist medical terms used in Radiation Oncology has been developed. We report the development of a Specialist Medical Vocabu-lary for Radiation Oncology using an objective and systematic method of discovery of data elements published in the Radia-tion Oncology literature. The importance of the data elements to radiation oncologists is judged according to the criterion that a submitted report has been deemed worthy of publica-tion. Within the time period of discovery, 97 articles were retrieved and, during the analysis of 80 articles, 622 individual data elements and 2392 instances of use were found. Infrequent data elements comprised the majority of individual data elements (54%), and frequently used data elements were a minority (27 individual data elements with 10 or more in-stances of use). However these 10 data elements comprised 49.5% of the total data elements found

Primary Choroidal Lymphoma Diagnosed with 27-Gauge Pars Plana Vitrectomy Choroidal Biopsy

Currently, transvitreal fine-needle aspiration biopsy is the most widely used tissue biopsy technique in cases of suspected intraocular lymphoma due to its relative simplicity and low trauma. The small sample produced, however, may be inadequate for diagnostic and prognostic analyses due to mechanical artefacts, insufficient material, or sampling errors. Small case series have demonstrated choroidal biopsy via vitrectomy to be safe and effective. With smaller-gauge vitrectomy instruments, visual recovery is rapid, and post-operative inflammation and conjunctival scarring is minimised. Furthermore, smaller-gauge instrumentation does not appear to affect the diagnostic yield of biopsies for intraocular lymphoma in vitro. We report a case of primary choroidal lymphoma successfully diagnosed with 27-gauge pars plana vitrectomy choroidal biopsy. Case Presentation: A 72-year-old female presented with a 6-month history of painless blurred vision in her right eye. Fundus examination revealed a large pale choroidal mass centred on the posterior pole with overlying exudative retinal detachment. Enhanced depth imaging optical coherence tomography revealed a markedly thickened choroid with an undulating appearance. B-scan ultrasonography demonstrated diffuse, smooth thickening of the choroid, and retrobulbar extrascleral hypoechoic nodules. A 27-gauge pars plana vitrectomy was performed and choroidal biopsy taken. Histopathologic, immunohistochemical, and flow cytometry studies confirmed a diagnosis of extranodal marginal zone B-cell lymphoma. Systemic workup found no evidence of systemic lymphoma. As such, the patient was diagnosed with primary choroidal lymphoma. She underwent intensity-modulated external beam radiotherapy with subsequent resolution of disease. Conclusions: Primary choroidal lymphoma can be safely and effectively diagnosed via 27-gauge vitrectomy choroidal biopsy

Laser speckle contrast imaging versus microvascular Doppler sonography in aneurysm surgery: A prospective study.

OBJECTIVE This study aimed to compare microvascular Doppler sonography (MDS) and laser speckle contrast imaging (LSCI) for assessing vessel patency and aneurysm occlusion during microsurgical clipping of intracranial aneurysms. METHODS MDS and LSCI were used after clip placement during six neurovascular procedures including six patients, and agreement between the two techniques was assessed. LSCI was performed in parallel or right after MDS evaluation. The Doppler response was assessed through listening while flow in the LSCI videos was evaluated by three blinded neurovascular surgeons after the surgery. Statistical analysis determined the agreement between the techniques in assessing flow in 18 regions of interest (ROIs). RESULTS Agreement between MDS and LSCI in assessing vessel patency was observed in 87 % of the ROIs. LSCI accurately identified flow in 93.3 % of assessable ROIs, with no false positive or negative measurements. Three ROIs were not assessable with LSCI due to motion artifacts or poor image quality. No complications were observed. CONCLUSIONS LSCI demonstrated high agreement with MDS in assessing vessel patency during microsurgical clipping of intracranial aneurysms. It provided continuous, real-time, full-field imaging with high spatial resolution and temporal resolution. While MDS allowed evaluation of deep vascular regions, LSCI complemented it by offering unlimited assessment of surrounding vessels

Risk-Adapted Target Delineation for Breast Cancer: Controversies and Considerations

The advent of computed tomography–based planning coupled with modern tools for target delineation and hypofractionated treatment schedules has increased efficiency and throughput for patients with breast cancer. While the benefit of adjuvant radiation therapy (RT) in reducing locoregional recurrences is established, disentangling local versus regional recurrence risks with modern treatment protocols has become an area of active research to de-escalate treatment. Delineation guidelines for nodal regions either attempt to replicate results of conventional RT techniques by translating bony landmarks to clinical target volumes or use landmarks based on the fact that lymphatic channels run along the vasculature. Because direct comparisons of both approaches are implausible, mapping studies of nodal recurrences have reported on the proportion of nodes included in these delineation guidelines, and larger, bony, landmark-based guidelines appear intuitively appealing for patients with unfavorable risk factors. A pooled analysis of these studies is reported here, along with literature supporting the exclusion of the true chest wall from postmastectomy/breast-conserving surgery clinical target volumes and the selective (versus routine) use of bolus during postmastectomy RT. The risk-adapted approach suggested here accounts for the risk of recurrence as well as toxicity and endorses nuanced target volume delineation rather than a one-size-fits-all approach

Implementation of a rapid learning platform: predicting 2-year survival in laryngeal carcinoma patients in a clinical setting

Background and Purpose To improve quality and personalization of oncology health care, decision aid tools are needed to advise physicians and patients. The aim of this work is to demonstrate the clinical relevance of a survival prediction model as a first step to multi institutional rapid learning and compare this to a clinical trial dataset. Materials and Methods Data extraction and mining tools were used to collect uncurated input parameters from Illawarra Cancer Care Centre\u27s (clinical cohort) oncology information system. Prognosis categories previously established from the Maastricht Radiation Oncology (training cohort) dataset, were applied to the clinical cohort and the radiotherapy only arm of the RTOG-9111 (trial cohort). Results Data mining identified 125 laryngeal carcinoma patients, ending up with 52 patients in the clinical cohort who were eligible to be evaluated by the model to predict 2-year survival and 177 for the trial cohort. The model was able to classify patients and predict survival in the clinical cohort, but for the trial cohort it failed to do so. Conclusions The technical infrastructure and model is able to support the prognosis prediction of laryngeal carcinoma patients in a clinical cohort. The model does not perform well for the highly selective patient population in the trial cohort