MRI radiomic features are independently associated with overall survival in soft tissue sarcoma

Purpose: Soft tissue sarcomas (STS) represent a heterogeneous group of diseases, and selection of individualized treatments remains a challenge. The goal of this study was to determine whether radiomic features extracted from magnetic resonance (MR) images are independently associated with overall survival (OS) in STS. Methods and Materials: This study analyzed 2 independent cohorts of adult patients with stage II-III STS treated at center 1 (N = 165) and center 2 (N = 61). Thirty radiomic features were extracted from pretreatment T1-weighted contrast-enhanced MR images. Prognostic models for OS were derived on the center 1 cohort and validated on the center 2 cohort. Clinical-only (C), radiomics-only (R), and clinical and radiomics (C+R) penalized Cox models were constructed. Model performance was assessed using Harrell\u27s concordance index. Results: In the R model, tumor volume (hazard ratio [HR], 1.5) and 4 texture features (HR, 1.1-1.5) were selected. In the C+R model, both age (HR, 1.4) and grade (HR, 1.7) were selected along with 5 radiomic features. The adjusted c-indices of the 3 models ranged from 0.68 (C) to 0.74 (C+R) in the derivation cohort and 0.68 (R) to 0.78 (C+R) in the validation cohort. The radiomic features were independently associated with OS in the validation cohort after accounting for age and grade (HR, 2.4; Conclusions: This study found that radiomic features extracted from MR images are independently associated with OS when accounting for age and tumor grade. The overall predictive performance of 3-year OS using a model based on clinical and radiomic features was replicated in an independent cohort. Optimal models using clinical and radiomic features could improve personalized selection of therapy in patients with STS

Energy-dependent Ps-He momentum-transfer cross section at low energies

Positronium (Ps)-He scattering presents one of the few opportunities for both theory and experiment to tackle the fundamental interactions of Ps with ordinary matter. Below the dissociation energy of 6.8 eV, experimental and theoretical work has struggled to find agreement on the strength of this interaction as measured by the momentum-transfer cross section (Ïm). Here, we present work utilizing the Doppler broadening technique with an age-momentum correlation apparatus. This work demonstrates a strong energy dependence for this cross section at energies below 1 eV and is consistent with previous experimental results

Imaging tumour hypoxia with positron emission tomography.

Hypoxia, a hallmark of most solid tumours, is a negative prognostic factor due to its association with an aggressive tumour phenotype and therapeutic resistance. Given its prominent role in oncology, accurate detection of hypoxia is important, as it impacts on prognosis and could influence treatment planning. A variety of approaches have been explored over the years for detecting and monitoring changes in hypoxia in tumours, including biological markers and noninvasive imaging techniques. Positron emission tomography (PET) is the preferred method for imaging tumour hypoxia due to its high specificity and sensitivity to probe physiological processes in vivo, as well as the ability to provide information about intracellular oxygenation levels. This review provides an overview of imaging hypoxia with PET, with an emphasis on the advantages and limitations of the currently available hypoxia radiotracers.Cancer Research UK (CRUK) funded the National Cancer Research Institute (NCRI) PET Research Working party to organise a meeting to discuss imaging cancer with hypoxia tracers and Positron Emission Tomography. IF was funded by CRUK and is also supported by the Chief Scientific Office. ALH is supported by CRUK and the Breast Cancer Research Foundation. RM is funded by NIHR Cambridge Biomedical Research Centre.This is the accepted manuscript. The final version is available from Nature Publishing at http://www.nature.com/bjc/journal/vaop/ncurrent/full/bjc2014610a.html

Blood transfusion during radical chemo-radiotherapy does not reduce tumour hypoxia in squamous cell cancer of the head and neck.

Background Patients with head and neck squamous cell carcinoma (HNSCC) undergoing radical chemo-radiation (CRT) frequently receive transfusion with packed red cells (PRCT) during radiotherapy on the basis that PRCT increases tumour oxygenation and overcomes hypoxia-induced radio-resistance. This is likely to be a significant oversimplification given the fact that tumour hypoxia is the result of several intrinsic and extrinsic factors, including many that are not directly related to serum haemoglobin (Hb). Therefore, we have studied the effect of PRCT on tumour oxygenation in a prospective cohort of patients who developed low Hb during radical CRT for HNSCC.Methods This was a prospective study of 20 patients with HNSCC receiving radical CRT undergoing PRCT for Hb-1. Patients underwent pretransfusion and posttransfusion intrinsic susceptibility-weighted (SWI) MRI and dynamic contrast-enhanced (DCE) MRI. Blood samples were obtained at the time of MRI scanning and two further time points for measuring Hb and a panel of serum cytokine markers of tumour hypoxia. 3D T2* and Ktrans maps were calculated from the MRI data for primary tumours and cervical lymph node metastases.Results PRCT produced no change (11 patients) or reduced (1 patient) T2* (tumour oxygenation) in 12 of the 16 (75%) evaluable primary tumours. Three of the four patients with improved tumour oxygenation progressed or had partial response following treatment completion. There were variable changes in Ktrans (tumour perfusion or vessel permeability) following PRCT that were of small magnitude for most tumours. Pre- and Post-PRCT levels of measured cytokines were not significantly different.Conclusions This study suggests that PRCT during radical CRT for HNSCC does not improve tumour oxygenation. Therefore, oncologists should consider changing practice according to NICE and American Association of Blood Banks guidelines on PRCT for anaemia

Utilization and Outcomes of Experiential Learning Pedagogy in the Setting of Medical Education: A Systematic Review

Background: Experiential learning is part of the pedagogical model of educational theory. Instruction of students using this model has been shown to improve educational outcomes. Students learning medicine, with an emphasis on physician assistant students in this paper, have been traditionally taught in a lecture-based model following a more experiential model by beginning with didactic studies and then a period of time in clinical practice, respectively. This paper is intended to shed light on the current ways the experiential learning model is being utilized in medical education and in the development of educational objectives using student’s perspectives and unique learning styles. Purpose: To investigate the current literature on experiential learning and whether its use is beneficial in medical education and in particular, PA education. Methods: A comprehensive literature review was conducted using various databases focusing on literature discussing experiential learning pedagogy implementation during didactic phase of physician assistant and medical professional education. Exclusion criteria included articles published before 2017 (except for three articles used to give context to definitions and history of experiential learning theory), articles too specific to different pedagogical learning theories, and articles not related to experiential learning strategies applicable to students studying medicine. Databases used were Google Scholar, PubMed, National Center for Biotechnology Information (NCBI), National Institutes of Health (NIH), Physician Assistant Education Association (PAEA), Health Affairs, Science Direct, and Journal of Physician Assistant Education (JPAE). Conclusions: Experiential learning theory has sufficient evidence to support that its use, in conjunction with traditional lecture-based learning, is beneficial to the education of students learning medicine. Introducing experiential learning in the didactic year of PA education may be more beneficial to students than the current one year didactic with primarily lecture-based learning, and one year clinical set-up

TU‐F‐12A‐05: Sensitivity of Textural Features to 3D Vs. 4D FDG‐PET/CT Imaging in NSCLC Patients

Purpose: Neighborhood Gray‐level difference matrices (NGLDM) based texture parameters extracted from conventional (3D) 18F‐FDG PET scans in patients with NSCLC have been previously shown to associate with response to chemoradiation and poorer patient outcome. However, the change in these parameters when utilizing respiratory‐correlated (4D) FDG‐PET scans has not yet been characterized for NSCLC. The Objectives: of this study was to assess the extent to which NGLDM‐based texture parameters on 4D PET images vary with reference to values derived from 3D scans in NSCLC. Methods: Eight patients with newly diagnosed NSCLC treated with concomitant chemoradiotherapy were included in this study. 4D PET scans were reconstructed with OSEM‐IR in 5 respiratory phase‐binned images and corresponding CT data of each phase were employed for attenuation correction. NGLDM‐based texture features, consisting of coarseness, contrast, busyness, complexity and strength, were evaluated for gross tumor volumes defined on 3D/4D PET scans by radiation oncologists. Variation of the obtained texture parameters over the respiratory cycle were examined with respect to values extracted from 3D scans. Results: Differences between texture parameters derived from 4D scans at different respiratory phases and those extracted from 3D scans ranged from −30% to 13% for coarseness, −12% to 40% for contrast, −5% to 50% for busyness, −7% to 38% for complexity, and −43% to 20% for strength. Furthermore, no evident correlations were observed between respiratory phase and 4D scan texture parameters. Conclusion: Results of the current study showed that NGLDM‐based texture parameters varied considerably based on choice of 3D PET and 4D PET reconstruction of NSCLC patient images, indicating that standardized image acquisition and analysis protocols need to be established for clinical studies, especially multicenter clinical trials, intending to validate prognostic values of texture features for NSCLC