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  1. Article ; Online: A deep learning architecture with an object-detection algorithm and a convolutional neural network for breast mass detection and visualization

    Steven J. Frank

    Healthcare Analytics, Vol 3, Iss , Pp 100186- (2023)

    2023  

    Abstract: This study presents an integrated deep learning architecture with an object-detection algorithm and a convolutional neural network (CNN) for breast mass detection and visualization. Mammograms are analyzed to identify and localize breast mass lesions to ... ...

    Abstract This study presents an integrated deep learning architecture with an object-detection algorithm and a convolutional neural network (CNN) for breast mass detection and visualization. Mammograms are analyzed to identify and localize breast mass lesions to aid clinician review. Two complementary forms of deep learning are used to identify the regions of interest (ROIs). An object-detection algorithm, YOLO v5, analyzes the entire mammogram to identify discrete image regions likely to represent masses. Object detections exhibit high precision, but the object-detection stage alone has insufficient overall accuracy for a clinical application. A CNN independently analyzes the mammogram after it has been decomposed into subregion tiles and is trained to emphasize sensitivity (recall). The ROIs identified by each analysis are highlighted in different colors to facilitate an efficient staged review. The CNN stage nearly always detects tumor masses when present but typically occupies a larger area of the image. By inspecting the high-precision regions followed by the high-sensitivity regions, clinicians can quickly identify likely lesions before completing the review of the full mammogram. On average, the ROIs occupy less than 20% of the tissue in the mammograms, even without removing pectoral muscle from the analysis. As a result, the proposed system helps clinicians review mammograms with greater accuracy and efficiency.
    Keywords Intelligence ; Deep learning ; Convolutional neural network ; Decision support ; Object detection ; Radiology ; Computer applications to medicine. Medical informatics ; R858-859.7
    Subject code 006
    Language English
    Publishing date 2023-11-01T00:00:00Z
    Publisher Elsevier
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: An Introduction to the International Journal of Particle Therapy’s Special Issue on Particle Therapy for Head and Neck Malignancies

    Steven J. Frank, MD

    International Journal of Particle Therapy, Vol 8, Iss 1, Pp 1-

    2021  Volume 2

    Keywords Medical physics. Medical radiology. Nuclear medicine ; R895-920 ; Nuclear and particle physics. Atomic energy. Radioactivity ; QC770-798
    Language English
    Publishing date 2021-06-01T00:00:00Z
    Publisher Particle Therapy Co-operative Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Financial Toxicity in Head and Neck Cancer Patients Treated With Proton Therapy

    Grace L. Smith, MD, PhD, MPH / Ya-Chen Tina Shih, PhD / Steven J. Frank, MD

    International Journal of Particle Therapy, Vol 8, Iss 1, Pp 366-

    2021  Volume 373

    Abstract: Cancer-related financial toxicity impacts head and neck cancer patients and survivors. With increasing use of proton therapy as a curative treatment for head and neck cancer, the multifaceted financial and economic implications of proton therapy— ... ...

    Abstract Cancer-related financial toxicity impacts head and neck cancer patients and survivors. With increasing use of proton therapy as a curative treatment for head and neck cancer, the multifaceted financial and economic implications of proton therapy—dimensions of “financial toxicity”—need to be addressed. Herein, we identify knowledge gaps and potential solutions related to the problem of financial toxicity. To date, while cost-effectiveness analysis has been used to assess the value of proton therapy for head and neck cancer, it may not fully incorporate empiric comparisons of patients’ and survivors’ lost productivity and disability after treatment. A cost-of-illness framework for evaluation could address this gap, thereby more comprehensively identifying the value of proton therapy and distinctly incorporating a measurable aspect of financial toxicity in evaluation. Overall, financial toxicity burdens remain understudied in head and neck cancer patients from a patient-centered perspective. Systematic, validated, and accurate measurement of financial toxicity in patients receiving proton therapy is needed, especially relative to conventional photon-based strategies. This will enrich the evidence base for optimal selection and rationale for payer coverage of available treatment options for head and neck cancer patients. In the setting of cancer care delivery, a combination of conducting proactive screening for financial toxicity in patients selected for proton therapy, initiating early financial navigation in vulnerable patients, engaging stakeholders, improving oncology provider team cost communication, expanding policies to promote price transparency, and expanding insurance coverage for proton therapy are critical practices to mitigate financial toxicity in head and neck cancer patients.
    Keywords financial toxicity ; head and neck cancer ; proton ; Medical physics. Medical radiology. Nuclear medicine ; R895-920 ; Nuclear and particle physics. Atomic energy. Radioactivity ; QC770-798
    Subject code 610
    Language English
    Publishing date 2021-06-01T00:00:00Z
    Publisher Particle Therapy Co-operative Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: The Role of Particle Therapy in Adenoid Cystic Carcinoma and Mucosal Melanoma of the Head and Neck

    Daniel K. Ebner, MD, MPH / Timothy D. Malouff, MD / Steven J. Frank, MD / Masashi Koto, MD, PhD

    International Journal of Particle Therapy, Vol 8, Iss 1, Pp 273-

    2021  Volume 284

    Abstract: Particle irradiation is suitable for resistant histologies owing to a combination of improved dose delivery with potential radiobiologic advantages in high linear energy transfer radiation. Within the head and neck, adenoid cystic carcinoma and mucosal ... ...

    Abstract Particle irradiation is suitable for resistant histologies owing to a combination of improved dose delivery with potential radiobiologic advantages in high linear energy transfer radiation. Within the head and neck, adenoid cystic carcinoma and mucosal melanoma are two such histologies, being radioresistant and lying closely proximal to critical structures. Here, we review the use of particle irradiation for adenoid cystic carcinoma and mucosal melanoma of the head and neck.
    Keywords carbon-ion radiotherapy ; particle radiotherapy ; adenoid cystic carcinoma ; mucosal melanoma ; proton radiotherapy ; Medical physics. Medical radiology. Nuclear medicine ; R895-920 ; Nuclear and particle physics. Atomic energy. Radioactivity ; QC770-798
    Language English
    Publishing date 2021-06-01T00:00:00Z
    Publisher Particle Therapy Co-operative Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: A Review of Particle Therapy for Skull Base Tumors

    Eugen B. Hug, MD / Maciej Pelak, MD, PhD / Steven J. Frank, MD / Piero Fossati, PhD

    International Journal of Particle Therapy, Vol 8, Iss 1, Pp 168-

    Modern Considerations and Future Directions

    2021  Volume 178

    Abstract: Skull base tumors constitute one of the established indications for particle therapy, specifically proton therapy. However, a number of prognostic factors, practical clinical management issues, and the emerging role of carbon ion therapy remain subjects ... ...

    Abstract Skull base tumors constitute one of the established indications for particle therapy, specifically proton therapy. However, a number of prognostic factors, practical clinical management issues, and the emerging role of carbon ion therapy remain subjects of active clinical investigation. This review summarizes these topics, assesses the present status, and reflects on future research directions focusing on the management of chordomas, one of the most aggressive skull base tumors. In addition, the role of particle therapy for benign tumors of the skull base, including pituitary adenoma and acoustic neuroma, is reviewed.
    Keywords skull base tumors ; chordoma ; carbon ion therapy ; particle therapy ; proton beam therapy ; Medical physics. Medical radiology. Nuclear medicine ; R895-920 ; Nuclear and particle physics. Atomic energy. Radioactivity ; QC770-798
    Language English
    Publishing date 2021-06-01T00:00:00Z
    Publisher Particle Therapy Co-operative Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: Patterns of failure for recurrent head and neck squamous cell carcinoma treated with salvage surgery and postoperative IMRT reirradiation

    Abdallah S.R. Mohamed / Geoffrey V. Martin / Sweet Ping Ng / Vinita Takiar / Beth M. Beadle / Mark Zafereo / Adam S. Garden / Steven J. Frank / C. David Fuller / G. Brandon Gunn / William H. Morrison / David I. Rosenthal / Jay Reddy / Amy Moreno / Anna Lee / Jack Phan

    Clinical and Translational Radiation Oncology, Vol 44, Iss , Pp 100700- (2024)

    1481  

    Abstract: Purpose/Objectives: The purpose of this study was to evaluate patterns of locoregional recurrence (LRR) after surgical salvage and adjuvant reirradiation with IMRT for recurrent head and neck squamous cell cancer (HNSCC). Materials/Methods: Patterns of ... ...

    Abstract Purpose/Objectives: The purpose of this study was to evaluate patterns of locoregional recurrence (LRR) after surgical salvage and adjuvant reirradiation with IMRT for recurrent head and neck squamous cell cancer (HNSCC). Materials/Methods: Patterns of LRR for 61 patients treated consecutively between 2003 and 2014 who received post-operative IMRT reirradiation to ≥ 60 Gy for recurrent HNSCC were determined by 2 methods: 1) physician classification via visual comparison of post-radiotherapy imaging to reirradiation plans; and 2) using deformable image registration (DIR). Those without evaluable CT planning image data were excluded. All recurrences were verified by biopsy or radiological progression. Failures were defined as in-field, marginal, or out-of-field. Logistic regression analyses were performed to identify predictors for LRR. Results: A total of 55 patients were eligible for analysis and 23 (42 %) had documented LRR after reirradiation. Location of recurrent disease prior to salvage surgery (lymphatic vs. mucosal) was the most significant predictor of LRR after post-operative reirradiation with salvage rate of 67 % for lymphatic vs. 33 % for mucosal sites (p = 0.037). Physician classification of LRR yielded 14 (61 %) in-field failures, 3 (13 %) marginal failures, and 6 (26 %) out-of-field failures, while DIR yielded 10 (44 %) in-field failures, 4 (17 %) marginal failures, and 9 (39 %) out-of-field failures. Most failures (57 %) occurred within the original site of recurrence or first echelon lymphatic drainage. Of patients who had a free flap placed during salvage surgery, 56 % of failures occurred within 1 cm of the surgical flap. Conclusion: Our study highlights the role of DIR in enhancing the accuracy and consistency of POF analysis. Compared to traditional visual inspection, DIR reduces interobserver variability and provides more nuanced insights into dose-specific and spatial parameters of locoregional recurrences. Additionally, the study identifies the location of the initial recurrence as a key ...
    Keywords Head and neck ; Squamous cell carcinoma ; Reirradiation ; Surgery ; Patterns of failure ; DIR ; Medical physics. Medical radiology. Nuclear medicine ; R895-920 ; Neoplasms. Tumors. Oncology. Including cancer and carcinogens ; RC254-282
    Subject code 616
    Language English
    Publishing date 2024-01-01T00:00:00Z
    Publisher Elsevier
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  7. Article ; Online: Proton Radiotherapy to Reduce Late Complications in Childhood Head and Neck Cancers

    Michael T. Spiotto, MD, PhD / Susan L. McGovern, MD, PhD / G. Brandon Gunn, MD / David Grosshans, MD / Mary Frances McAleer, MD, PhD / Steven J. Frank, MD / Arnold C. Paulino, MD

    International Journal of Particle Therapy, Vol 8, Iss 1, Pp 155-

    2021  Volume 167

    Abstract: In most childhood head and neck cancers, radiotherapy is an essential component of treatment; however, it can be associated with problematic long-term complications. Proton beam therapy is accepted as a preferred radiation modality in pediatric cancers ... ...

    Abstract In most childhood head and neck cancers, radiotherapy is an essential component of treatment; however, it can be associated with problematic long-term complications. Proton beam therapy is accepted as a preferred radiation modality in pediatric cancers to minimize the late radiation side effects. Given that childhood cancers are a rare and heterogeneous disease, the support for proton therapy comes from risk modeling and a limited number of cohort series. Here, we discuss the role of proton radiotherapy in pediatric head and neck cancers with a focus on reducing radiation toxicities. First, we compare the efficacy and expected toxicities in proton and photon radiotherapy for childhood cancers. Second, we review the benefit of proton radiotherapy in reducing acute and late radiation toxicities, including risks for secondary cancers, craniofacial development, vision, and cognition. Finally, we review the cost effectiveness for proton radiotherapy in pediatric head and neck cancers. This review highlights the benefits of particle radiotherapy for pediatric head and neck cancers to improve the quality of life in cancer survivors, to reduce radiation morbidities, and to maximize efficient health care use.
    Keywords radiotherapy ; intensity-modulated ; proton therapy ; neoplasms ; radiation-induced ; Medical physics. Medical radiology. Nuclear medicine ; R895-920 ; Nuclear and particle physics. Atomic energy. Radioactivity ; QC770-798
    Subject code 616
    Language English
    Publishing date 2021-06-01T00:00:00Z
    Publisher Particle Therapy Co-operative Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  8. Article ; Online: The Biological Basis for Enhanced Effects of Proton Radiation Therapy Relative to Photon Radiation Therapy for Head and Neck Squamous Cell Carcinoma

    Li Wang, MD, PhD / Piero Fossati, MD / Harald Paganetti, PhD / Li Ma, PhD / Maura Gillison, MD, PhD / Jeffrey N. Myers, MD, PhD / Eugen Hug, MD / Steven J. Frank, MD

    International Journal of Particle Therapy, Vol 8, Iss 1, Pp 3-

    2021  Volume 13

    Abstract: Head and neck squamous cell carcinomas (HNSCCs) often present as local-regionally advanced disease at diagnosis, for which a current standard of care is x-ray–based radiation therapy, with or without chemotherapy. This approach provides effective local ... ...

    Abstract Head and neck squamous cell carcinomas (HNSCCs) often present as local-regionally advanced disease at diagnosis, for which a current standard of care is x-ray–based radiation therapy, with or without chemotherapy. This approach provides effective local regional tumor control, but at the cost of acute and late toxicity that can worsen quality of life and contribute to mortality. For patients with human papillomavirus (HPV)–associated oropharyngeal squamous cell carcinoma (SCC) in particular, for whom the prognosis is generally favorable, de-escalation of the radiation dose to surrounding normal tissues without diminishing the radiation dose to tumors is desired to mitigate radiation-related toxic effects. Proton radiation therapy (PRT) may be an excellent de-escalation strategy because of its physical properties (that eliminate unnecessary radiation to surrounding tissues) and because of its biological properties (including tumor-specific variations in relative biological effectiveness [RBE] and linear energy transfer [LET]), in combination with concurrent systemic therapy. Early clinical evidence has shown that compared with x-ray–based radiation therapy, PRT offers comparable disease control with fewer and less severe treatment-related toxicities that can worsen the quality of life for patients with HNSCC. Herein, we review aspects of the biological basis of enhanced HNSCC cell response to proton versus x-ray irradiation in terms of radiation-induced gene and protein expression, DNA damage and repair, cell death, tumor immune responses, and radiosensitization of tumors.
    Keywords proton radiation therapy ; x-ray radiation therapy ; head and neck cancer ; biological effect ; radiation sensitization ; Medical physics. Medical radiology. Nuclear medicine ; R895-920 ; Nuclear and particle physics. Atomic energy. Radioactivity ; QC770-798
    Subject code 616
    Language English
    Publishing date 2021-06-01T00:00:00Z
    Publisher Particle Therapy Co-operative Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  9. Article ; Online: Non-canonical function of DGCR8 in DNA double-strand break repair signaling and tumor radioresistance

    Qinglei Hang / Liyong Zeng / Li Wang / Litong Nie / Fan Yao / Hongqi Teng / Yalan Deng / Shannon Yap / Yutong Sun / Steven J. Frank / Junjie Chen / Li Ma

    Nature Communications, Vol 12, Iss 1, Pp 1-

    2021  Volume 18

    Abstract: The molecular mechanisms underlying cancer cell radioresistance need to be elucidated. In this study, the authors show that the microRNA biogenesis factor DGCR8 is stabilized by USP51 and ATM upon irradiation and by consequence it promotes the repair of ... ...

    Abstract The molecular mechanisms underlying cancer cell radioresistance need to be elucidated. In this study, the authors show that the microRNA biogenesis factor DGCR8 is stabilized by USP51 and ATM upon irradiation and by consequence it promotes the repair of DNA double-strand breaks and radioresistance by recruiting RNF168 to sites of damage.
    Keywords Science ; Q
    Language English
    Publishing date 2021-06-01T00:00:00Z
    Publisher Nature Portfolio
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  10. Article ; Online: Predictive performance of different NTCP techniques for radiation-induced esophagitis in NSCLC patients receiving proton radiotherapy

    Mei Chen / Zeming Wang / Shengpeng Jiang / Jian Sun / Li Wang / Narayan Sahoo / G. Brandon Gunn / Steven J. Frank / Cheng Xu / Jiayi Chen / Quynh-Nhu Nguyen / Joe Y. Chang / Zhongxing Liao / X. Ronald Zhu / Xiaodong Zhang

    Scientific Reports, Vol 12, Iss 1, Pp 1-

    2022  Volume 8

    Abstract: Abstract This study aimed to compare the predictive performance of different modeling methods in developing normal tissue complication probability (NTCP) models for predicting radiation-induced esophagitis (RE) in non–small cell lung cancer (NSCLC) ... ...

    Abstract Abstract This study aimed to compare the predictive performance of different modeling methods in developing normal tissue complication probability (NTCP) models for predicting radiation-induced esophagitis (RE) in non–small cell lung cancer (NSCLC) patients receiving proton radiotherapy. The dataset was composed of 328 NSCLC patients receiving passive-scattering proton therapy and 41.6% of the patients experienced ≥ grade 2 RE. Five modeling methods were used to build NTCP models: standard Lyman–Kutcher–Burman (sLKB), generalized LKB (gLKB), multivariable logistic regression using two variable selection procedures-stepwise forward selection (Stepwise-MLR), and least absolute shrinkage and selection operator (LASSO-MLR), and support vector machines (SVM). Predictive performance was internally validated by a bootstrap approach for each modeling method. The overall performance, discriminative ability, and calibration were assessed using the Negelkerke R2, area under the receiver operator curve (AUC), and Hosmer–Lemeshow test, respectively. The LASSO-MLR model showed the best discriminative ability with an AUC value of 0.799 (95% confidence interval (CI): 0.763–0.854), and the best overall performance with a Negelkerke R2 value of 0.332 (95% CI: 0.266–0.486). Both of the optimism-corrected Negelkerke R2 values of the SVM and sLKB models were 0.301. The optimism-corrected AUC of the gLKB model (0.796) was higher than that of the SVM model (0.784). The sLKB model had the smallest optimism in the model variation and discriminative ability. In the context of classification and probability estimation for predicting the NTCP for radiation-induced esophagitis, the MLR model developed with LASSO provided the best predictive results. The simplest LKB modeling had similar or even better predictive performance than the most complex SVM modeling, and it was least likely to overfit the training data. The advanced machine learning approach might have limited applicability in clinical settings with a relatively small amount of ...
    Keywords Medicine ; R ; Science ; Q
    Subject code 310
    Language English
    Publishing date 2022-06-01T00:00:00Z
    Publisher Nature Portfolio
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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