Radiation-Associated Angiosarcoma as a Presentation of Disease Progression in a Patient on Immunotherapy for Metastatic Non-small Cell Lung Cancer.

Non-small cell lung cancer (NSCLC) is the dominant form of lung cancer, comprising around 85% of cases. Stage 4 NSCLC has a grim prognosis; however, immunotherapy and radiation therapy have become vital treatments for advanced-stage NSCLC, despite the risk of inducing a second primary malignancy. This case report focuses on a 45-year-old female diagnosed with NSCLC and metastasis to the 11th thoracic vertebral body. After various treatments, including radiation, a potential radiation-associated secondary malignancy, epithelial angiosarcoma, was discovered. Following treatment modification, the patient achieved complete metabolic remission, highlighting the importance of clinicians being cautious about secondary primary cancers in NSCLC patients with a history of radiation therapy. Accurate diagnosis through biopsy and continuous surveillance are essential in managing NSCLC patients effectively.

Deep learning networks find unique mammographic differences in previous negative mammograms between interval and screen-detected cancers: a case-case study.

BACKGROUND: To determine if mammographic features from deep learning networks can be applied in breast cancer to identify groups at interval invasive cancer risk due to masking beyond using traditional breast density measures. METHODS: Full-field digital screening mammograms acquired in our clinics between 2006 and 2015 were reviewed. Transfer learning of a deep learning network with weights initialized from ImageNet was performed to classify mammograms that were followed by an invasive interval or screen-detected cancer within 12 months of the mammogram. Hyperparameter optimization was performed and the network was visualized through saliency maps. Prediction loss and accuracy were calculated using this deep learning network. Receiver operating characteristic (ROC) curves and area under the curve (AUC) values were generated with the outcome of interval cancer using the deep learning network and compared to predictions from conditional logistic regression with errors quantified through contingency tables. RESULTS: Pre-cancer mammograms of 182 interval and 173 screen-detected cancers were split into training/test cases at an 80/20 ratio. Using Breast Imaging-Reporting and Data System (BI-RADS) density alone, the ability to correctly classify interval cancers was moderate (AUC = 0.65). The optimized deep learning model achieved an AUC of 0.82. Contingency table analysis showed the network was correctly classifying 75.2% of the mammograms and that incorrect classifications were slightly more common for the interval cancer mammograms. Saliency maps of each cancer case found that local information could highly drive classification of cases more than global image information. CONCLUSIONS: Pre-cancerous mammograms contain imaging information beyond breast density that can be identified with deep learning networks to predict the probability of breast cancer detection.

Derived mammographic masking measures based on simulated lesions predict the risk of interval cancer after controlling for known risk factors: a case-case analysis.

PURPOSE: Women with radiographically dense or texturally complex breasts are at increased risk for interval cancer, defined as cancers diagnosed after a normal screening examination. The purpose of this study was to create masking measures and apply them to identify interval risk in a population of women who experienced either screen-detected or interval cancers after controlling for breast density. METHODS: We examined full-field digital screening mammograms acquired from 2006 to 2015. Examinations associated with 182 interval cancers were matched to 173 screen-detected cancers on age, race, exam date and time since last imaging examination. Local Image Quality Factor (IQF) values were calculated and used to create IQF maps that represented mammographic masking. We used various statistics to define global masking measures of these maps. Association of these masking measures with interval cancer vs screen-detected cancer was estimated using conditional logistic regression in a univariate and adjusted model for Breast Imaging-Reporting and Data System (BI-RADS) density. Receiver operator curves were calculated in each case to compare specificity vs sensitivity, and area under those curves were generated. Proportion of screen-detected cancer was estimated for stratifications of IQF features. RESULTS: Several masking features showed significant association with interval compared to screen-detected cancers after adjusting for BI-RADS density (up to P = 2.52E-6), and the 10th percentile of the IQF value (P = 1.72E-3) showed the strongest improvement in the area under the receiver operator curve, increasing from 0.65 using only BI-RADS density to 0.69. The highest masking group had a 32% proportion of screen-detected cancers while the low masking group had a 69% proportion. CONCLUSIONS: We conclude that computer vision methods using model observers may improve quantifying the probability of breast cancer detection beyond using breast density alone.

Selecting the Best of the Best: Associations between Anthropometric and Fitness Assessment Results and Success in Police Specialist Selection.

To successfully complete specialist police selection, officers must be physically fit. The aim of this study was to investigate the relationship between performance on selected anthropometric and fitness tests and successful selection into a specialist police unit. Thirty-two male police officers (mean age = 29.48±4.99 years) participated in a Barrier Fitness Assessment (BFA), followed by a Specialist Selection Course (SSC). The BFA spanned two consecutive days of testing (pull-ups, push-ups, seven-stage sit-ups, a timed loaded pack march, a Multi-Stage Fitness Test, an agility run, a lift and carry task and a 300m swim assessment). The SSC occurred 4 weeks later and consisted of 8 days of intense police training. Officers who successfully completed the SSC were graded based on their performance and this determined their ultimate selection. Data were categorized into four participant groups: Group 1 - Did not complete the BFA; Group 2 - Completed the BFA but not the SSC; Group 3 - Completed the SSC and were not selected; and Group 4 - Completed the SSC and were selected. A Spearman's rank order correlation analysis was conducted to assess the strengths of the relationships between selection stage achieved and scores on each of the predictor variables, with significance set at 0.05. Height (p=0.011), body weight (p=0.011), pull-ups (p=0.021) and push-ups (p=0.016), seven-stage sit-up scores (p=0.042) and lift and carry speed (p=0.010) were significantly and positively correlated with level of selection success. Results suggest that candidates wishing to attempt selection into specialist police units would benefit from being tall and training to optimize musculoskeletal strength and muscular endurance.

Grip Strength and Its Relationship to Police Recruit Task Performance and Injury Risk: A Retrospective Cohort Study.

Suitable grip strength is a police occupational requirement. The aim of this study was to investigate the association between grip strength, task performance and injury risk in a police population. Retrospective data of police recruits (n = 169) who had undergone basic recruit training were provided, including handgrip strength results, occupational task performance measures (consisting of police task simulations [SIM], tactical options [TACOPS] and marksmanship assessments) and injury records. Left hand grip strength (41.91 ± 8.29 kg) measures showed a stronger correlation than right hand grip strength (42.15 ± 8.53 kg) with all outcome measures. Recruits whose grip strength scores were lower were significantly more susceptible to failing the TACOPS occupational task assessment than those with greater grip strength scores, with significant (p ≤ 0.003) weak to moderate, positive correlations found between grip strength and TACOPS performance. A significant (p < 0.0001) correlation was found between grip strength, most notably of the left hand, and marksmanship performance, with those performing better in marksmanship having higher grip strength. Left hand grip strength was significantly associated with injury risk (r = -0.181, p = 0.018) but right hand grip strength was not. A positive association exists between handgrip strength and police recruit task performance (notably TACOPS and marksmanship) with recruits who scored poorly on grip strength being at greatest risk of occupational assessment task failure.

Dual energy X-ray absorptiometry body composition reference values of limbs and trunk from NHANES 1999-2004 with additional visualization methods.

Body Mass Index has traditionally been used as a measure of health, but Fat Mass Index (FMI) and Lean Mass Index (LMI) have been shown to be more predictive of mortality and health risk. Total body FMI and LMI reference curves have particularly been useful in quantifying sarcopenia and sarcopenic obesity. Research has shown regional composition has significant associations to health outcomes. We derived FMI and LMI reference curves of the regions of the body (leg, arm, and trunk) for 15,908 individuals in the 1999-2004 National Health and Nutrition Examination Survey data for each sex and ethnicity using the Lambda-Mu-Sigma (LMS) method and developed software to visualize this regional composition. These reference curves displayed differentiation between males and females during puberty and sharper limb LMI declines during late adulthood for males. For adults ages 30-50, females had 39%, 83%, and 47% larger arm, leg, and trunk FMI values than males, respectively. Males had 49%, 20%, and 15% higher regional LMI values than females for the arms, legs, and trunk respectively. The leg FMI and LMI of black females were 14% and 15% higher respectively than those of Hispanic and white females. White and Hispanic males had 37% higher trunk FMI values than black males. Hispanic females had 20% higher trunk FMI than white and black females. These data underscore the importance of accounting for sex and ethnicity in studies of regional composition. This study is the first to produce regional LMI and FMI reference tables and curves from the NHANES dataset. These reference curves provide a framework useful in studies and research involving sarcopenia, obesity, sarcopenic obesity, and other studies of compositional phenotypes. Further, the software tool we provide for visualizing regional composition will prove useful in monitoring progress in physical therapy, diets, or other attempts to attain healthier compositions.

The Functional Movement Screen as a predictor of police recruit occupational task performance.

AIM: The aim of this study was to determine whether poor movement patterns impact on police recruit task performance. METHODS: Fifty-three volunteers were randomly selected from a pool of 173 police recruits attending basic recruit training. Relationships between movement performance, as measured by the Functional Movement Screen, and four occupational tasks were investigated. RESULTS: Eleven percent failed the marksmanship and baton strike assessments, 21% failed defensive tactics and 36% failed the tactical options assessment. Mean Functional Movement Screen score was 13.96 points (±1.99 points). Only the tactical options assessment approached a significant difference (p = 0.077) between pass/fail recruits. When Functional Movement Screen scores when graded as pass (14+) or fail (<14) again only the tactical options assessment approached significance (p = 0.057). CONCLUSION: The results of this study suggest that a relationship between an officer's movement patterns and occupational performance, most notably choice of tactical options, may exist.

Leg Power As an Indicator of Risk of Injury or Illness in Police Recruits.

Tactical trainees, like those entering the police force, are required to undergo vigorous training as part of their occupational preparation. This training has the potential to cause injuries. In addition, the physical training, communal living and pressures of tactical training are known to induce immune suppression and have the potential to increase the risk of illness. The aim of this study was to investigate the relationship between leg power, as measured by a vertical jump (VJ), and rates of reported injuries and illnesses during police recruit training. Retrospective data from recruits (n = 1021) undergoing basic police recruit training at an Australian Police Force College was collected. Recruits completed a VJ assessment at the commencement of their second state of training. Formally reported illness and injuries were collected 12 weeks later, following completion of training. Correlations between VJ height and rates of reported illness and injury were low (r = -0.16 and -0.09, respectively) but significant (p < 0.005), with VJ height accounting for 2.6% and 0.8% of the variance in illness and injury rates, respectively. In terms of relative risks, recruits with the lowest recorded VJ heights were more than three times as likely as those with highest VJ heights to suffer injury and/or illness. Police recruits with lower VJ height are at a significantly greater risk of suffering an injury or illness during police basic recruit training.

Retention Rate of Electromagnetic Navigation Bronchoscopic Placed Fiducial Markers for Lung Radiosurgery.

BACKGROUND: Radiosurgery is becoming an increasingly used modality for the medically inoperable early stage lung cancer patient. The optimal fiducial marker with respect to retention rate has yet to be identified. METHODS: We retrospectively reviewed our experience with electromagnetic navigational bronchoscopic fiducial marker placement in preparation for stereotactic radiosurgery. RESULTS: Forty-eight patients, treated between 2010 and January 2013, were retrospectively reviewed. All patients had a diagnosis of early stage lung cancer. Comparison of initial fiducial placement procedure data with imaging at the time of treatment was accomplished for all patients in this data set. Fiducial retention rates were as follow: VortX coil fiducials were retained in 59 of 61 (96.7%) cases; two-band fiducials were retained in 24 of 33 (72.7%) of instances; and gold seed fiducials were retained in 23 of 33 (69.7%) of cases. Retention was statistically superior when comparing the VortX coil with the two-band fiducial or the gold seed (p = 0.004 and p = 0.0001). Anatomic location by lobe was analyzed, but no statistically significant differences were observed. CONCLUSIONS: The VortX coil fiducial marker showed a statistically significant increase in retention rate compared with gold seeds or two-band fiducials. This may translate to cost savings through placing fewer markers per patient as retention is high.

Optimal planning target volume margins for elective pelvic lymphatic radiotherapy in high-risk prostate cancer patients.

Purpose. High-risk prostate cancer patients often receive radiotherapy (RT) to pelvic lymphatics (PLs). The aim of this study was to determine the safety margin around clinical target volume for PL (PL-CTV) to construct planning target volume for PL (PL-PTV) and for planning elective PL irradiation. Methods and Materials. Six patients who received RT to PL as part of prostate cancer treatment were identified. To determine average daily shifts of PL, the right and left IVs were contoured at 3 predetermined slices on the daily MV scans and their daily shifts were measured at these 3 levels using a measuring tool. Results. A total of 1,932 observations were made. Daily shifts of IV were random in distribution, and the largest observed shift was 13.6 mm in lateral and 15.4 mm in AP directions. The mean lateral and AP shifts of IV were 2.1 mm (±2.2) and 3.5 mm (±2.7), respectively. The data suggest that AP and lateral margins of 8.9 mm and 6.5 mm are necessary. Conclusions. With daily alignment to the prostate, we recommend an additional PL-CTV to PL-PTV conversion margin of 9 mm (AP) and 7 mm (lateral) to account for daily displacement of PL relative to the prostate.

Why the dish makes a difference: quantitative comparison of polystyrene culture surfaces.

There is wide anecdotal recognition that biological cell viability and behavior can vary significantly as a function of the source of commercial tissue culture polystyrene (TCPS) culture vessels to which those cells adhere. However, this marked material dependency is typically resolved by selecting and then consistently using the same manufacturer's product - following protocol - rather than by investigating the material properties that may be responsible for such experimental variation. Here, we quantified several physical properties of TCPS surfaces obtained from a wide range of commercial sources and processing steps, through the use of atomic force microscopy (AFM)-based imaging and analysis, goniometry and protein adsorption quantification. We identify qualitative differences in surface features, as well as quantitative differences in surface roughness and wettability that cannot be attributed solely to differences in surface chemistry. We also find significant differences in cell morphology and proliferation among cells cultured on different TCPS surfaces, and resolve a correlation between nanoscale surface roughness and cell proliferation rate for both cell types considered. Interestingly, AFM images of living adherent cells on these nanotextured surfaces demonstrate direct interactions between cellular protrusions and topographically distinct features. These results illustrate and quantify the significant differences in material surface properties among these ubiquitous materials, allowing us to better understand why the dish can make a difference in biological experiments.