Educative Impact of Automatic Delineation Applied to Head and Neck Cancer Patients on Radiation Oncology Residents.

To evaluate the educational impact on radiation oncology residents in training when introducing an automatic segmentation software in head and neck cancer patients regarding organs at risk (OARs) and prophylactic cervical lymph node level (LNL) volumes. Two cases treated by exclusive intensity-modulated radiotherapy were delineated by an expert radiation oncologist and were considered as reference. Then, these cases were delineated by residents divided into two groups: group 1 (control group), experienced residents delineating manually, group 2 (experimental group), young residents on their first rotation trained with automatic delineation, delineating manually first (M -) and then after using the automatic system (M +). The delineation accuracy was assessed using the Overlap Volume (OV). Regarding the OARs, mean OV was 0.62 (SD = 0.05) for group 1, 0.56 (SD = 0.04) for group 2 M - , and 0.61 (SD = 0.03) for group 2 M + . Mean OV was higher in group 1 compared to group 2 M - (p = 0.01). There was no OV difference between group 1 and group 2 M + (p = 0.67). Mean OV was higher in the group 2 M + compared to group 2 M - (p < 0.003). Regarding LNL, mean OV was 0.53 (SD = 0.06) in group 1, 0.54 (SD = 0.03) in group 2 M - , and 0.58 (SD = 0.04) in group 2 M + . Mean OV was higher in group 2 M + for 11 of the 12 analysed structures compared to group 2 M - (p = 0.016). Prior use of the automatic delineation software reduced the average contouring time per case by 34 to 40%. Prior use of atlas-based automatic segmentation reduces the delineation duration, and provides reliable OARs and LNL delineations.

[Conversion disorder in childhood]. / Trouble de conversion chez l'enfant

Conversion disorder in childhood. Conversion disorder in childhood exists and remains a complex entity whose clinics and psychopathology vary according to the chosen definition or to the theoretical framework. At present, this pathology remains the source of numerous diagnostic questions and nosographic confusions in current pediatric practice. This article tries to define and describe in a synthetic way the specificities of child conversion disorder, and the processes underlying the symptomatic outbreak. Today, there is no consensus on the management of these young patients, but we will try to identify the main features for a comprehensive therapeutic approach.

Trouble de conversion chez l'enfant. Le trouble de conversion chez l'enfant existe et demeure une entité complexe dont la clinique et la psychopathologie varient en fonction de la définition retenue ou du corpus théorique choisi comme référence. Actuellement, cette pathologie reste source de nombreuses questions diagnostiques et de confusions nosographiques en pratique pédiatrique courante, conduisant à de nombreuses consultations médicales. Cet article tente de définir et de décrire de façon synthétique les spécificités du trouble de conversion de l'enfant, les processus sous-jacents à l'éclosion symptomatique. Aujourd'hui, il n'existe pas de consensus quant à la prise en charge de ces jeunes patients mais nous tenterons de dégager les lignes directrices principales d'une approche thérapeutique globale.