Patient-specific 3D Printed Liver Models for Pre-operative Planning and Improved Patient Adherence

Project Background: 3D anatomical relationships in the liver are not always visually accessible for surgeons performing resections even with advanced imaging options. Firm understanding of these relationships is essential for timely procedures, which can improve patient outcomes and lower hospital expenses. Patient-specific 3D modeling has existed for some time, though it is costly. New cost-effective techniques have surfaced which may yield opportunities for more effective preoperative planning in liver surgery and improved patient adherence. Methods: Digital patient-specific 3D reconstruction of a liver was completed by interpolating data from MRI scans using 3D Slicer, a segmenting program. The liver model was processed and 3D printed as a shell to be used as a mold. The liver shell, associated vasculature, and tumor were printed using polylactic acid (PLA) filament on an Ultimaker S5 3D printer. Transparent silicone was used as a cast, giving the model a solid form yet still allowing examination of the inside contents. Results: One completed liver model was used in pre-surgical consultation of a patient with hepatocellular carcinoma undergoing liver resection and during the surgical procedure as a guide for the surgical team. A follow-up survey concerning qualitative aspects of the model administered to the surgical team suggested high accuracy of the model compared to the anatomy observed during the procedure. Conclusion: Cost-effective techniques in producing patient specific 3D anatomical models appears not only feasible, but highly effective in improving communication between the surgical team during the procedure and also between the surgeon and the patient during pre-surgical consultation. Future research may be conducted concerning the model’s visual clarity as well as impact on patient adherence post-op

3D Printed Liver Models as a Tool to Improve Pre-Surgical Consultation and Enhance Patient Consent

Background: 3D printing has recently emerged as an effective, cost-efficient tool for healthcare innovation. We propose the fabrication of 3D printed, patient-specific liver models as a pre-surgical planning and communication tool for liver resection surgery. Methods: Creation of the model began with the segmentation of the patient\u27s abdominal CT scan, where specific sections of their anatomy, including the blood vessels (portal and hepatic systems), gallbladder, and tumor (when applicable), were digitally segmented. Each structure was then printed in a unique color using polylactic acid (PLA) plastic filament on an Ultimaker 5s printer. Once printed the components were arranged anatomically and placed in clear silicone representing the liver parenchyma. The model was presented to the surgical team pre-operatively, as well as given to the patient during their pre-operative consultation. Results: Two models were successfully printed from patient scans, both providing an accurate full-scale representation validated by the surgical team. The 3D printing time totaled 51 hours and was completed in two consecutive days with the utilization of three printers. The complete fabrication process, including the silicone curing, was accomplished in four days. The cost of materials to produce each liver was estimated at 113USD. Conclusions: Our results show 3D printed models are promising emerging technologies for improving aspects of surgical care. Although limited in scale, our work suggests custom anatomic models are feasible and cost-efficient within the timeframe of liver resection surgery. Moreover, anecdotally, the surgical team and patient valued the model as a teaching and communication asset. Further studies will be needed to better quantify the effects of 3D printed models on pre-surgical utility, patient satisfaction, and, more broadly, on their health outcomes

Comment on "Nucleon elastic form factors and local duality"

We comment on the papers "Nucleon elastic form factors and local duality" [Phys. Rev. {\bf D62}, 073008 (2000)] and "Experimental verification of quark-hadron duality" [Phys. Rev. Lett. {\bf 85}, 1186 (2000)]. Our main comment is that the reconstruction of the proton magnetic form factor, claimed to be obtained from the inelastic scaling curve thanks to parton-hadron local duality, is affected by an artifact.Comment: to appear in Phys. Rev.

Monotonicity Hints

A hint is any piece of side information about the target function to be learned. We consider the monotonicity hint, which states that the function to be learned is monotonic in some or all of the input variables. The application of monotonicity hints is demonstrated on two real-world problems- a credit card application task, and a problem in medical diagnosis. A measure of the monotonicity error of a candidate function is defined and an objective function for the enforcement of monotonicity is derived from Bayesian principles. We report experimental results which show that using monotonicity hints leads to a statistically significant improvement in performance on both problems

Dual-readout Calorimetry

The RD52 Project at CERN is a pure instrumentation experiment whose goal is to understand the fundamental limitations to hadronic energy resolution, and other aspects of energy measurement, in high energy calorimeters. We have found that dual-readout calorimetry provides heretofore unprecedented information event-by-event for energy resolution, linearity of response, ease and robustness of calibration, fidelity of data, and particle identification, including energy lost to binding energy in nuclear break-up. We believe that hadronic energy resolutions of {\sigma}/E $\approx$ 1 - 2% are within reach for dual-readout calorimeters, enabling for the first time comparable measurement preci- sions on electrons, photons, muons, and quarks (jets). We briefly describe our current progress and near-term future plans. Complete information on all aspects of our work is available at the RD52 website http://highenergy.phys.ttu.edu/dream/.Comment: 10 pages, 10 figures, Snowmass White pape

Hadron detection with a dual-readout fiber calorimeter

In this paper, we describe measurements of the response functions of a fiber-based dual- readout calorimeter for pions, protons and multiparticle "jets" with energies in the range from 10 to 180 GeV. The calorimeter uses lead as absorber material and has a total mass of 1350 kg. It is complemented by leakage counters made of scintillating plastic, with a total mass of 500 kg. The effects of these leakage counters on the calorimeter performance are studied as well. In a separate section, we investigate and compare different methods to measure the energy resolution of a calorimeter. Using only the signals provided by the calorimeter, we demonstrate that our dual-readout calorimeter, calibrated with electrons, is able to reconstruct the energy of proton and pion beam particles to within a few percent at all energies. The fractional widths of the signal distributions for these particles (sigma/E) scale with the beam energy as 30%/sqrt(E), without any additional contributing terms

Systematic review of context-aware digital behavior change interventions to improve health

Health risk behaviors are leading contributors to morbidity, premature mortality associated with chronic diseases, and escalating health costs. However, traditional interventions to change health behaviors often have modest effects, and limited applicability and scale. To better support health improvement goals across the care continuum, new approaches incorporating various smart technologies are being utilized to create more individualized digital behavior change interventions (DBCIs). The purpose of this study is to identify context-aware DBCIs that provide individualized interventions to improve health. A systematic review of published literature (2013-2020) was conducted from multiple databases and manual searches. All included DBCIs were context-aware, automated digital health technologies, whereby user input, activity, or location influenced the intervention. Included studies addressed explicit health behaviors and reported data of behavior change outcomes. Data extracted from studies included study design, type of intervention, including its functions and technologies used, behavior change techniques, and target health behavior and outcomes data. Thirty-three articles were included, comprising mobile health (mHealth) applications, Internet of Things wearables/sensors, and internet-based web applications. The most frequently adopted behavior change techniques were in the groupings of feedback and monitoring, shaping knowledge, associations, and goals and planning. Technologies used to apply these in a context-aware, automated fashion included analytic and artificial intelligence (e.g., machine learning and symbolic reasoning) methods requiring various degrees of access to data. Studies demonstrated improvements in physical activity, dietary behaviors, medication adherence, and sun protection practices. Context-aware DBCIs effectively supported behavior change to improve users' health behaviors

Radiative Corrections to Electron-Proton Scattering

The radiative corrections to elastic electron-proton scattering are analyzed in a hadronic model including the finite size of the nucleon. For initial electron energies above 8 GeV and large scattering angles, the proton vertex correction in this model increases by at least two percent the overall factor by which the one-photon exchange (Rosenbluth) cross section must be multiplied. The contribution of soft photon emission is calculated exactly. Comparison is made with the generally used expressions previously obtained by Mo and Tsai. Results are presented for some kinematics at high momentum transfer.Comment: 31 pages, 4 figure

Final survival analysis of topotecan and paclitaxel for first-line treatment of advanced cervical cancer: An NRG oncology randomized study

Càncer de coll uterí; Platí; TopotecanCáncer de cuello uterino; Platino; TopotecanCervical cancer; Platinum; TopotecanObjective To determine whether a non‑platinum chemotherapy doublet improves overall survival (OS) among patients with recurrent/metastatic cervical carcinoma. Methods Gynecologic Oncology Group protocol 240 is a phase 3, randomized, open-label, clinical trial that studied the efficacy of paclitaxel 175 mg/m2 plus topotecan 0.75 mg/m2 days 1–3 (n = 223) vs cisplatin 50 mg/m2 plus paclitaxel 135 or 175 mg/m2 (n = 229), in 452 patients with recurrent/metastatic cervical cancer. Each chemotherapy doublet was also studied with and without bevacizumab (15 mg/kg). Cycles were repeated every 21 days until progression, unacceptable toxicity, or complete response. The primary endpoints were OS and the frequency and severity of adverse effects. We report the final analysis of OS. Results At the protocol-specified final analysis, median OS was 16.3 (cisplatin-paclitaxel backbone) and 13.8 months (topotecan-paclitaxel backbone) (HR 1.12; 95% CI, 0.91–1.38; p = 0.28). Median OS for cisplatin-paclitaxel and topotecan-paclitaxel was 15 vs 12 months, respectively (HR 1.10; 95% CI,0.82–1.48; p = 0.52), and for cisplatin-paclitaxel-bevacizumab and topotecan-paclitaxel-bevacizumab was 17.5 vs 16.2 months, respectively (HR 1.16; 95% CI, 0.86–1.56; p = 0.34). Among the 75% of patients in the study population previously exposed to platinum, median OS was 14.6 (cisplatin-paclitaxel backbone) vs 12.9 months (topotecan-paclitaxel backbone), respectively (HR 1.09; 95% CI, 0.86–1.38;p = 0.48). Post-progression survival was 7.9 (cisplatin-paclitaxel backbone) vs 8.1 months (topotecan-paclitaxel backbone) (HR 0.95; 95% CI, 0.75–1.19). Grade 4 hematologic toxicity was similar between chemotherapy backbones. Conclusions Topotecan plus paclitaxel does not confer a survival benefit to women with recurrent/metastatic cervical cancer, even among platinum-exposed patients. Topotecan-paclitaxel should not be routinely recommended in this population.This study was supported by the following National Cancer Institute and Genentech grants: NRG Oncology (1U10CA180822), NRG Operations (U10CA180868) and NCORP grant UG1CA189867