Anonymization and validation of three-dimensional volumetric renderings of computed tomography data using commercially available T1-weighted magnetic resonance imaging-based algorithms.

Purpose: Previous studies have demonstrated that three-dimensional (3D) volumetric renderings of magnetic resonance imaging (MRI) brain data can be used to identify patients using facial recognition. We have shown that facial features can be identified on simulation-computed tomography (CT) images for radiation oncology and mapped to face images from a database. We aim to determine whether CT images can be anonymized using anonymization software that was designed for T1-weighted MRI data. Approach: Our study examines (1) the ability of off-the-shelf anonymization algorithms to anonymize CT data and (2) the ability of facial recognition algorithms to identify whether faces could be detected from a database of facial images. Our study generated 3D renderings from 57 head CT scans from The Cancer Imaging Archive database. Data were anonymized using AFNI (deface, reface, and 3Dskullstrip) and FSL's BET. Anonymized data were compared to the original renderings and passed through facial recognition algorithms (VGG-Face, FaceNet, DLib, and SFace) using a facial database (labeled faces in the wild) to determine what matches could be found. Results: Our study found that all modules were able to process CT data and that AFNI's 3Dskullstrip and FSL's BET data consistently showed lower reidentification rates compared to the original. Conclusions: The results from this study highlight the potential usage of anonymization algorithms as a clinical standard for deidentifying brain CT data. Our study demonstrates the importance of continued vigilance for patient privacy in publicly shared datasets and the importance of continued evaluation of anonymization methods for CT data.

Interplay of Immunosuppression and Immunotherapy Among Patients With Cancer and COVID-19.

Importance: Cytokine storm due to COVID-19 can cause high morbidity and mortality and may be more common in patients with cancer treated with immunotherapy (IO) due to immune system activation. Objective: To determine the association of baseline immunosuppression and/or IO-based therapies with COVID-19 severity and cytokine storm in patients with cancer. Design, Setting, and Participants: This registry-based retrospective cohort study included 12 046 patients reported to the COVID-19 and Cancer Consortium (CCC19) registry from March 2020 to May 2022. The CCC19 registry is a centralized international multi-institutional registry of patients with COVID-19 with a current or past diagnosis of cancer. Records analyzed included patients with active or previous cancer who had a laboratory-confirmed infection with SARS-CoV-2 by polymerase chain reaction and/or serologic findings. Exposures: Immunosuppression due to therapy; systemic anticancer therapy (IO or non-IO). Main Outcomes and Measures: The primary outcome was a 5-level ordinal scale of COVID-19 severity: no complications; hospitalized without requiring oxygen; hospitalized and required oxygen; intensive care unit admission and/or mechanical ventilation; death. The secondary outcome was the occurrence of cytokine storm. Results: The median age of the entire cohort was 65 years (interquartile range [IQR], 54-74) years and 6359 patients were female (52.8%) and 6598 (54.8%) were non-Hispanic White. A total of 599 (5.0%) patients received IO, whereas 4327 (35.9%) received non-IO systemic anticancer therapies, and 7120 (59.1%) did not receive any antineoplastic regimen within 3 months prior to COVID-19 diagnosis. Although no difference in COVID-19 severity and cytokine storm was found in the IO group compared with the untreated group in the total cohort (adjusted odds ratio [aOR], 0.80; 95% CI, 0.56-1.13, and aOR, 0.89; 95% CI, 0.41-1.93, respectively), patients with baseline immunosuppression treated with IO (vs untreated) had worse COVID-19 severity and cytokine storm (aOR, 3.33; 95% CI, 1.38-8.01, and aOR, 4.41; 95% CI, 1.71-11.38, respectively). Patients with immunosuppression receiving non-IO therapies (vs untreated) also had worse COVID-19 severity (aOR, 1.79; 95% CI, 1.36-2.35) and cytokine storm (aOR, 2.32; 95% CI, 1.42-3.79). Conclusions and Relevance: This cohort study found that in patients with cancer and COVID-19, administration of systemic anticancer therapies, especially IO, in the context of baseline immunosuppression was associated with severe clinical outcomes and the development of cytokine storm. Trial Registration: ClinicalTrials.gov Identifier: NCT04354701.

Trends in guideline-adherent chemoradiation therapy for locally advanced cervical cancer before and after the affordable care act.

OBJECTIVE: To assess trends in guideline-adherent chemoradiation therapy (GA-CRT) for locally advanced cervical cancer relative to Patient Protection and Affordable Care Act (ACA) implementation. METHODS: National Cancer Database patients treated with chemoradiation for locally advanced cervical cancer (FIGO 2018 Stage IB3-IVA) from 2004 to 2016 were included. GA-CRT was defined according to NCCN guidelines and included: 1) delivery of external beam radiation, 2) brachytherapy, and 3) chemotherapy, 4) no radical hysterectomy. Logistic regression was used to determine trends in GA-CRT relative to the ACA. Survival was also estimated using Kaplan-Meier analysis. RESULTS: 37,772 patients met inclusion criteria (Pre-ACA:16,169; Post-ACA:21,673). A total of 33,116 patients had squamous cell carcinoma and 4626 patients had other histologies. Forty-five percent of patients had lymph node-positive disease. A total of 14.6% of patients had Stage I disease, 41.8% had Stage II disease, 36.4% had Stage III disease, and 7.9% had Stage IVA disease. On multivariable analysis, medicare insurance (OR 0.91; 95%CI: 0.84-0.99 compared to commercial insurance), non-squamous histology (OR 0.83; 95%CI: 0.77-0.89 for adenocarcinoma) and increasing Charlson-Deyo score were associated with decreased odds of receiving GA care. Increasing T-stage was associated with greater receipt of GA-CRT. The percentage of the population that received guideline adherent care increased post-ACA (Pre-ACA 28%; Post-ACA 34%; p < 0.001). Adherence to treatment guidelines increased 2-year survival by 15% (GA 76%; Not GA 61%; p < 0.001). Increased 2-year survival was seen in the post-ACA cohort (Pre-ACA 62%; Post-ACA 69%; p < 0.001). CONCLUSIONS: Implementation of the ACA was associated with improved GA-CRT and survival in patients with locally advanced cervical cancer.

Categorization of Adverse Events Reported to the FDA Pertaining to Tibia Intramedullary Nailing.

OpenFDA is an open access database maintained by the United States Food and Drug Administration (FDA) that we queried for adverse events (AEs) related to product devices used during tibia intramedullary nailing (IMN) procedures. There was a total of 1,799 reports pertaining to tibial intramedullary nailing from 1996 to 2020. Causes included infection (451), nonunion (380), intraoperative issue (343), painful hardware (234), implant fracture (195), other (68), loosening (35), surgeon error (24), packing problem (24), patient injury (12), expiration (12), contamination (11) and allergic reaction (10). The total number of events increased in 2016 and 2018, which was attributed to 510k approval for Stryker. Of the Aes, 1,400 resulted in an injury to the patient. In total, 78% occurred in the post-operative period, and 68% required additional surgery. Most incidents related to tibia IMNs result in injury and require additional surgery. When new products are released, AEs occur quickly and in bulk. (Journal of Surgical Orthopaedic Advances 31(4):237-241, 2022).

Unmasking a Privacy Concern: Potential Identification of Patients in an Immobilization Mask from 3-Dimensional Reconstructions of Simulation Computed Tomography.

Previous studies have demonstrated that patients can be identified from 3-dimensional (3D) reconstructions of computed tomography (CT) or magnetic resonance imaging data of the brain or head and neck. This presents a privacy and security concern for scan data released to public data sets. It is unknown whether thermoplastic immobilization masks used for treatment planning in radiation therapy are sufficient to prevent facial recognition. Our study sought to evaluate whether patients with an immobilization mask could be identified on 3D reconstructions of scan data. Our study reconstructed 3D images from simulation CT (SIM-CT) scans of 35 patients and compared these to original patient photographs to test if the thermoplastic mask obfuscated facial features. Blind review from 4 facial recognition algorithms and a human (radiation oncologist) was evaluated for the ability to match 3D reconstructions of patients scans to patient images. The matching procedure was repeated against an expanded testing data set of the 35 patient photographs plus 13,233 facial photographs from the "Labeled Faces in the Wild" data set (13,268 photographs in total). Facial recognition algorithms were able to match a maximum of 83% (range, 60%-83%) of patients to the corresponding images. Radiation Oncologist blinded review correctly matched 80% of patients to the corresponding images. Ethnicity and facial hair were the most common reasons for patient mismatch. In the expanded testing data set, algorithms were also able to match a maximum of 83% (range, 57%-83%) of patients. The majority of patients were able to be identified through computer algorithm or human review even under a SIM-CT mask. These results suggest there is a potential privacy and security concern when SIM-CT data are released to publicly available data sets.

Adverse events of after-loading high dose rate brachytherapy reported to the United States Food and Drug Administration (FDA).

PURPOSE: To provide an assessment of safety regarding high-dose-rate after-loading brachytherapy (HDR-BT) based on adverse events reported to the OpenFDA, an open access database maintained by the United States Food and Drug Administration (FDA). METHODS: OpenFDA was queried for HDR-BT events between 1993 and 2019. A brachytherapist categorized adverse events (AEs) based on disease site, applicator, manufacturer, event type, dosimetry impact, and outcomes. Important findings are summarized. RESULTS: 372 AEs were reported between 1993 and 2019, with a downwards trend after 2014. Nearly half of AEs (48.9%) were caused by a device malfunction, and 27.4% resulted in patient injury. Breast (49.2%) and Gyn (23.7%) were the most common disease sites of AEs. Applicator breaks cause the majority of AEs (64.2%) and breast balloon implants were the most common applicator to malfunction (38.7%). User error contributed to only 16.7% of events. 11.0% of events required repair of the afterloader. There were no reported staff injuries or patient deaths from an AE, however 24.7% of patients received resultant incorrect radiation dose, 16.4% required additional procedures to rectify the AE, and 3.0% resulted in unintended radiation to staff. CONCLUSION: The OpenFDA database has shown a decreasing trend in AEs since 2014 for HDR-BT. Most AEs are not caused by user error and do not cause patient injury or incorrect radiation dose. Investigation into methods to prevent failures and improve applicators such as the breast balloon could improve safety. These results support the continued use of HDR-BT as a safe treatment modality for cancer.