Demonstrating the benefits of corrective intraoperative feedback in improving the quality of duodenal hydrogel spacer placement.
Demonstrating the benefits of corrective intraoperative feedback in improving the quality of duodenal hydrogel spacer placement.
复制标题
证明术中纠正反馈在提高十二指肠水凝胶间隔器放置质量方面的受益。
DOI：
10.1002/mp.15665
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发表时间：
2022-07
期刊：
影响因子：
3.8
通讯作者：
Ding, Kai
中科院分区：
文献类型：
--
作者：
Hooshangnejad, Hamed;Han-Oh, Sarah;Shin, Eun Ji;Narang, Amol;Rao, Avani Dholakia;Lee, Junghoon;McNutt, Todd;Hu, Chen;Wong, John;Ding, Kai
关键词：
胰腺癌是癌症相关死亡的第四大原因，5年总生存率（OS）为10%。放射治疗（RT）加上剂量递增，通过显著增加2年和3年的OS改善了结局，但受到十二指肠毒性的阻碍。我们的研究小组表明，插入水凝胶间隔物可降低十二指肠毒性，但复杂的解剖结构和苛刻的手术使其获益高度不确定。在这里，我们研究了增加术中反馈的工作流程的可行性，以减少不确定性的不良影响。我们模拟了四具尸体的虚拟间隔器的三种情况，具有两种类型的总肿瘤体积（GTV）（小和大）;第一，理想注射;第二，非理想注射，包括常见的间隔器放置不确定性;第三，校正注射，使用非理想注射的模拟结果，旨在补偿不确定性的影响。我们考虑了两个常见的不确定性：（1）“缩小”定义为注入的间隔物体积小于计划。(2)“缺失部分”定义为未能在十二指肠的上升部分中注射间隔物。共设计了32个立体定向体部放射治疗（SBRT）计划（33戈伊，分5次），用于4具尸体、2种GTV尺寸和2种不确定性。从剂量学和几何学的角度，将每种情况下的预注射方案与虚拟间隔器放置的三种方案进行比较。我们发现，重叠PTV空间与十二指肠是一个信息量，以确定有效的定位间隔。理想的间隔器分布将小GTV和大GTV的十二指肠V33 Gy从平均3.3cc和1.2cc降低到小于0.3和0.1cc。然而，间隔器放置的不确定性降低了间隔器保留十二指肠的有效性（十二指肠V33 Gy：1.3和0.4cc）。十二指肠与GTV之间的间隔平均减少了5.3和4.6 mm。纠正反馈可以有效地恢复融合器理想位置的预期受益（平均V33 Gy为0.4和0.1cc）。引入了一个信息反馈指标，用于减轻融合器放置不确定性的影响，并最大限度地发挥EUS引导手术的受益。
Pancreatic cancer is the fourth leading cause of cancer‐related death with a 10% 5‐year overall survival rate (OS). Radiation therapy (RT) in addition to dose escalation improves the outcome by significantly increasing the OS at 2 and 3 years but is hindered by the toxicity of the duodenum. Our group showed that the insertion of hydrogel spacer reduces duodenal toxicity, but the complex anatomy and the demanding procedure make the benefits highly uncertain. Here, we investigated the feasibility of augmenting the workflow with intraoperative feedback to reduce the adverse effects of the uncertainties. We simulated three scenarios of the virtual spacer for four cadavers with two types of gross tumor volume (GTV) (small and large); first, the ideal injection; second, the nonideal injection that incorporates common spacer placement uncertainties; and third, the corrective injection that uses the simulation result from nonideal injection and is designed to compensate for the effect of uncertainties. We considered two common uncertainties: (1) “Narrowing” is defined as the injection of smaller spacer volume than planned. (2) “Missing part” is defined as failure to inject spacer in the ascending section of the duodenum. A total of 32 stereotactic body radiation therapy (SBRT) plans (33 Gy in 5 fractions) were designed, for four cadavers, two GTV sizes, and two types of uncertainties. The preinjection scenario for each case was compared with three scenarios of virtual spacer placement from the dosimetric and geometric points of view. We found that the overlapping PTV space with the duodenum is an informative quantity for determining the effective location of the spacer. The ideal spacer distribution reduced the duodenal V33Gy for small and large GTV to less than 0.3 and 0.1cc, from an average of 3.3cc, and 1.2cc for the preinjection scenario. However, spacer placement uncertainties reduced the efficacy of the spacer in sparing the duodenum (duodenal V33Gy: 1.3 and 0.4cc). The separation between duodenum and GTV decreased by an average of 5.3 and 4.6 mm. The corrective feedback can effectively bring back the expected benefits from the ideal location of the spacer (averaged V33Gy of 0.4 and 0.1cc). An informative feedback metric was introduced and used to mitigate the effect of spacer placement uncertainties and maximize the benefits of the EUS‐guided procedure.
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用于胰腺癌放射治疗的可生物降解水凝胶垫片保留十二指肠的剂量预测模型
DOI：
10.1016/j.ijrobp.2018.07.184
发表时间：
2018-11-01
期刊：
International journal of radiation oncology, biology, physics
影响因子：
--
作者：
Feng Z;Rao AD;Cheng Z;Shin EJ;Moore J;Su L;Kim SH;Wong J;Narang A;Herman JM;McNutt T;Li D;Ding K
通讯作者：
Ding K
影响因子：
3.8
作者：
Hooshangnejad, Hamed;Youssefian, Sina;Ding, Kai
通讯作者：
Ding, Kai
在尸体模型中进行 EUS 引导的水凝胶微粒注射。
影响因子：
2.1
作者：
Kim SH;Ding K;Rao A;He J;Bhutani MS;Herman JM;Narang A;Shin EJ
通讯作者：
Shin EJ
DOI：
10.1016/j.ijrobp.2015.12.003
发表时间：
2016-03-15
期刊：
International journal of radiation oncology, biology, physics
影响因子：
--
作者：
Krishnan S;Chadha AS;Suh Y;Chen HC;Rao A;Das P;Minsky BD;Mahmood U;Delclos ME;Sawakuchi GO;Beddar S;Katz MH;Fleming JB;Javle MM;Varadhachary GR;Wolff RA;Crane CH
通讯作者：
Crane CH
影响因子：
4.7
作者：
Hooshangnejad H;Youssefian S;Narang A;Shin EJ;Rao AD;Han-Oh S;McNutt T;Lee J;Hu C;Wong J;Ding K
通讯作者：
Ding K