565 results on '"Alderliesten T"'
Search Results
202. PD-0492 SEROMA VOLUME CHANGE AS AN INDICATOR FOR THE NEED OF REPLANNING DURING ADAPTIVE RT OF BREAST CANCER
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Franssen, G., primary, Alderliesten, T., additional, van Kesteren, Z., additional, Elkhuizen, P., additional, Conijn, S., additional, Duijn, A., additional, Janssen, T., additional, Remeijer, P., additional, and van Vliet-Vroegindeweij, C., additional
- Published
- 2012
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203. Bringing IDEAs into Practice: Optimization in a Minimally Invasive Vascular Intervention Simulation System
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Systemen der Beslissingsondersteuning, Dep Informatica, Bosman, P.A.N., Alderliesten, T., Systemen der Beslissingsondersteuning, Dep Informatica, Bosman, P.A.N., and Alderliesten, T.
- Published
- 2004
204. 259 The MARI procedure; Mapping of the Axilla with Radioactive Iodine seeds
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Straver, M., primary, Donker, M., additional, Loo, C.E., additional, Wesseling, J., additional, Maessen, H., additional, Steggerda, M., additional, Alderliesten, T., additional, Holtkamp, M., additional, Rutgers, E.J.T.H., additional, and Peeters, M.T.F.D. Vrancken, additional
- Published
- 2010
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205. SEROMA AFTER BREAST CONSERVING SURGERY: A COMPARISON OF THREE RADIOTHERAPY PLANNING TECHNIQUES
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Den Hollander, S., primary, Alderliesten, T., additional, Yang, J., additional, Elkhuizen, P., additional, van Mourik, A., additional, Hurkmans, C., additional, and van Vliet-Vroegindewij, C., additional
- Published
- 2009
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206. ASSESSMENT OF SETUP VARIABILITY FOR BREATH-HOLD RADIOTHERAPY FOR BREAST CANCER PATIENTS BY SURFACE IMAGING
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Alderliesten, T., primary, Sonke, J.J., additional, Heddes, R., additional, Betgen, A., additional, Remeijer, P., additional, and van Vliet-Vroegindewij, C., additional
- Published
- 2009
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207. Marking the axilla with radioactive iodine seeds (MARl procedure) may reduce the need for axillary dissection after neoadjuvant chemotherapy for breast cancer.
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Strayer, M. E., Loo, C. E., Alderliesten, T., Rutgers, E. J. T., and Peeters, M. T. F. D. Vrancken
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BREAST cancer surgery ,CANCER treatment ,CANCER in women ,DRUG therapy ,TREATMENT effectiveness - Abstract
The article presents a study which investigates the efficacy of marking the axilla with radioactive iodine seeds (MARI) as a new procedure for treating breast cancer. The results show that this procedure, which involves neoadjuvant chemotherapy, is feasible for treatment of breast cancer. It was concluded that this procedure has the potential when making axilla-conserving surgery in treating breast cancer.
- Published
- 2010
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208. Potential benefit of semi-automatic volumetric measurement of extent of breast tumors from contrast-enhanced MRI
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Alderliesten, T., Schlief, A.T.E.F., Peterse, J.L., Loo, C.E., Teertstra, H.J., Klein Zeggelink, W.F.A., Muller, S.H., and Gilhuijs, K.G.A.
- Published
- 2006
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209. Radioactive seed localization in breast cancer treatment
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Janssen, N. N., Jasper Nijkamp, Alderliesten, T., Loo, C. E., Rutgers, E. J., Sonke, J. J., and Vrancken Peeters, M. T.
210. OC-0445 Automated optimization for cervix brachytherapy requires more than the EMBRACE-II planning aims.
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Dickhoff, L., Kerkhof, E.M., Pieters, B.R., Westerveld, H., Stalpers, L.J., Velema, L.A., Barten, D.L., Gratama van Andel, H., Niatsetski, Y., Creutzberg, C.L., Bosman, P.A., and Alderliesten, T.
- Subjects
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RADIOISOTOPE brachytherapy - Published
- 2022
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211. OC-0275 Incorporating control of contiguous high-dose volumes in automated optimization for prostate BT.
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Commandeur, J.L., Bouter, A., Dickhoff, L.R., Barten, D.L., Westerveld, H., Pieters, B.R., Alderliesten, T., and Bosman, P.A.
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PROSTATE - Published
- 2022
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212. PD-0498 Deep learning-based segmentation considering observer variation - evaluation in prostate MRI for BT.
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Dushatskiy, A., Bosman, P.A.N., Hinnen, K.A., Wiersma, J., Westerveld, H., Pieters, B., and Alderliesten, T.
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PROSTATE , *MAGNETIC resonance imaging - Published
- 2023
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213. PO-0216 Healthy tissue constraints for catheter position optimization in HDR prostate brachytherapy planning.
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van der Meer, M.C., van Dorth, D., Bosman, P.A., Pieters, B.R., Niatsetski, Y., Alderliesten, T., and Bel, A.
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HIGH dose rate brachytherapy , *CATHETERS , *TISSUES - Published
- 2021
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214. Optimal Mixing Evolutionary Algorithms for Large-Scale Real-Valued Optimization: Including Real-World Medical Applications
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Bouter, P.A., Bosman, P.A.N., Alderliesten, T., and Delft University of Technology
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Multi-objective Optimisation ,Graphics Processing Unit (GPU) ,Brachytherapy ,Gene-pool Optimal Mixing ,Real-valued optimization ,CUDA ,Evolutionary Algorithms ,Deformable image registration ,Large-scale optimization ,Treatment planning ,Gray-box optimization - Abstract
In recent years, the use of Artificial Intelligence (AI) has become prevalent in a large number of societally relevant, real-world problems, e.g., in the domains of engineering and health care. The field of Evolutionary Computation (EC) can be considered to be a sub-field of AI, concerning optimization using Evolutionary Algorithms (EAs), which are population-based (meta-)heuristics that employ the Darwinian principles of evolution, i.e., variation and selection. Such EAs are historically mainly considered for the optimization of difficult, non-linear problems in a Black-Box Optimization (BBO) setting, because EAs can effectively optimize such problems even when very little is known about the optimization problem and its structure. This is in contrast to optimization methods that are specifically designed for certain problems of which the definition and structure are known, i.e., a White-Box Optimization (WBO) setting.
- Published
- 2023
215. Model-based evolutionary algorithms for finding diverse high-quality solutions with an application in brachytherapy for prostate cancer
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Maree, S.C., Bosman, P.A.N., Rasch, C.R.N., Alderliesten, T., Bel, A., and Faculteit der Geneeskunde
- Abstract
Evolutionary algorithms can be used to quickly obtain a high-quality solution to a real-world optimization problem. In practice, it can however be difficult to capture all desirable aspects of a solution into a quantitative objective function. To overcome this, we focus on the design, development, and application of model-based evolutionary algorithms for finding not one solution, but a set of diverse high-quality solutions, via multi-objective optimization and via multimodal optimization. By obtaining and comparing diverse high-quality solutions, the normally implicit trade-offs of a problem can be made explicit, which can help decision makers in selecting the most desirable solution for their problem. We develop the simple yet effective hill-valley clustering method, which can be employed for efficient and effective multimodal optimization of single-objective and multi-objective problems. In addition, we advance the field of multi-objective optimization by demonstrating how efficient hypervolume-based multi-objective optimization with convergence to optimality can be accomplished. We show how this approach can be used to obtain smoothly navigable solution sets, aimed to make the selection of the most desirable solution more intuitive for the decision maker. Finally, we consider a problem that arises in the treatment of prostate cancer with brachytherapy, which is a form of internal radiation therapy. We show that by approaching the problem as a bi-objective optimization problem, and solving it with an evolutionary algorithm, novel insight is gained in patient-specific trade-offs, and resulting treatment plans are almost always preferred over clinically-used treatment plans.
- Published
- 2021
216. Radiograph-based organ dose reconstruction for childhood cancer survivors with long-term follow-up
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Wang, Z., Rasch, Coenraad R. N., Bosman, Peter A. N., Alderliesten, Tanja, Bel, Adrianus, CCA - Treatment and quality of life, CCA - Imaging and biomarkers, Radiotherapy, Graduate School, Rasch, C.R.N., Bosman, P.A.N., Alderliesten, T., Bel, A., and Faculteit der Geneeskunde
- Abstract
The motivation of the research presented in this thesis was to provide solutions for accurate organ dose reconstruction based on the clinical records of childhood cancer survivors treated in the 2D radiation treatment (RT) planning era. The reconstructed dose information can be used to investigate dose-effect relationships in childhood cancer survivors with long-term follow-up. We need this knowledge to, for example, determine the dose that can be maximally delivered to specific organs so that children can receive better treatment. In this thesis, we investigated the impact of anatomical discrepancies between surrogate anatomies and the patient’s true anatomy on dose reconstruction quality, and formulated solutions to minimize this impact. To achieve this, we first assessed the feasibility of using patient CT scans as surrogate anatomies for organ dose reconstruction using a common literature standard (i.e., age and sex) for selecting a surrogate anatomy. Thereafter, we investigated the correlations between the deviations of a set of patient characteristics / anatomical features and deviations in organ dose reconstruction. Further, we proposed two novel approaches utilizing big data and machine learning (ML) techniques, one creating individualized surrogate anatomies, and the other one uses no surrogate anatomies at all. Finally, we validated and compared our approaches with the current state-of-the-art approaches on a common data set. Our approaches achieved an equally good (if not better) quality of dose reconstruction results with better efficiency and robustness compared to the current state-of-the-art approaches.
- Published
- 2021
217. PO-0200 Comparison of catheter position planning algorithms for HDR prostate brachytherapy under uncertainty.
- Author
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van der Meer, M.C., Pieters, B.R., Niehoff, P., Milickovic, N., Niatsetski, Y., Alderliesten, T., Bosman, P.A., and Bel, A.
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HIGH dose rate brachytherapy , *CATHETERS , *UNCERTAINTY , *ALGORITHMS - Published
- 2021
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218. Design and Application of Gene-pool Optimal Mixing Evolutionary Algorithms for Genetic Programming
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Virgolin, Marco, Bosman, P.A.N., Witteveen, C., Alderliesten, T., and Delft University of Technology
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machine learning ,genetic programming ,evolutionary algorithms ,radiotherapy ,pediatric cancer - Abstract
Machine learning is impacting modern society at large, thanks to its increasing potential to effciently and effectively model complex and heterogeneous phenomena. While machine learning models can achieve very accurate predictions in many applications, they are not infallible. In some cases, machine learning models can deliver unreasonable outcomes. For example, deep neural networks for self-driving cars have been found to provide wrong steering directions based on the lighting conditions of street lanes (e.g., due to cloudy weather). In other cases, models can capture and reflect unwanted biases thatwere concealed in the training data. For example, deep neural networks used to predict likely jobs and social status of people based on their pictures, were found to consistently discriminate based on gender and ethnicity–this was later attributed to human bias in the labels of the training data.
- Published
- 2020
219. Optimizing target volume definition and treatment accuracy in esophageal cancer
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Machiels, M., Rasch, Coenraad R. N., Hulshof, Martinus C. C. M., Alderliesten, Tanja, CCA - Treatment and quality of life, Graduate School, Radiotherapy, Rasch, C.R.N., Hulshof, M.C.C.M., Alderliesten, T., and Faculteit der Geneeskunde
- Abstract
The rise of the multimodality treatment of esophageal cancer has resulted in a considerable improvement of long-term oncologic outcomes. The accuracy of esophageal cancer radiotherapy did contrariwise not improve over the last decennium. Visualization of the esophageal tumor extent using a planning computed tomography scan for delineation purposes, or cone-beam CT scan for verification purposes, can be notoriously challenging. The research presented in this thesis aimed to increase the accuracy of the gross target volume and the clinical target volume definition in esophageal cancer radiotherapy with the aid of fiducial markers placed on (echo)endoscopically determined tumor borders. We also investigated an alternative strategy to improve the bony-anatomy based setup verification, and the best strategy to take respiration-induced target motion into account; geometrical uncertainties typically compensated by the clinical target volume-to-planning target volume margin. We demonstrated that fiducial markers are capable of improving accuracy of esophageal cancer radiotherapy, and made it possible to understand and potentially mitigate different kinds of uncertainties. We endorse the use of fiducial makers placed on (echo)endoscopically determined tumor borders, an anisotropic and region-specific margin to construct the planning target volume margin, and a mid-position strategy for esophageal cancer radiotherapy.
- Published
- 2020
220. Exploring the potential and feasibility of multi-objective deformable image registration for breast cancer treatment
- Author
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Pirpinia, Kleopatra, van Herk, M.B., Sonke, J.J., Alderliesten, T., Bosman, P.A.N., Faculteit der Geneeskunde, van Herk, Marcellinus B., Sonke, Jan-Jakob, Alderliesten, Tanja, Bosman, Peter A. N., CCA - Imaging and biomarkers, Other Research, Cancer Center Amsterdam, and Graduate School
- Abstract
Deformable image registration (DIR), the process of deforming one image to match another, is an image processing technique of increasing importance in cancer diagnosis, monitoring and treatment, as it allows to, e.g., align image data acquired in different patient orientation, or capture patient anatomy changes over time. To solve the DIR problem, current DIR methods rely on multiple parameters that need to be tuned, a non-trivial task; further, it is difficult for these methods to capture large deformations and content mismatch present in the images. In part due to such obstacles, the use of DIR in clinical practice remains limited. In this thesis, to improve and facilitate use of DIR in clinical practice, we proposed a novel perspective on DIR based on multi-objective optimization, i.e., we did not model DIR as a problem with one unique solution, but as a problem with a set of solutions that can be considered equally good, each one representing a high-quality trade-off between DIR objectives of interest. We considered two challenging DIR problems in the context of breast cancer treatment, which involve large deformations and content mismatch: prone-to-supine breast MRI registration, and pre- to post-operative breast CT registration. In Part I, we saw that a multi-objective perspective on DIR can improve the way current DIR methods are fine-tuned, thereby improving their use in clinical practice for problems with limited deformations. In Part II, we made the first algorithmic steps towards developing a purely multi-objective DIR method, for solving hard registration problems.
- Published
- 2020
221. Geometrical variability of esophageal tumors and its implications for accurate radiation therapy
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Jin, Peng, Rasch, C.R.N., Alderliesten, T., Hulshof, M.C.C.M., Faculteit der Geneeskunde, Rasch, Coenraad R. N., Alderliesten, Tanja, Hulshof, Martinus C. C. M., CCA - Treatment and quality of life, CCA - Imaging and biomarkers, Radiotherapy, and Graduate School
- Abstract
Esophageal cancer is currently ranked the eighth most common cancer worldwide. Radiation therapy with concurrent chemotherapy is preferred for both preoperative and definitive treatment. One major concern in accurate radiation therapy is the geometrical uncertainty of the clinical target volume. Currently, inter- and intra-observer variation in target delineation are large due to the limited soft-tissue contrast on CT. Fiducial markers implanted at the tumor borders can significantly reduce the delineation variation. Apart from delineation variation, interfractional tumor position variation has a major contribution to the geometrical uncertainty in the case of bony anatomy-based setup verification. It is most pronounced in the cranial-caudal direction and in the cardia, implying the need of an anisotropic and region-dependent safety margin for uncertainty compensation. Carina-based setup verification cannot reduce the interfractional tumor position variation compared to bony anatomy-based setup verification. Furthermore, gastrointestinal gas volume variation can also degrade the dose distribution. In clinical practice, using density override could mitigate the gas-induced effect. Another source of geometrical uncertainty is respiration-induced tumor motion. It is also most pronounced in the cranial-caudal direction and in the distal esophagus. Moreover, the interfractional variability of respiration-induced tumor motion is limited. Thus, it is recommended to use 4D-CT for treatment planning. In this case, compared to the concept of internal target volume, using the mid-position strategy may reduce dose to organs at risk such as lung and heart by 10%. There are also other approaches to mitigate geometrical uncertainty. Further research needs to be done in the future.
- Published
- 2019
222. Organ motion in children for high-precision radiotherapy: Why treat children like adults?
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Huijskens, S.C., Rasch, C.R.N., Bel, A., Alderliesten, T., and Faculteit der Geneeskunde
- Abstract
Het doel bij radiotherapie is om de tumor heel nauwkeurig te bestralen en daarbij het omliggende gezonde weefsel zoveel mogelijk te sparen. Maar doordat je beweegt, eet, en natuurlijk ademhaalt, is de positie van de tumoren en organen in je lichaam nooit elke dag of zelfs elke seconde hetzelfde. Vooral in de buik en borst is er veel beweging. Om zeker te weten dat je de hele tumor bestraalt voegen we een extra marge toe. Om de bewegingen te kunnen meten en uit te rekenen hoe groot die marge moet zijn, worden CB-CT scans gemaakt. Tot een aantal jaar geleden ontbraken deze beelden tijdens radiotherapie bij kinderen. Daarom werden gegevens van volwassenen gebruikt. Omdat kinderen kleiner zijn, verwachtten we minder beweging en zouden we dus mogelijk met een kleinere marge kunnen bestralen. Met de actuele ontwikkelingen in Nederland op het gebied van radiotherapie met protonen, waarbij de tumor met nog meer precisie en hogere energie (=schadelijker) kan worden bestraald, is het dus nóg belangrijker dat we de juiste marge kunnen bepalen. In dit proefschrift kwantificeren we de orgaanbeweging in kinderen tijdens beeldgestuurde radiotherapie en vergelijken dit met volwassen data. Met deze uitkomsten kunnen we een betere inschatting maken over de beweging van de tumor en organen tijdens de behandeling, en dragen we bij aan betere bepaling van de juiste marge voor elke patiënt. Zo kunnen we de nauwkeurigheid van bestralingen verbeteren, wat zal leiden tot minder schadelijke straling aan gezond weefsel en een hogere kans op gezonde overleving.
- Published
- 2019
223. Optical coherence tomography of the esophagus in radiation therapy
- Author
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Jelvehgaran Esfahani, M., van Herk, M.B., de Boer, Johannes, de Bruin, Daniel, Alderliesten, T., and Faculteit der Geneeskunde
- Abstract
Esophageal cancer is the eight most common type of cancer worldwide and the sixth leading cause of cancer-related death with a five-year survival rate of 15-25%. Prominent histopathological types of cancer are squamous cell carcinoma and adenocarcinoma. Currently, the clinical guidelines for esophageal cancer patients (>T2) involves neoadjuvant chemo-radiation therapy (nCRT) followed by esophagectomy. The main objective during radiation therapy (RT) is to precisely deliver the radiation dose to the tumor and tumor-involved lymph nodes while sparing surrounding healthy tissue. Although image-guided RT enhances the local tumor control, detailed knowledge of the tumor extent is limited and improvements are required. Computed tomography (CT) and recently magnetic resonance imaging (MRI) are the main imaging modalities used for RT planning. CT and MRI are limited in terms of resolution to visualize the tumor extent, and therefore endoscopic ultrasound (EUS) is used to assess the longitudinal extent of the tumor. However, EUS has a low soft-tissue contrast and suffers from understaging due to the limited resolution of EUS to visualize microscopic tumor extent and overstaging since it is unable to distinguish tumor infiltration from inflammatory changes. Such uncertainties require a large expansion of the gross tumor volume (GTV) into the clinical target volume (CTV) during RT planning. Optical coherence tomography (OCT) with a 10-fold higher resolution than EUS may potentially better visualize the tumor extent, which can reduce CTV margins. The aim of this thesis was to adopt OCT for image-guided RT of esophageal cancer and diagnostics of radiation-induced esophageal damages during RT of thoracic and head and neck cancer.
- Published
- 2019
224. Normal regional tissue oxygen saturation in neonates: a systematic qualitative review.
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Bruckner M, Wolfsberger CH, Dempsey EM, Liem KD, Lemmers P, Alderliesten T, Alarcon A, Mintzer J, de Boode WP, Schmölzer GM, and Pichler G
- Subjects
- Humans, Infant, Newborn, Reference Values, Oximetry methods, Spectroscopy, Near-Infrared, Infant, Premature, Oxygen metabolism, Oxygen blood, Oxygen Saturation
- Abstract
Background: The aim of this systematic qualitative review was to give an overview of reference ranges defined as normal values or centile charts of regional tissue oxygen saturation measured by near-infrared spectroscopy (NIRS) in term and preterm neonates., Methods: A systematic search of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials was performed. Additional articles were identified by manual search of cited references. Only human studies in neonates were included., Results: Nineteen studies were identified. Eight described regional tissue oxygen saturation during fetal-to-neonatal transition, six during the first 3 days after birth, four during the first 7 days after birth, and one during the first 8 weeks after birth. Nine described regional tissue oxygen saturation in term, nine in preterm neonates, and one in both. Eight studies published centile charts for cerebral regional tissue oxygen saturation, and only five included large cohorts of infants. Eleven studies described normal values for cerebral, muscle, renal, and abdominal regional tissue oxygen saturation, the majority with small sample sizes. Four studies of good methodological quality were identified describing centile charts of cerebral regional tissue oxygen saturation., Conclusions: In clinical settings, quality centile charts are available and should be the preferred method when using NIRS monitoring., Impact: Near-infrared spectroscopy (NIRS) enables a bed-side non-invasive continuous monitoring of tissue oxygenation. When using NIRS monitoring in a clinical setting, centile charts with good quality are available and should be preferred to normal values. High-quality reference ranges of regional tissue oxygenation in term and preterm born neonates are an important step toward routine clinical application of NIRS., (© 2021. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.)
- Published
- 2024
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225. Cerebral near-infrared spectroscopy monitoring (NIRS) in children and adults: a systematic review with meta-analysis.
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Hansen ML, Hyttel-Sørensen S, Jakobsen JC, Gluud C, Kooi EMW, Mintzer J, de Boode WP, Fumagalli M, Alarcon A, Alderliesten T, and Greisen G
- Subjects
- Humans, Child, Adult, Brain metabolism, Randomized Controlled Trials as Topic, Monitoring, Physiologic methods, Infant, Newborn, Spectroscopy, Near-Infrared methods
- Abstract
Background: Cerebral oxygenation monitoring utilising near-infrared spectroscopy (NIRS) is increasingly used to guide interventions in clinical care. The objective of this systematic review with meta-analysis and Trial Sequential Analysis is to evaluate the effects of clinical care with access to cerebral NIRS monitoring in children and adults versus care without., Methods: This review conforms to PRISMA guidelines and was registered in PROSPERO (CRD42020202986). Methods are outlined in our protocol (doi: 10.1186/s13643-021-01660-2)., Results: Twenty-five randomised clinical trials were included (2606 participants). All trials were at a high risk of bias. Two trials assessed the effects of NIRS during neonatal intensive care, 13 during cardiac surgery, 9 during non-cardiac surgery and 1 during neurocritical care. Meta-analyses showed no significant difference for all-cause mortality (RR 0.75, 95% CI 0.51-1.10; 1489 participants; I
2 = 0; 11 trials; very low certainty of evidence); moderate or severe, persistent cognitive or neurological deficit (RR 0.74, 95% CI 0.42-1.32; 1135 participants; I2 = 39.6; 9 trials; very low certainty of evidence); and serious adverse events (RR 0.82; 95% CI 0.67-1.01; 2132 participants; I2 = 68.4; 17 trials; very low certainty of evidence)., Conclusion: The evidence on the effects of clinical care with access to cerebral NIRS monitoring is very uncertain., Impact: The evidence of the effects of cerebral NIRS versus no NIRS monitoring are very uncertain for mortality, neuroprotection, and serious adverse events. Additional trials to obtain sufficient information size, focusing on lowering bias risk, are required. The first attempt to systematically review randomised clinical trials with meta-analysis to evaluate the effects of cerebral NIRS monitoring by pooling data across various clinical settings. Despite pooling data across clinical settings, study interpretation was not substantially impacted by heterogeneity. We have insufficient evidence to support or reject the clinical use of cerebral NIRS monitoring., (© 2022. The Author(s).)- Published
- 2024
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226. Association between sleep stages and brain microstructure in preterm infants: Insights from DTI analysis.
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de Groot ER, Wang X, Wojtal K, Janson E, Alderliesten T, Tataranno ML, Benders MJNL, and Dudink J
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- Humans, Male, Female, Retrospective Studies, Infant, Newborn, Internal Capsule diagnostic imaging, White Matter diagnostic imaging, Pyramidal Tracts diagnostic imaging, Brain diagnostic imaging, Diffusion Tensor Imaging methods, Infant, Premature, Sleep Stages physiology
- Abstract
Study Objectives: The aim of this study was to investigate the relationship between sleep stages and neural microstructure - measured using diffusion tensor imaging - of the posterior limb of the internal capsule and corticospinal tract in preterm infants., Methods: A retrospective cohort of 50 preterm infants born between 24 + 4 and 29 + 3 weeks gestational age was included in the study. Sleep stages were continuously measured for 5-7 consecutive days between 29 + 0 and 31 + 6 weeks postmenstrual age using an in-house-developed, and recently published, automated sleep staging algorithm based on routinely measured heart rate and respiratory rate. Additionally, a diffusion tensor imaging scan was conducted at term equivalent age as part of standard care. Region of interest analysis of the posterior limb of the internal capsule was performed, and tractography was used to analyze the corticospinal tract. The association between sleep and white matter microstructure of the posterior limb of the internal capsule and corticospinal tract was examined using a multiple linear regression model, adjusted for potential confounders., Results: The results of the analyses revealed an interaction effect between sleep stage and days of invasive ventilation on the fractional anisotropy of the left and right posterior limb of the internal capsule (β = 0.04, FDR-adjusted p = 0.001 and β = 0.04, FDR-adjusted p = 0.02, respectively). Furthermore, an interaction effect between sleep stage and days of invasive ventilation was observed for the radial diffusivity of the mean of the left and right PLIC (β = -4.1e-05, FDR-adjusted p = 0.04)., Conclusions: Previous research has shown that, in very preterm infants, invasive ventilation has a negative effect on white matter tract maturation throughout the brain. A positive association between active sleep and white matter microstructure of the posterior limb of the internal capsule, may indicate a protective role of sleep in this vulnerable population., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
227. Noncontact respiration monitoring techniques in young children: A scoping review.
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van der Linden M, Veldhoen ES, Arasteh E, Long X, Alderliesten T, de Goederen R, and Dudink J
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- Humans, Child, Monitoring, Physiologic methods, Monitoring, Physiologic instrumentation, Child, Preschool, Polysomnography methods, Infant, Respiratory Rate physiology, Sleep Apnea Syndromes diagnosis, Sleep Apnea Syndromes physiopathology
- Abstract
Pediatric sleep-related breathing disorders, or sleep-disordered breathing (SDB), cover a range of conditions, including obstructive sleep apnea, central sleep apnea, sleep-related hypoventilation disorders, and sleep-related hypoxemia disorder. Pediatric SDB is often underdiagnosed, potentially due to difficulties associated with performing the gold standard polysomnography in children. This scoping review aims to: (1) provide an overview of the studies reporting on safe, noncontact monitoring of respiration in young children, (2) describe the accuracy of these techniques, and (3) highlight their respective advantages and limitations. PubMed and EMBASE were searched for studies researching techniques in children <12 years old. Both quantitative data and the quality of the studies were analyzed. The evaluation of study quality was conducted using the QUADAS-2 tool. A total of 19 studies were included. Techniques could be grouped into bed-based methods, microwave radar, video, infrared (IR) cameras, and garment-embedded sensors. Most studies either measured respiratory rate (RR) or detected apneas; n = 2 aimed to do both. At present, bed-based approaches are at the forefront of research in noncontact RR monitoring in children, boasting the most sophisticated algorithms in this field. Yet, despite extensive studies, there remains no consensus on a definitive method that outperforms the rest. The accuracies reported by these studies tend to cluster within a similar range, indicating that no single technique has emerged as markedly superior. Notably, all identified methods demonstrate capability in detecting body movements and RR, with reported safety for use in children across the board. Further research into contactless alternatives should focus on cost-effectiveness, ease-of-use, and widespread availability., (© 2024 The Authors. Pediatric Pulmonology published by Wiley Periodicals LLC.)
- Published
- 2024
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228. Keeping your best options open with AI-based treatment planning in prostate and cervix brachytherapy.
- Author
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Dickhoff LRM, Scholman RJ, Barten DLJ, Kerkhof EM, Roorda JJ, Velema LA, Stalpers LJA, Pieters BR, Bosman PAN, and Alderliesten T
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- Male, Female, Humans, Prostate, Radiotherapy Dosage, Cervix Uteri, Radiotherapy Planning, Computer-Assisted methods, Artificial Intelligence, Prostatic Neoplasms radiotherapy, Brachytherapy methods
- Abstract
Purpose: Without a clear definition of an optimal treatment plan, no optimization model can be perfect. Therefore, instead of automatically finding a single "optimal" plan, finding multiple, yet different near-optimal plans, can be an insightful approach to support radiation oncologists in finding the plan they are looking for., Methods and Materials: BRIGHT is a flexible AI-based optimization method for brachytherapy treatment planning that has already been shown capable of finding high-quality plans that trade-off target volume coverage and healthy tissue sparing. We leverage the flexibility of BRIGHT to find plans with similar dose-volume criteria, yet different dose distributions. We further describe extensions that facilitate fast plan adaptation should planning aims need to be adjusted, and straightforwardly allow incorporating hospital-specific aims besides standard protocols., Results: Results are obtained for prostate (n = 12) and cervix brachytherapy (n = 36). We demonstrate the possible differences in dose distribution for optimized plans with equal dose-volume criteria. We furthermore demonstrate that adding hospital-specific aims enables adhering to hospital-specific practice while still being able to automatically create cervix plans that more often satisfy the EMBRACE-II protocol than clinical practice. Finally, we illustrate the feasibility of fast plan adaptation., Conclusions: Methods such as BRIGHT enable new ways to construct high-quality treatment plans for brachytherapy while offering new insights by making explicit the options one has. In particular, it becomes possible to present to radiation oncologists a manageable set of alternative plans that, from an optimization perspective are equally good, yet differ in terms of coverage-sparing trade-offs and shape of the dose distribution., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2024
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229. Machine Learning-Derived Active Sleep as an Early Predictor of White Matter Development in Preterm Infants.
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Wang X, de Groot ER, Tataranno ML, van Baar A, Lammertink F, Alderliesten T, Long X, Benders MJNL, and Dudink J
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- Infant, Female, Humans, Infant, Newborn, Brain diagnostic imaging, Magnetic Resonance Imaging, Sleep, Infant, Premature, White Matter diagnostic imaging
- Abstract
White matter dysmaturation is commonly seen in preterm infants admitted to the neonatal intensive care unit (NICU). Animal research has shown that active sleep is essential for early brain plasticity. This study aimed to determine the potential of active sleep as an early predictor for subsequent white matter development in preterm infants. Using heart and respiratory rates routinely monitored in the NICU, we developed a machine learning-based automated sleep stage classifier in a cohort of 25 preterm infants (12 females). The automated classifier was subsequently applied to a study cohort of 58 preterm infants (31 females) to extract active sleep percentage over 5-7 consecutive days during 29-32 weeks of postmenstrual age. Each of the 58 infants underwent high-quality T2-weighted magnetic resonance brain imaging at term-equivalent age, which was used to measure the total white matter volume. The association between active sleep percentage and white matter volume was examined using a multiple linear regression model adjusted for potential confounders. Using the automated classifier with a superior sleep classification performance [mean area under the receiver operating characteristic curve (AUROC) = 0.87, 95% CI 0.83-0.92], we found that a higher active sleep percentage during the preterm period was significantly associated with an increased white matter volume at term-equivalent age [ β = 0.31, 95% CI 0.09-0.53, false discovery rate (FDR)-adjusted p -value = 0.021]. Our results extend the positive association between active sleep and early brain development found in animal research to human preterm infants and emphasize the potential benefit of sleep preservation in the NICU setting., (Copyright © 2024 the authors.)
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- 2024
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230. Brain MRI Injury Patterns across Gestational Age among Preterm Infants with Perinatal Asphyxia.
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Parmentier CEJ, El Bakkali L, Verhagen EA, Steggerda SJ, Alderliesten T, Lequin MH, van de Pol LA, Benders MJNL, van Bel F, Koopman-Esseboom C, de Haan TR, de Vries LS, and Groenendaal F
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- Humans, Infant, Newborn, Female, Retrospective Studies, Male, Brain diagnostic imaging, Brain Injuries diagnostic imaging, Brain Injuries etiology, Infant, Apgar Score, Magnetic Resonance Imaging, Asphyxia Neonatorum diagnostic imaging, Asphyxia Neonatorum complications, Gestational Age, Infant, Premature
- Abstract
Introduction: Brain injury patterns of preterm infants with perinatal asphyxia (PA) are underreported. We aimed to explore brain magnetic resonance imaging (MRI) findings and associated neurodevelopmental outcomes in these newborns., Methods: Retrospective multicenter study included infants with gestational age (GA) 24.0-36.0 weeks and PA, defined as ≥2 of the following: (1) umbilical cord pH ≤7.0, (2) 5-min Apgar score ≤5, and (3) fetal distress or systemic effects of PA. Findings were compared between GA <28.0 (group 1), 28.0-31.9 (group 2), and 32.0-36.0 weeks (group 3). Early MRI (<36 weeks postmenstrual age or <10 postnatal days) was categorized according to predominant injury pattern, and MRI around term-equivalent age (TEA, 36.0-44.0 weeks and ≥10 postnatal days) using the Kidokoro score. Adverse outcomes included death, cerebral palsy, epilepsy, severe hearing/visual impairment, or neurodevelopment <-1 SD at 18-24 months corrected age., Results: One hundred nineteen infants with early MRI (n = 94) and/or MRI around TEA (n = 66) were included. Early MRI showed predominantly hemorrhagic injury in groups 1 (56%) and 2 (45%), and white matter (WM)/watershed injury in group 3 (43%). Around TEA, WM scores were highest in groups 2 and 3. Deep gray matter (DGM) (aOR 15.0, 95% CI: 3.8-58.9) and hemorrhagic injury on early MRI (aOR 2.5, 95% CI: 1.3-4.6) and Kidokoro WM (aOR 1.3, 95% CI: 1.0-1.6) and DGM sub-scores (aOR 4.8, 95% CI: 1.1-21.7) around TEA were associated with adverse neurodevelopmental outcomes., Conclusion: The brain injury patterns following PA in preterm infants differ across GA. Particularly DGM abnormalities are associated with adverse neurodevelopmental outcomes., (© 2024 The Author(s). Published by S. Karger AG, Basel.)
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- 2024
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231. Cranial MRI beyond the Neonatal Period and Neurodevelopmental Outcomes in Neonatal Encephalopathy Due to Perinatal Asphyxia: A Systematic Review.
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Parmentier CEJ, Kropman T, Groenendaal F, Lequin MH, de Vries LS, Benders MJNL, and Alderliesten T
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Background: Magnetic resonance imaging (MRI) including diffusion-weighted imaging within seven days after birth is widely used to obtain prognostic information in neonatal encephalopathy (NE) following perinatal asphyxia. Later MRI could be useful for infants without a neonatal MRI or in the case of clinical concerns during follow-up. Therefore, this review evaluates the association between cranial MRI beyond the neonatal period and neurodevelopmental outcomes following NE., Methods: A systematic literature search was performed using PubMed and Embase on cranial MRI between 2 and 24 months after birth and neurodevelopmental outcomes following NE due to perinatal asphyxia. Two independent researchers performed the study selection and risk of bias analysis. Results were separately described for MRI before and after 18 months., Results: Twelve studies were included (high-quality n = 2, moderate-quality n = 6, low-quality n = 4). All reported on MRI at 2-18 months: seven studies demonstrated a significant association between the pattern and/or severity of injury and overall neurodevelopmental outcomes and three showed a significant association with motor outcome. There were insufficient data on non-motor outcomes and the association between MRI at 18-24 months and neurodevelopmental outcomes., Conclusions: Cranial MRI performed between 2 and 18 months after birth is associated with neurodevelopmental outcomes in NE following perinatal asphyxia. However, more data on the association with non-motor outcomes are needed.
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- 2023
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232. Evaluation of Sleep Practices and Knowledge in Neonatal Healthcare.
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de Groot ER, Ryan MA, Sam C, Verschuren O, Alderliesten T, Dudink J, and van den Hoogen A
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- Infant, Newborn, Humans, Surveys and Questionnaires, Sleep, Delivery of Health Care, Intensive Care Units, Neonatal, Health Personnel
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Background: Developmental care is designed to optimize early brain maturation by integrating procedures that support a healing environment. Protecting preterm sleep is important in developmental care. However, it is unclear to what extent healthcare professionals are aware of the importance of sleep and how sleep is currently implemented in the day-to-day care in the neonatal intensive care unit (NICU)., Purpose: Identifying the current state of knowledge among healthcare professionals regarding neonatal sleep and how this is transferred to practice., Methods: A survey was distributed among Dutch healthcare professionals. Three categories of data were sought, including (1) demographics of respondents; (2) questions relating to sleep practices; and (3) objective knowledge questions relating to sleep physiology and importance of sleep. Data were analyzed using Spearman's rho test and Cramer's V test. Furthermore, frequency tables and qualitative analyses were employed., Results: The survey was completed by 427 participants from 34 hospitals in 25 Dutch cities. While healthcare professionals reported sleep to be especially important for neonates admitted in the NICU, low scores were achieved in the area of knowledge of sleep physiology. Most healthcare professionals (91.8%) adapted the timing of elective care procedures to sleep. However, sleep assessments were not based on scientific knowledge. Therefore, the difference between active sleep and wakefulness may often be wrongly assessed. Finally, sleep is rarely discussed between colleagues (27.4% regularly/always) and during rounds (7.5%-14.3% often/always)., Implications: Knowledge about sleep physiology should be increased through education among neonatal healthcare professionals. Furthermore, sleep should be considered more often during rounds and handovers., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the National Association of Neonatal Nurses.)
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- 2023
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233. Ultra-Wideband Radar for Simultaneous and Unobtrusive Monitoring of Respiratory and Heart Rates in Early Childhood: A Deep Transfer Learning Approach.
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Arasteh E, Veldhoen ES, Long X, van Poppel M, van der Linden M, Alderliesten T, Nijman J, de Goederen R, and Dudink J
- Abstract
Unobtrusive monitoring of children's heart rate (HR) and respiratory rate (RR) can be valuable for promoting the early detection of potential health issues, improving communication with healthcare providers and reducing unnecessary hospital visits. A promising solution for wireless vital sign monitoring is radar technology. This paper presents a novel approach for the simultaneous estimation of children's RR and HR utilizing ultra-wideband (UWB) radar using a deep transfer learning algorithm in a cohort of 55 children. The HR and RR are calculated by processing radar signals via spectrogram from time epochs of 10 s (25 sample length of hamming window with 90% overlap) and then transforming the resultant representation into 2-dimensional images. These images were fed into a pre-trained Visual Geometry Group-16 (VGG-16) model (trained on ImageNet dataset), with weights of five added layers fine-tuned using the proposed data. The prediction on the test data achieved a mean absolute error (MAE) of 7.3 beats per minute (BPM < 6.5% of average HR) and 2.63 breaths per minute (BPM < 7% of average RR). We also achieved a significant Pearson's correlation of 77% and 81% between true and extracted for HR and RR, respectively. HR and RR samples are extracted every 10 s.
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- 2023
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234. Additional Value of 3-Month Cranial Magnetic Resonance Imaging in Infants with Neonatal Encephalopathy following Perinatal Asphyxia.
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Parmentier CEJ, Lequin MH, Alderliesten T, Swanenburg de Veye HFN, van der Aa NE, Dudink J, Benders MJNL, Harteman JC, Koopman-Esseboom C, Groenendaal F, and de Vries LS
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- Infant, Newborn, Pregnancy, Female, Infant, Humans, Retrospective Studies, Asphyxia complications, Magnetic Resonance Imaging methods, Atrophy pathology, Brain diagnostic imaging, Brain pathology, Infant, Newborn, Diseases, Asphyxia Neonatorum complications, Asphyxia Neonatorum diagnostic imaging, Brain Injuries pathology
- Abstract
Objective: To assess the evolution of neonatal brain injury noted on magnetic resonance imaging (MRI), develop a score to assess brain injury on 3-month MRI, and determine the association of 3-month MRI with neurodevelopmental outcome in neonatal encephalopathy (NE) following perinatal asphyxia., Methods: This was a retrospective, single-center study including 63 infants with perinatal asphyxia and NE (n = 28 cooled) with cranial MRI <2 weeks and 2-4 months after birth. Both scans were assessed using biometrics, a validated injury score for neonatal MRI, and a new score for 3-month MRI, with a white matter (WM), deep gray matter (DGM), and cerebellum subscore. The evolution of brain lesions was assessed, and both scans were related to 18- to 24-month composite outcome. Adverse outcome included cerebral palsy, neurodevelopmental delay, hearing/visual impairment, and epilepsy., Results: Neonatal DGM injury generally evolved into DGM atrophy and focal signal abnormalities, and WM/watershed injury evolved into WM and/or cortical atrophy. Although the neonatal total and DGM scores were associated with composite adverse outcomes, the 3-month DGM score (OR 1.5, 95% CI 1.2-2.0) and WM score (OR 1.1, 95% CI 1.0-1.3) also were associated with composite adverse outcomes (occurring in n = 23). The 3-month multivariable model (including the DGM and WM subscores) had higher positive (0.88 vs 0.83) but lower negative predictive value (0.83 vs 0.84) than neonatal MRI. Inter-rater agreement for the total, WM, and DGM 3-month score was 0.93, 0.86, and 0.59., Conclusions: In particular, DGM abnormalities on 3-month MRI, preceded by DGM abnormalities on the neonatal MRI, were associated with 18- to 24-month outcome, indicating the utility of 3-month MRI for treatment evaluation in neuroprotective trials. However, the clinical usefulness of 3-month MRI seems limited compared with neonatal MRI., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)
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- 2023
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235. Continuous Data-Driven Monitoring in Critical Congenital Heart Disease: Clinical Deterioration Model Development.
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Zoodsma RS, Bosch R, Alderliesten T, Bollen CW, Kappen TH, Koomen E, Siebes A, and Nijman J
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Background: Critical congenital heart disease (cCHD)-requiring cardiac intervention in the first year of life for survival-occurs globally in 2-3 of every 1000 live births. In the critical perioperative period, intensive multimodal monitoring at a pediatric intensive care unit (PICU) is warranted, as their organs-especially the brain-may be severely injured due to hemodynamic and respiratory events. These 24/7 clinical data streams yield large quantities of high-frequency data, which are challenging in terms of interpretation due to the varying and dynamic physiology innate to cCHD. Through advanced data science algorithms, these dynamic data can be condensed into comprehensible information, reducing the cognitive load on the medical team and providing data-driven monitoring support through automated detection of clinical deterioration, which may facilitate timely intervention., Objective: This study aimed to develop a clinical deterioration detection algorithm for PICU patients with cCHD., Methods: Retrospectively, synchronous per-second data of cerebral regional oxygen saturation (rSO
2 ) and 4 vital parameters (respiratory rate, heart rate, oxygen saturation, and invasive mean blood pressure) in neonates with cCHD admitted to the University Medical Center Utrecht, the Netherlands, between 2002 and 2018 were extracted. Patients were stratified based on mean oxygen saturation during admission to account for physiological differences between acyanotic and cyanotic cCHD. Each subset was used to train our algorithm in classifying data as either stable, unstable, or sensor dysfunction. The algorithm was designed to detect combinations of parameters abnormal to the stratified subpopulation and significant deviations from the patient's unique baseline, which were further analyzed to distinguish clinical improvement from deterioration. Novel data were used for testing, visualized in detail, and internally validated by pediatric intensivists., Results: A retrospective query yielded 4600 hours and 209 hours of per-second data in 78 and 10 neonates for, respectively, training and testing purposes. During testing, stable episodes occurred 153 times, of which 134 (88%) were correctly detected. Unstable episodes were correctly noted in 46 of 57 (81%) observed episodes. Twelve expert-confirmed unstable episodes were missed in testing. Time-percentual accuracy was 93% and 77% for, respectively, stable and unstable episodes. A total of 138 sensorial dysfunctions were detected, of which 130 (94%) were correct., Conclusions: In this proof-of-concept study, a clinical deterioration detection algorithm was developed and retrospectively evaluated to classify clinical stability and instability, achieving reasonable performance considering the heterogeneous population of neonates with cCHD. Combined analysis of baseline (ie, patient-specific) deviations and simultaneous parameter-shifting (ie, population-specific) proofs would be promising with respect to enhancing applicability to heterogeneous critically ill pediatric populations. After prospective validation, the current-and comparable-models may, in the future, be used in the automated detection of clinical deterioration and eventually provide data-driven monitoring support to the medical team, allowing for timely intervention., (©Ruben S Zoodsma, Rian Bosch, Thomas Alderliesten, Casper W Bollen, Teus H Kappen, Erik Koomen, Arno Siebes, Joppe Nijman. Originally published in JMIR Cardio (https://cardio.jmir.org), 16.05.2023.)- Published
- 2023
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236. Respiratory Rate Extraction from Neonatal Near-Infrared Spectroscopy Signals.
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Hakimi N, Shahbakhti M, Horschig JM, Alderliesten T, Van Bel F, Colier WNJM, and Dudink J
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- Infant, Newborn, Humans, Monitoring, Physiologic methods, Hemodynamics, Apnea, Oxygen, Respiratory Rate, Spectroscopy, Near-Infrared methods
- Abstract
Background: Near-infrared spectroscopy (NIRS) relative concentration signals contain 'noise' from physiological processes such as respiration and heart rate. Simultaneous assessment of NIRS and respiratory rate (RR) using a single sensor would facilitate a perfectly time-synced assessment of (cerebral) physiology. Our aim was to extract respiratory rate from cerebral NIRS intensity signals in neonates admitted to a neonatal intensive care unit (NICU). Methods: A novel algorithm, NRR (NIRS RR), is developed for extracting RR from NIRS signals recorded from critically ill neonates. In total, 19 measurements were recorded from ten neonates admitted to the NICU with a gestational age and birth weight of 38 ± 5 weeks and 3092 ± 990 g, respectively. We synchronously recorded NIRS and reference RR signals sampled at 100 Hz and 0.5 Hz, respectively. The performance of the NRR algorithm is assessed in terms of the agreement and linear correlation between the reference and extracted RRs, and it is compared statistically with that of two existing methods. Results: The NRR algorithm showed a mean error of 1.1 breaths per minute (BPM), a root mean square error of 3.8 BPM, and Bland-Altman limits of agreement of 6.7 BPM averaged over all measurements. In addition, a linear correlation of 84.5% ( p < 0.01) was achieved between the reference and extracted RRs. The statistical analyses confirmed the significant ( p < 0.05) outperformance of the NRR algorithm with respect to the existing methods. Conclusions: We showed the possibility of extracting RR from neonatal NIRS in an intensive care environment, which showed high correspondence with the reference RR recorded. Adding the NRR algorithm to a NIRS system provides the opportunity to record synchronously different physiological sources of information about cerebral perfusion and respiration by a single monitoring system. This allows for a concurrent integrated analysis of the impact of breathing (including apnea) on cerebral hemodynamics.
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- 2023
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237. Radiation-Induced Retinopathy and Optic Neuropathy after Radiation Therapy for Brain, Head, and Neck Tumors: A Systematic Review.
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Kinaci-Tas B, Alderliesten T, Verbraak FD, and Rasch CRN
- Abstract
Background: Patients with brain, head, and neck tumors experience a decline in their quality of life due to radiation retinopathy and optic neuropathy. Little is known about the dose-response relationship and patient characteristics. We aimed to systematically review the prevalence of radiation retinopathy and optic neuropathy., Method: The primary outcome was the pooled prevalence of radiation retinopathy and optic neuropathy. The secondary outcome included the effect of the total radiation dose prescribed for the tumor according to the patient's characteristics. Furthermore, we aimed to evaluate the radiation dose parameters for organs at risk of radiation retinopathy and optic neuropathy., Results: The pooled prevalence was 3.8%. No retinopathy was reported for the tumor's prescribed dose of <50 Gy. Optic neuropathy was more prevalent for a prescribed dose of >50 Gy than <50 Gy. We observed a higher prevalence rate for retinopathy (6.0%) than optic neuropathy (2.0%). Insufficient data on the dose for organs at risk were reported., Conclusion: The prevalence of radiation retinopathy was higher compared to optic neuropathy. This review emphasizes the need for future studies considering retinopathy and optic neuropathy as primary objective parameters.
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- 2023
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238. Delayed Surgical Closure of the Patent Ductus Arteriosus: Does the Brain Pay the Price?
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Lemmers P, Vijlbrief D, Benders M, Alderliesten T, Veldhuis M, Baerts W, Koopman-Esseboom C, Groenendaal F, and van Bel F
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- Infant, Newborn, Infant, Humans, Child, Preschool, Infant, Premature, Brain diagnostic imaging, Gestational Age, Ductus Arteriosus, Patent surgery
- Abstract
Objective: To investigate the relation between duration of hemodynamically significant patent ductus arteriosus (PDA), cerebral oxygenation, magnetic resonance imaging-determined brain growth, and 2-year neurodevelopmental outcome in a cohort of infants born preterm whose duct was closed surgically., Study Design: Infants born preterm at <30 weeks of gestational age who underwent surgical ductal closure between 2008 and 2018 (n = 106) were included in this observational study. Near infrared spectroscopy-monitored cerebral oxygen saturation during and up to 24 hours after ductal closure and a Bayley III developmental test at the corrected age of 2 years is the institutional standard of care for this patient group. Infants also had magnetic resonance imaging at term-equivalent age., Results: In total, 90 infants fulfilled the inclusion criteria (median [range]: 25.9 weeks [24.0-28.9]; 856 g [540-1350]. Days of a PDA ranged from 1 to 41. Multivariable linear regression analysis showed that duration of a PDA negatively influenced cerebellar growth and motor and cognitive outcome at 2 years of corrected age., Conclusions: Prolonged duration of a PDA in this surgical cohort is associated with reduced cerebellar growth and suboptimal neurodevelopmental outcome., (Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.)
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- 2023
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239. Towards artificial intelligence-based automated treatment planning in clinical practice: A prospective study of the first clinical experiences in high-dose-rate prostate brachytherapy.
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Barten DLJ, Pieters BR, Bouter A, van der Meer MC, Maree SC, Hinnen KA, Westerveld H, Bosman PAN, Alderliesten T, van Wieringen N, and Bel A
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- Male, Humans, Prostate, Artificial Intelligence, Prospective Studies, Radiotherapy Dosage, Radiotherapy Planning, Computer-Assisted methods, Brachytherapy methods, Prostatic Neoplasms radiotherapy
- Abstract
Purpose: This prospective study evaluates our first clinical experiences with the novel ``BRachytherapy via artificial Intelligent GOMEA-Heuristic based Treatment planning'' (BRIGHT) applied to high-dose-rate prostate brachytherapy., Methods and Materials: Between March 2020 and October 2021, 14 prostate cancer patients were treated in our center with a 15Gy HDR-brachytherapy boost. BRIGHT was used for bi-objective treatment plan optimization and selection of the most desirable plans from a coverage-sparing trade-off curve. Selected BRIGHT plans were imported into the commercial treatment planning system Oncentra Brachy . In Oncentra Brachy a dose distribution comparison was performed for clinical plan choice, followed by manual fine-tuning of the preferred BRIGHT plan when deemed necessary. The reasons for plan selection, clinical plan choice, and fine-tuning, as well as process speed were monitored. For each patient, the dose-volume parameters of the (fine-tuned) clinical plan were evaluated., Results: In all patients, BRIGHT provided solutions satisfying all protocol values for coverage and sparing. In four patients not all dose-volume criteria of the clinical plan were satisfied after manual fine-tuning. Detailed information on tumour coverage, dose-distribution, dwell time pattern, and insight provided by the patient-specific trade-off curve, were used for clinical plan choice. Median time spent on treatment planning was 42 min, consisting of 16 min plan optimization and selection, and 26 min undesirable process steps., Conclusions: BRIGHT is implemented in our clinic and provides automated prostate high-dose-rate brachytherapy planning with trade-off based plan selection. Based on our experience, additional optimization aims need to be implemented to further improve direct clinical applicability of treatment plans and process efficiency., (Copyright © 2022 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.)
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- 2023
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240. Automatic landmark correspondence detection in medical images with an application to deformable image registration.
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Grewal M, Wiersma J, Westerveld H, Bosman PAN, and Alderliesten T
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Purpose: Deformable image registration (DIR) can benefit from additional guidance using corresponding landmarks in the images. However, the benefits thereof are largely understudied, especially due to the lack of automatic landmark detection methods for three-dimensional (3D) medical images., Approach: We present a deep convolutional neural network (DCNN), called DCNN-Match, that learns to predict landmark correspondences in 3D images in a self-supervised manner. We trained DCNN-Match on pairs of computed tomography (CT) scans containing simulated deformations. We explored five variants of DCNN-Match that use different loss functions and assessed their effect on the spatial density of predicted landmarks and the associated matching errors. We also tested DCNN-Match variants in combination with the open-source registration software Elastix to assess the impact of predicted landmarks in providing additional guidance to DIR., Results: We tested our approach on lower abdominal CT scans from cervical cancer patients: 121 pairs containing simulated deformations and 11 pairs demonstrating clinical deformations. The results showed significant improvement in DIR performance when landmark correspondences predicted by DCNN-Match were used in the case of simulated ( p = 0 e 0 ) as well as clinical deformations ( p = 0.030 ). We also observed that the spatial density of the automatic landmarks with respect to the underlying deformation affect the extent of improvement in DIR. Finally, DCNN-Match was found to generalize to magnetic resonance imaging scans without requiring retraining, indicating easy applicability to other datasets., Conclusions: DCNN-match learns to predict landmark correspondences in 3D medical images in a self-supervised manner, which can improve DIR performance., (© 2023 The Authors.)
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- 2023
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241. Fetal MRI of the heart and brain in congenital heart disease.
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Moerdijk AS, Claessens NH, van Ooijen IM, van Ooij P, Alderliesten T, and Grotenhuis HB
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- Female, Humans, Pregnancy, Ultrasonography, Prenatal methods, Magnetic Resonance Imaging methods, Brain diagnostic imaging, Prenatal Diagnosis methods, Heart Defects, Congenital diagnostic imaging
- Abstract
Antenatal assessment of congenital heart disease and associated anomalies by ultrasound has improved perinatal care. Fetal cardiovascular MRI and fetal brain MRI are rapidly evolving for fetal diagnostic testing of congenital heart disease. We give an overview on the use of fetal cardiovascular MRI and fetal brain MRI in congenital heart disease, focusing on the current applications and diagnostic yield of structural and functional imaging during pregnancy. Fetal cardiovascular MRI in congenital heart disease is a promising supplementary imaging method to echocardiography for the diagnosis of antenatal congenital heart disease in weeks 30-40 of pregnancy. Concomitant fetal brain MRI is superior to brain ultrasound to show the complex relationship between fetal haemodynamics in congenital heart disease and brain development., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)
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- 2023
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242. Uncrowded Hypervolume-Based Multiobjective Optimization with Gene-Pool Optimal Mixing.
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Maree SC, Alderliesten T, and Bosman PAN
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- Problem Solving, Algorithms, Biological Evolution
- Abstract
Domination-based multiobjective (MO) evolutionary algorithms (EAs) are today arguably the most frequently used type of MOEA. These methods, however, stagnate when the majority of the population becomes nondominated, preventing further convergence to the Pareto set. Hypervolume-based MO optimization has shown promising results to overcome this. Direct use of the hypervolume, however, results in no selection pressure for dominated solutions. The recently introduced Sofomore framework overcomes this by solving multiple interleaved single-objective dynamic problems that iteratively improve a single approximation set, based on the uncrowded hypervolume improvement (UHVI). It thereby however loses many advantages of population-based MO optimization, such as handling multimodality. Here, we reformulate the UHVI as a quality measure for approximation sets, called the uncrowded hypervolume (UHV), which can be used to directly solve MO optimization problems with a single-objective optimizer. We use the state-of-the-art gene-pool optimal mixing evolutionary algorithm (GOMEA) that is capable of efficiently exploiting the intrinsically available grey-box properties of this problem. The resulting algorithm, UHV-GOMEA, is compared with Sofomore equipped with GOMEA, and the domination-based MO-GOMEA. In doing so, we investigate in which scenarios either domination-based or hypervolume-based methods are preferred. Finally, we construct a simple hybrid approach that combines MO-GOMEA with UHV-GOMEA and outperforms both., (© 2021 Massachusetts Institute of Technology.)
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- 2022
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243. Interactive Education on Sleep Hygiene with a Social Robot at a Pediatric Oncology Outpatient Clinic: Feasibility, Experiences, and Preliminary Effectiveness.
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van Bindsbergen KLA, van der Hoek H, van Gorp M, Ligthart MEU, Hindriks KV, Neerincx MA, Alderliesten T, Bosman PAN, Merks JHM, Grootenhuis MA, and van Litsenburg RRL
- Abstract
Objectives: Children with cancer often experience sleep problems, which are associated with many negative physical and psychological health outcomes, as well as with a lower quality of life. Therefore, interventions are strongly required to improve sleep in this population. We evaluated interactive education with respect to sleep hygiene with a social robot at a pediatric oncology outpatient clinic regarding the feasibility, experiences, and preliminary effectiveness., Methods: Researchers approached children (8 to 12 years old) who were receiving anticancer treatment and who were visiting the outpatient clinic with their parents during the two-week study period. The researchers completed observation forms regarding feasibility, and parents completed the Children's Sleep Hygiene Scale before and two weeks after the educational regimen. The experiences of children and parents were evaluated in semi-structured interviews. We analyzed open answers by labeling each answer with a topic reflecting the content and collapsed these topics into categories. We used descriptive statistics to describe the feasibility and experiences, and a dependent-samples t -test to evaluate the preliminary effectiveness., Results: Twenty-eight families participated (58% response rate) and all interactions with the robot were completed. The children and parents reported that they learned something new (75% and 50%, respectively), that they wanted to learn from the robot more often (83% and 75%, respectively), and that they applied the sleeping tips from the robot afterwards at home (54%). Regarding the preliminary effectiveness, children showed a statistically significant improvement in their sleep hygiene ( p = 0.047, d = 0.39)., Conclusions: Providing an educational regimen on sleep hygiene in a novel, interactive way by using a social robot at the outpatient clinic seemed feasible, and the children and parents mostly exhibited positive reactions. We found preliminary evidence that the sleep hygiene of children with cancer improved.
- Published
- 2022
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244. Validation and Comparison of Radiograph-Based Organ Dose Reconstruction Approaches for Wilms Tumor Radiation Treatment Plans.
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Wang Z, Virgolin M, Balgobind BV, van Dijk IWEM, Smith SA, Howell RM, Mille MM, Lee C, Lee C, Ronckers CM, Bosman PAN, Bel A, and Alderliesten T
- Abstract
Purpose: Our purpose was to validate and compare the performance of 4 organ dose reconstruction approaches for historical radiation treatment planning based on 2-dimensional radiographs., Methods and Materials: We considered 10 patients with Wilms tumor with planning computed tomography images for whom we developed typical historic Wilms tumor radiation treatment plans, using anteroposterior and posteroanterior parallel-opposed 6 MV flank fields, normalized to 14.4 Gy. Two plans were created for each patient, with and without corner blocking. Regions of interest (lungs, heart, nipples, liver, spleen, contralateral kidney, and spinal cord) were delineated, and dose-volume metrics including organ mean and minimum dose (D
mean and Dmin ) were computed as the reference baseline for comparison. Dosimetry for the 20 plans was then independently reconstructed using 4 different approaches. Three approaches involved surrogate anatomy, among which 2 used demographic-matching criteria for phantom selection/building, and 1 used machine learning. The fourth approach was also machine learning-based, but used no surrogate anatomies. Absolute differences in organ dose-volume metrics between the reconstructed and the reference values were calculated., Results: For Dmean and Dmin (average and minimum point dose) all 4 dose reconstruction approaches performed within 10% of the prescribed dose (≤1.4 Gy). The machine learning-based approaches showed a slight advantage for several of the considered regions of interest. For Dmax (maximum point dose), the absolute differences were much higher, that is, exceeding 14% (2 Gy), with the poorest agreement observed for near-beam and out-of-beam organs for all approaches., Conclusions: The studied approaches give comparable dose reconstruction results, and the choice of approach for cohort dosimetry for late effects studies should still be largely driven by the available resources (data, time, expertise, and funding)., (© 2022 The Authors.)- Published
- 2022
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245. Brain proton magnetic resonance spectroscopy and neurodevelopment after preterm birth: a systematic review.
- Author
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Cebeci B, Alderliesten T, Wijnen JP, van der Aa NE, Benders MJNL, de Vries LS, van den Hoogen A, and Groenendaal F
- Subjects
- Adolescent, Aspartic Acid, Brain metabolism, Choline, Female, Humans, Infant, Infant, Newborn, Infant, Premature metabolism, Magnetic Resonance Imaging, Magnetic Resonance Spectroscopy methods, Proton Magnetic Resonance Spectroscopy methods, Protons, Premature Birth metabolism
- Abstract
Background: Preterm infants are at risk of neurodevelopmental impairments. At present, proton magnetic resonance spectroscopy (
1 H-MRS) is used to evaluate brain metabolites in asphyxiated term infants. The aim of this review is to assess associations between cerebral1 H-MRS and neurodevelopment after preterm birth., Methods: PubMed and Embase were searched to identify studies using1 H-MRS and preterm birth. Eligible studies for this review included1 H-MRS of the brain, gestational age ≤32 weeks, and neurodevelopment assessed at a corrected age (CA) of at least 12 months up to the age of 18 years., Results: Twenty papers evaluated1 H-MRS in preterm infants at an age between near-term and 18 years and neurodevelopment.1 H-MRS was performed in both white (WM) and gray matter (GM) in 12 of 20 studies. The main regions were frontal and parietal lobe for WM and basal ganglia for GM. N-acetylaspartate/choline (NAA/Cho) measured in WM and/or GM is the most common metabolite ratio associated with motor, language, and cognitive outcome at 18-24 months CA., Conclusions: NAA/Cho in WM assessed at term-equivalent age was associated with motor, cognitive, and language outcome, and NAA/Cho in deep GM was associated with language outcome at 18-24 months CA., Impact: In preterm born infants, brain metabolism assessed using1 H-MRS at term-equivalent age is associated with motor, cognitive, and language outcomes at 18-24 months.1 H-MRS at term-equivalent age in preterm born infants may be used as an early indication of brain development. Specific findings relating to NAA were most predictive of outcome., (© 2021. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.)- Published
- 2022
- Full Text
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246. Therapeutic applications of radioactive sources: from image-guided brachytherapy to radio-guided surgical resection.
- Author
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Dickhoff LR, Vrancken Peeters MJ, Bosman PA, and Alderliesten T
- Subjects
- Humans, Male, Brachytherapy, Breast Neoplasms, Radioactivity
- Abstract
It is well known nowadays that radioactivity can destroy the living cells it interacts with. It is therefore unsurprising that radioactive sources, such as iodine-125, were historically developed for treatment purposes within radiation oncology with the goal of damaging malignant cells. However, since then, new techniques have been invented that make creative use of the same radioactivity properties of these sources for medical applications. Here, we review two distinct kinds of therapeutic uses of radioactive sources with applications to prostate, cervical, and breast cancer: brachytherapy and radioactive seed localization. In brachytherapy (BT), the radioactive sources are used for internal radiation treatment. Current approaches make use of real-time image guidance, for instance by means of magnetic resonance imaging, ultrasound, computed tomography, and sometimes positron emission tomography, depending on clinical availability and cancer type. Such image-guided BT for prostate and cervical cancer presents a promising alternative and/or addition to external beam radiation treatments or surgical resections. Radioactive sources can also be used for radio-guided tumor localization during surgery, for which the example of iodine-125 seed use in breast cancer is given. Radioactive seed localization (RSL) is increasingly popular as an alternative tumor localization technique during breast cancer surgery. Advantages of applying RSL include added flexibility in the clinical scheduling logistics, an increase in tumor localization accuracy, and higher patient satisfaction; safety measures do however have to be employed. We exemply the implementation of RSL in a clinic through our experiences at the Netherlands Cancer Institute.
- Published
- 2021
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247. The clinical effects of cerebral near-infrared spectroscopy monitoring (NIRS) versus no monitoring: a protocol for a systematic review with meta-analysis and trial sequential analysis.
- Author
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Hansen ML, Hyttel-Sørensen S, Jakobsen JC, Gluud C, Kooi EMW, Mintzer J, de Boode WP, Fumagalli M, Alarcon A, Alderliesten T, and Greisen G
- Subjects
- Adult, Child, Humans, Infant, Newborn, Lung, Meta-Analysis as Topic, Systematic Reviews as Topic, Brain, Spectroscopy, Near-Infrared
- Abstract
Background: Multiple clinical conditions are associated with cerebral hypoxia/ischaemia and thereby an increased risk of hypoxic-ischaemic brain injury. Cerebral near-infrared spectroscopy monitoring (NIRS) is a tool to monitor brain oxygenation and perfusion, and the clinical uptake of NIRS has expanded over recent years. Specifically, NIRS is used in the neonatal, paediatric, and adult perioperative and intensive care settings. However, the available literature suggests that clinical benefits and harms of cerebral NIRS monitoring are uncertain. As rates of clinically significant hypoxic-ischaemic brain injuries are typically low, it is difficult for randomised clinical trials to capture a sufficiently large number of events to evaluate the clinical effect of cerebral NIRS monitoring, when focusing on specific clinical settings. The aim of this systematic review will be to evaluate the benefits and harms of clinical care with access to cerebral NIRS monitoring versus clinical care without cerebral NIRS monitoring in children and adults across all clinical settings., Methods: We will conduct a systematic review with meta-analysis and trial sequential analysis. We will only include randomised clinical trials. The primary outcomes are all-cause mortality, moderate or severe persistent cognitive or neurological deficit, and proportion of participants with one or more serious adverse events. We will search CENTRAL, EMBASE, MEDLINE, and the Science Citation Index Expanded from their inception and onwards. Two reviewers will independently screen all citations, full-text articles, and extract data. The risk of bias will be appraised using the Cochrane risk of bias tool version 2.0. If feasible, we will conduct both random-effects meta-analysis and fixed-effect meta-analysis of outcome data. Additional analysis will be conducted to explore the potential sources of heterogeneity (e.g. risk of bias, clinical setting)., Discussion: As we include trials across multiple clinical settings, there is an increased probability of reaching a sufficient information size. However, heterogeneity between the included trials may impair our ability to interpret results to specific clinical settings. In this situation, we may have to depend on subgroup analyses with inherent increased risks of type I and II errors., Systematic Review Registration: PROSPERO CRD42020202986 . This systematic review protocol has been submitted for registration in the International Prospective Register of Systematic Reviews (PROSPERO) (http://www.crd.york.ac.uk/prospero) on the 12th of October 2020 and published on the 12th of November 2020 (registration ID CRD42020202986 ).
- Published
- 2021
- Full Text
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248. Cerebellar injury in term neonates with hypoxic-ischemic encephalopathy is underestimated.
- Author
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Annink KV, Meerts L, van der Aa NE, Alderliesten T, Nikkels PGJ, Nijboer CHA, Groenendaal F, de Vries LS, Benders MJNL, Hoebeek FE, and Dudink J
- Subjects
- Female, Humans, Hypoxia-Ischemia, Brain diagnostic imaging, Infant, Newborn, Infant, Newborn, Diseases diagnostic imaging, Magnetic Resonance Imaging, Male, Retrospective Studies, Cerebellum pathology, Hypoxia-Ischemia, Brain pathology, Infant, Newborn, Diseases pathology
- Abstract
Background: Postmortem examinations frequently show cerebellar injury in infants with severe hypoxic-ischemic encephalopathy (HIE), while it is less well visible on MRI. The primary aim was to investigate the correlation between cerebellar apparent diffusion coefficient (ADC) values and histopathology in infants with HIE. The secondary aim was to compare ADC values in the cerebellum of infants with HIE and infants without brain injury., Methods: ADC values in the cerebellar vermis, hemispheres and dentate nucleus (DN) of (near-)term infants with HIE (n = 33) within the first week after birth were compared with neonates with congenital non-cardiac anomalies, normal postoperative MRIs and normal outcome (n = 22). Microglia/macrophage activation was assessed using CD68 and/or HLA-DR staining and Purkinje cell (PC) injury using H&E-stained slices. The correlation between ADC values and the histopathological measures was analyzed., Results: ADC values in the vermis (p = 0.021) and DN (p < 0.001) were significantly lower in infants with HIE compared to controls. ADC values in the cerebellar hemispheres were comparable. ADC values in the vermis were correlated with the number and percentage of normal PCs; otherwise ADC values and histology were not correlated., Conclusion: Histopathological injury in the cerebellum is common in infants with HIE. ADC values underestimate histopathological injury., Impact: ADC values might underestimate cerebellar injury in neonates with HIE. ADC values in the vermis and dentate nucleus of infants with HIE are lower compared to controls, but not in the cerebellar hemispheres. Abnormal ADC values are only found when cytotoxic edema is very severe. ADC values in the vermis are correlated with Purkinje cell injury in the vermis; furthermore, there were no correlations between ADC values and histopathological measures.
- Published
- 2021
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249. Achieving Highly Scalable Evolutionary Real-Valued Optimization by Exploiting Partial Evaluations.
- Author
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Bouter A, Alderliesten T, and Bosman PAN
- Subjects
- Computer Simulation, Genetic Linkage, Algorithms, Biological Evolution
- Abstract
It is known that to achieve efficient scalability of an Evolutionary Algorithm (EA), dependencies (also known as linkage) must be properly taken into account during variation. In a Gray-Box Optimization (GBO) setting, exploiting prior knowledge regarding these dependencies can greatly benefit optimization. We specifically consider the setting where partial evaluations are possible, meaning that the partial modification of a solution can be efficiently evaluated. Such problems are potentially very difficult, for example, non-separable, multimodal, and multiobjective. The Gene-pool Optimal Mixing Evolutionary Algorithm (GOMEA) can effectively exploit partial evaluations, leading to a substantial improvement in performance and scalability. GOMEA was recently shown to be extendable to real-valued optimization through a combination with the real-valued estimation of distribution algorithm AMaLGaM. In this article, we definitively introduce the Real-Valued GOMEA (RV-GOMEA), and introduce a new variant, constructed by combining GOMEA with what is arguably the best-known real-valued EA, the Covariance Matrix Adaptation Evolution Strategies (CMA-ES). Both variants of GOMEA are compared to L-BFGS and the Limited Memory CMA-ES (LM-CMA-ES). We show that both variants of RV-GOMEA achieve excellent performance and scalability in a GBO setting, which can be orders of magnitude better than that of EAs unable to efficiently exploit the GBO setting.
- Published
- 2021
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250. Robust optimization for HDR prostate brachytherapy applied to organ reconstruction uncertainty.
- Author
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van der Meer MC, Bosman PAN, Niatsetski Y, Alderliesten T, Pieters BR, and Bel A
- Subjects
- Algorithms, Humans, Male, Radiometry, Radiotherapy Dosage, Radiotherapy Planning, Computer-Assisted, Uncertainty, Brachytherapy methods, Image Processing, Computer-Assisted, Prostatic Neoplasms diagnostic imaging, Prostatic Neoplasms radiotherapy, Radiation Dosage
- Abstract
Purpose: Recently, we introduced a bi-objective optimization approach based on dose-volume indices to automatically create clinically good HDR prostate brachytherapy plans. To calculate dose-volume indices, a reconstruction algorithm is used to determine the 3D organ shape from 2D contours, inevitably containing settings that influence the result. We augment the optimization approach to quickly find plans that are robust to differences in 3D reconstruction., Methods: Studied reconstruction settings were: interpolation between delineated organ contours, overlap between contours, and organ shape at the top and bottom contour. Two options for each setting yields 8 possible 3D organ reconstructions per patient, over which the robust model defines minimax optimization. For the original model, settings were based on our treatment planning system. Both models were tested on data of 26 patients and compared by re-evaluating selected optimized plans both in the original model (1 organ reconstruction, the difference determines the cost), and in the robust model (8 organ reconstructions, the difference determines the benefit)., Results: Robust optimization increased the run time from 3 to 6 min. The median cost for robust optimization as observed in the original model was -0.25% in the dose-volume indices with a range of [-0.01%, -1.03%]. The median benefit of robust optimization as observed in the robust model was 0.93% with a range of [0.19%, 4.16%]. For 4 patients, selected plans that appeared good when optimized in the original model, violated the clinical protocol with more than 1% when considering different settings. This was not the case for robustly optimized plans., Conclusions: Plans of high quality, irrespective of 3D organ reconstruction settings, can be obtained using our robust optimization approach. With its limited effect on total runtime, our approach therefore offers a way to account for dosimetry uncertainties that result from choices in organ reconstruction settings that is viable in clinical practice.
- Published
- 2021
- Full Text
- View/download PDF
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