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Radiotherapy and Oncology : Journal of... May 2022Image-guided adaptive brachytherapy (IGABT) is a key component in the treatment of cervical cancer, but the nature of the clinical workflow makes it vulnerable to...
BACKGROUND AND PURPOSE
Image-guided adaptive brachytherapy (IGABT) is a key component in the treatment of cervical cancer, but the nature of the clinical workflow makes it vulnerable to suboptimal plans, as the theoretical optimal plan depends heavily on organ configuration. Patient anatomy-based quality-assurance (QA) with overlap volume histograms (OVHs) is a promising tool to detect such suboptimal plans, and in this analysis its suitability as a multi-institutional clinical QA tool is investigated.
MATERIALS AND METHODS
A total of 223 plans of 145 patients treated in accordance with the current state-of-the-art IGABT protocols from UMC Utrecht (UMCU) and Erasmus MC (EMC) were included. Machine-learning models were trained to predict dose D to bladder, rectum, sigmoid and small bowel with the help of OVHs. For this strategy, points are sampled on the organs-at-risk (OARs), and the distances of the sampled points to the target are computed and combined in a histogram. Machine-learning models can then be trained to predict dose-volume histograms (DVHs) for unseen data. Single-center model robustness to needle use and applicator type and multi-center model translatability were investigated. Performance of models was assessed by the difference between planned (clinical) and predicted D values.
RESULTS
Intra-validation of UMCU data demonstrated OVH model robustness to needle use and applicator type. The model trained on UMCU data was found to be robust within the same protocol on EMC data, for all investigated OARs. Mean squared error between planned and predicted D values of OARs ranged between 0.13 and 0.40 Gy within the same protocol, indicating model translatability. For the former protocol cohort of Erasmus MC large deviations were found between the planned and predicted D values, indicating plan deviation from protocol. Mean squared error for this cohort ranged from 0.84 to 4.71 Gy.
CONCLUSION
OVH-based models can provide a solid basis for multi-institutional QA when trained on a sufficiently strict protocol. Further research will quantify the model's impact as a QA tool.
Topics: Brachytherapy; Female; Humans; Machine Learning; Organs at Risk; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Uterine Cervical Neoplasms
PubMed: 35219799
DOI: 10.1016/j.radonc.2022.02.022 -
Clinical Oral Investigations Jan 2022To compare the accuracy of implant placement performed with either a surgical motor or a torque wrench as part of a half-guided surgical protocol. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To compare the accuracy of implant placement performed with either a surgical motor or a torque wrench as part of a half-guided surgical protocol.
MATERIALS AND METHODS
Implant insertion with half-guided surgical protocol was utilized by surgical motor (machine-driven group) or torque wrench (manual group) in the posterior maxilla. After the healing period, accuracy comparison between planned and actual implant positions was performed based on preoperative cone beam computed tomography and postoperative digital intraoral scans. Coronal, apical, and angular deviations, insertion time, and insertion torque were evaluated.
RESULTS
Forty patients were treated with 1 implant each; 20 implants were inserted with a surgical motor and 20 implants with a torque wrench. Global coronal and apical deviations were 1.20 ± 0.46 mm and 1.45 ± 0.79 mm in the machine-driven group, and 1.13 ± 0.38 mm and 1.18 ± 0.28 mm in the manual group (respectively). The mean angular deviation was 4.82 ± 2.07° in the machine-driven group and 4.11 ± 1.63° in the manual group. Mean insertion torque was 21.75 ± 9.75 Ncm in the machine-driven group, compared to 18.75 ± 7.05 Ncm in the manual group. Implant placement duration was 9.25 ± 1.86 s in the machine-driven group at a speed of 50 rpm, and 36.40 ± 8.15 s in the manual group.
CONCLUSION
No significant difference was found between the two groups in terms of accuracy and mean insertion torque, while machine-driven implant placement was significantly less time-consuming.
CLINICAL RELEVANCE
Optimal implant placement accuracy utilized by half-guided surgical protocol can be achieved with both machine-driven and torque wrench insertion.
TRIAL REGISTRATION
ID: NCT04854239.
Topics: Cone-Beam Computed Tomography; Dental Implantation, Endosseous; Dental Implants; Humans; Maxilla; Prospective Studies; Surgery, Computer-Assisted
PubMed: 34401946
DOI: 10.1007/s00784-021-04087-0 -
Journal of Oral and Maxillofacial... May 2023Implant surgical guides, in combination with implant planning software, have been designed for accurate surgery, especially in partial edentulism. The purpose of this...
PURPOSE
Implant surgical guides, in combination with implant planning software, have been designed for accurate surgery, especially in partial edentulism. The purpose of this study was to examine the effect of fixation pins of surgical guides on the accuracy of static computer-assisted implant surgeries in a maxillary free-end situation.
MATERIALS AND METHODS
This in vitro study was conducted to compare surgical guides using various fixation pin protocols in implant surgery. A patient dental model with missing teeth from maxillary right first premolar to third molar was used as the study model… Implant placement was planned at maxillary right first premolar, right first molar, and right second molar; Straumann full guide templates were designed and fabricated using the coDiagnostiX software. The experiment involved surgical guides with no fixation pins (NF), buccal unilateral fixation pin (BF), palatal unilateral fixation pin (PF), and bilateral fixation pins on the buccal and palatal sides (BPF), based on the position and number of fixation pins. The deviation between the actual and planned positions was used to evaluate implant accuracy. The fixation pin protocols were the primary predictive variables. Angular, 3D platform, and 3D apex deviations were the primary outcome variables. Statistical analysis was performed using the one-way analysis of variance and Tukey's test (α = 0.05).
RESULTS
NF generated the maximum angular deviation (3.65 ± 1.39°), 3D platform deviation (1.58 ± 0.55 mm), and 3D apex deviation (2.18 ± 0.79 mm), whereas BPF produced the minimum angular deviation (1.88 ± 0.86°), 3D platform deviation (1.09 ± 0.51 mm), and 3D apex deviation (1.53 ± 0.45 mm). A statistically significant difference between NF and BPF in the angular deviation, 3D platform, and apex deviation (P < .0001, P = .009, and P = .002, respectively) was identified. The unilateral fixation pin exerted a significant effect only on the angular accuracy (BF, P = .0018; PF, P = .0001).
CONCLUSION
In a maxillary free-end situation, templates with a fixation pin generate better implant accuracy than those without it. A bilateral fixation pin protocol may produce less deviation than those without fixation pins. The implant accuracy does not appear to be affected by the position of the unilateral fixation pin.
Topics: Humans; Dental Implantation, Endosseous; Dental Implants; Cone-Beam Computed Tomography; Imaging, Three-Dimensional; Computer-Aided Design; Surgery, Computer-Assisted
PubMed: 36716792
DOI: 10.1016/j.joms.2022.12.017 -
The Journal of Prosthetic Dentistry Mar 2019Conventional guided implant surgery promises clinical success through implant placement accuracy; however, it requires multiple drills along with surgical sleeves and...
STATEMENT OF PROBLEM
Conventional guided implant surgery promises clinical success through implant placement accuracy; however, it requires multiple drills along with surgical sleeves and sleeve adapters for the horizontal and vertical control of osteotomy drills. This results in cumbersome surgery, problems with patients having limited mouth opening, and restriction to specific drill or implant manufacturers. A protocol for using trephination drills to simplify guided surgery and accommodate multiple implant systems is introduced.
PURPOSE
The purpose of this clinical study was to evaluate the accuracy of implant placement using this novel guided trephine drill protocol with and without a surgical sleeve.
MATERIAL AND METHODS
Intraoral scanning and preoperative cone beam computed tomography (CBCT) scans were used for implant treatment planning. Surgical guides were fabricated using stereolithography. Implant surgery was performed using the guided trephination protocol with and without a surgical sleeve. Postoperative CBCT scans were used to measure the implant placement deviations rather than the implant planning position. Surgical placement time and patient satisfaction were also documented. One-tailed t test and F-test (P=.01) were used to determine statistical significance.
RESULTS
Thirty-five implants in 17 participants were included in this study. With a surgical sleeve, implant positional deviations were 0.51 ±0.13 mm vertically, 0.32 ±0.10 mm facially, 0.11 ±0.11 mm lingually, and 0.38 ±0.13 mm mesially. Without a surgical sleeve, implant positional deviations were 0.58 ±0.27 mm vertically, 0.3 ±0.14 mm facially, 0.39 ±0.16 mm lingually, and 0.41 ±0.12 mm mesially. No statistically significant difference was found between the 2 protocols (P>.01), except that the sleeve group had greater vertical control precision (F-test, P=.006), reduced placement time, and the time variation was reduced (t test, P=.003; F-test, P<.001).
CONCLUSIONS
This trephination-based, guided implant surgery protocol produces accurate surgical guides that permit guided surgery in limited vertical access and with the same guided surgery protocol for multiple implant systems. Guided sleeves, although not always necessary, improve depth control and reduce surgical time in implant placement.
Topics: Computer-Aided Design; Cone-Beam Computed Tomography; Dental Implantation, Endosseous; Dental Implants; Humans; Patient Care Planning; Surgery, Computer-Assisted; Trephining
PubMed: 30503150
DOI: 10.1016/j.prosdent.2018.06.004 -
Clinical Oral Implants Research Sep 2021To compare fully guided with conventionally guided implant surgery performed by dental students in terms of deviation of actual implant position from an ideal implant... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To compare fully guided with conventionally guided implant surgery performed by dental students in terms of deviation of actual implant position from an ideal implant position.
MATERIALS AND METHODS
Twenty-five patients in need of 26 straightforward implant-supported single crowns were randomly allocated to a fully guided (FG, n = 14) or a conventionally guided (CG, n = 12) implant surgery. In the preoperative CBCTs, 3 experienced investigators placed a virtual implant in the ideal position, twice, allowing deviational analysis in the facio-lingual (coronal) and mesio-distal (sagittal) planes for 7 parameters. Facio-lingual crestal deviation, facio-lingual apical deviation, facio-lingual angular deviation, mesio-distal crestal deviation, mesio-distal apical deviation, mesio-distal angular deviation, and vertical deviation between the ideal, virtually placed position and actual implant position for the FG and CG groups were compared statistically (p < .05).
RESULTS
Statistically significant differences between ideal and actual implant position were only seen for the facio-lingual apical deviation (p = .047) and for the facio-lingual angular deviation (p = .019), where the CG group deviated more from the ideal position than the FG group. The 5 other examined variables did not show any significant differences, and none of the implants in the FG group and CG group were placed in conflict with the clinical guidelines.
CONCLUSIONS
The present study reported no difference in 5 out of 7 deviational parameters concerning actual implant position in relation to ideal implant position between a FG and CG implant placement protocol performed by dental students. Facio-lingual angular deviation and apical deviation were lower, when a FG protocol was followed. All implants were positioned according to clinical guidelines.
Topics: Computer-Aided Design; Crowns; Dental Implantation, Endosseous; Dental Implants; Humans; Students, Dental; Surgery, Computer-Assisted
PubMed: 34166539
DOI: 10.1111/clr.13802 -
International Journal of Radiation... May 2022To evaluate the results of the radiation therapy (RT) quality assurance (QA) program of the phase 3 randomized SAKK 09/10 trial in patients with biochemically recurrent...
PURPOSE
To evaluate the results of the radiation therapy (RT) quality assurance (QA) program of the phase 3 randomized SAKK 09/10 trial in patients with biochemically recurrent prostate cancer after prostatectomy.
METHODS AND MATERIALS
Within the Schweizerische Arbeitsgemeinschaft für Klinische Krebsforschung (SAKK) 09/10 trial testing 64-Gy versus 70-Gy salvage RT, a central collection of treatment plans was performed and thoroughly reviewed by a dedicated medical physicist and radiation oncologist. Adherence to the treatment protocol and specifically to the European Organization for the Research and Treatment of Cancer (EORTC) guidelines for target volume definition (classified as deviation observed yes vs no) and its potential correlation with acute and late toxicity (Common Terminology Criteria for Adverse Events version 4.0) and freedom from biochemical progression (FFBP) were investigated.
RESULTS
The treatment plans for 344 patients treated between February 2011 and April 2014 depicted important deviations from the EORTC guidelines and the recommendations per trial protocol. For example, in up to half of the cases, the delineated structures deviated from the protocol (eg, prostate bed in 48.8%, rectal wall [RW] in 41%). In addition, variations in clinical target volume (CTV) and planning target volume (PTV) occurred frequently (eg, CTV and PTV deviations in up to 42.4% and 25.9%, respectively). The detected deviations showed a significant association with a lower risk of grade ≥2 gastrointestinal acute toxicity when the CTV did not overlap the RW versus when the CTV overlapped the RW (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.22-0.85; P = .014), and a higher rate of grade ≥2 late genitourinary (GU) toxicity when the CTV overlapped the RW (OR, 2.58; 95% CI, 1.17-5.72; P = .019). A marginally significant lower risk of grade ≥2 late GU toxicity was observed when the prostate bed did not overlap versus did overlap the RW (OR, 0.51; 95% CI, 0.25-1.03; P = .06). In addition, a marginally significant decrease in FFBP was observed in patients with PTV not including surgical clips as potential markers of the limits of the prostate bed (hazard ratio, 1.44; 95% CI, 0.96-2.17; P = .07).
CONCLUSIONS
Despite a thorough QA program, the central review of a phase 3 trial showed limited adherence to treatment protocol recommendations, which was associated with a higher risk of toxicity by means of acute or late gastrointestinal or GU toxicity and showed a trend toward worse FFBP. Data from this QA review might help to refine future QA programs and prostate bed delineation guidelines.
Topics: Gastrointestinal Diseases; Humans; Male; Prostatectomy; Prostatic Neoplasms; Radiotherapy, Intensity-Modulated; Rectum; Salvage Therapy
PubMed: 34990777
DOI: 10.1016/j.ijrobp.2021.12.174 -
Seminars in Cell & Developmental Biology Jul 2022Kidney organoid technology has led to a renaissance in kidney developmental biology. The complex underpinnings of mammalian kidney development have provided a framework...
Kidney organoid technology has led to a renaissance in kidney developmental biology. The complex underpinnings of mammalian kidney development have provided a framework for the generation of kidney cells and tissues from human pluripotent stem cells. Termed kidney organoids, these 3-dimensional structures contain kidney-specific cell types distributed similarly to in vivo architecture. The adult human kidney forms from the reciprocal induction of two disparate tissues, the metanephric mesenchyme (MM) and ureteric bud (UB), to form nephrons and collecting ducts, respectively. Although nephrons and collecting ducts are derived from the intermediate mesoderm (IM), their development deviates in time and space to impart distinctive inductive signaling for which separate differentiation protocols are required. Here we summarize the directed differentiation protocols which generate nephron kidney organoids and collecting duct kidney organoids, making note of similarities as much as differences. We discuss limitations of these present approaches and discuss future directions to improve kidney organoid technology, including a greater understanding of anterior IM and its derivatives to enable an improved differentiation protocol to collecting duct organoids for which historic and future developmental biology studies will be instrumental.
Topics: Adult; Animals; Cell Differentiation; Humans; Kidney; Mammals; Nephrons; Organogenesis; Organoids; Pluripotent Stem Cells
PubMed: 34627669
DOI: 10.1016/j.semcdb.2021.09.017 -
The Journal of Prosthetic Dentistry Jul 2023Although fully guided dental implant surgery has been reported to provide a high degree of accuracy, it has disadvantages including the lack of external irrigation...
STATEMENT OF PROBLEM
Although fully guided dental implant surgery has been reported to provide a high degree of accuracy, it has disadvantages including the lack of external irrigation during osteotomy formation and the need for special drills and equipment. Whether a custom 2-piece surgical guide has sufficient accuracy is unclear.
PURPOSE
The purpose of this in vitro study was to design and fabricate a new surgical guide concept that fully guides the placement of implants to the desired position and angulation without affecting the external irrigation during osteotomy preparation, to eliminate the need for a special armamentarium, and to determine the accuracy of the guide.
MATERIAL AND METHODS
A 2-piece surgical guide was 3-dimensionally designed and fabricated. Implants were placed according to the all-on-4 concepts in laboratory casts using the newly fabricated surgical guide. Placement accuracy was determined from a postoperative cone beam computed tomography scan that was superimposed over the preplanned implant positions to calculate the degree of angular deviation and position of placement. Adopting 5% alpha error and 80% study power in estimating sample size, a total of 88 implants were placed according to the all-on-4 concept in 22 mandibular laboratory casts. These were divided into 2 groups: with the newly fabricated surgical guide and with a traditional fully guided protocol. Deviations at the point of entry, at the apex horizontally, the vertical apical depth, and angular deviations from the proposed plan were measured from the superimposed scans. Differences in apical depth, horizontal deviation at the apex, and horizontal deviation in the hexagon measurements were compared with the independent t test, while differences in angular deviation were assessed with the Mann-Whitney U test (α=.05).
RESULTS
No statistically significant difference was found in the apical depth deviation (P>.05), but significant differences were found in the apex (P=.002), hexagon (P<.001), and angular deviation (P<.001) between the new guide and the traditional guide.
CONCLUSIONS
The new surgical guide showed potential for higher accuracy in implant placement when compared with the fully guided sleeveless surgical guide. In addition, it provided an undisturbed flow of irrigation around the drill throughout the drilling procedure, with the advantage of eliminating the special armamentarium usually required.
Topics: Dental Implants; Dental Implantation, Endosseous; Surgery, Computer-Assisted; Imaging, Three-Dimensional; Computer-Aided Design; Cone-Beam Computed Tomography
PubMed: 37230911
DOI: 10.1016/j.prosdent.2023.04.022 -
Journal of Clinical Medicine Sep 2019Principles of treat-to-target (T2T) have been widely adopted in both multinational and regional guidelines for rheumatoid arthritis (RA). Several questionnaire studies... (Review)
Review
Principles of treat-to-target (T2T) have been widely adopted in both multinational and regional guidelines for rheumatoid arthritis (RA). Several questionnaire studies among physicians and real-world data have suggested that an evidence-practice gap exists in RA management. Investigating physician adherence to T2T, which requires a process measure, is difficult. Different practice patterns among physicians are observed, while adherence to protocolized treatment declines over time. Rheumatologist awareness, agreement, and claims of adherence to T2T guidelines are not always consistent with medical records. Comorbidities, a difficult disease course, communication barriers, and individual preferences may hinder an intensive, proactive treatment stance. Interpreting deviations from protocolized treatment/T2T guidelines requires sufficient clinical context, though higher adherence seems to improve clinical outcomes. Nonmedical constraints in routine care may consist of barriers in healthcare structure and socioeconomic factors. Therefore, strategies to improve the institution of T2T should be tailored to local healthcare. Educational interventions to improve T2T adherence among physicians may show a moderate, although beneficial effect. Meanwhile, a proportion of patients with inadequately controlled RA exists, while management decisions may not be in accordance with T2T. Physicians tend to be aware of current guidelines, but their institution in routine practice seems challenging, which warrants attention and further study.
PubMed: 31500394
DOI: 10.3390/jcm8091416 -
Cureus Oct 2022In today's world, the upper cross syndrome is growing more common and becoming very prevalent among dental undergraduate practitioners. One of the most important...
Measuring the Efficacy of Myofascial Rollers and Post-isometric Relaxation Technique in Relieving Pain Intensity and Postural Deviation Using Plumb Line Assessment for the Treatment of Upper Cross Syndrome in Dental Undergraduate (UG) Students.
BACKGROUND
In today's world, the upper cross syndrome is growing more common and becoming very prevalent among dental undergraduate practitioners. One of the most important conditions for which dentists seek physiotherapy treatment is neck pain. It is characterized by overactive pectoralis and trapezius muscles. It is frequently linked to poor posture in dental students' daily life, causing them to miss their work.
OBJECTIVES
The first objective of our study was to find the efficacy of myofascial rollers and post-isometric relaxation technique along with conventional therapy for pain relief and correction of postural deviation in undergraduate dental students. And, the second objective of the study was to compare the effect of myofascial rollers and post-isometric relaxation techniques in upper cross syndrome.
METHODS
The study was conducted with pre-test and post-test methods. The study consisted of 80 participants who were included based on our inclusion and exclusion criteria. The study sample was randomly assigned into two groups. Each group consisted of a total of 40 participants. Group A was treated using myofascial rollers and hot packs, and Group B was treated using the post-isometric relaxation technique and hot packs. Patients were asked to mark their intensity of pain on the Numerical Pain Rating Scale and an assessment of postural deviations (in mm) was noted through a plumb line in the posture grid. Posture assessment was done in lateral view. The protocol covered four weeks of treatment based on the defined protocol. Finally, the t-square test and Chi-square test were used to compare the difference in the result. Also, the level of significance was kept at <0.05.
RESULT
Statistical analysis was done using descriptive and inferential statistics using student paired, unpaired, and chi-square test. IBM SPSS Statistics for Windows, Version 27.0 (Released 2020; IBM Corp., Armonk, New York, United States) was used. The Numerical Pain Rating Scale showed mean deviations of (4.15±1.29) for Group A and (3.30±1.01) for Group B. Plumb line assessment showed mean deviations of (9.09±4.31) for Group A and (6.33±2.36) for Group B. Also, Numerical Pain Rating Scale showed (t=3.26, p=0.002) and Plumb line deviation showed (t=3.57, p=0.001).
CONCLUSION
Through our study, we conclude that statistically no significant differences were found in pre-intervention and post-intervention, but myofascial rollers gave better results as compared to the post-isometric relaxation technique in alleviating pain and correcting postural deviation.
PubMed: 36337788
DOI: 10.7759/cureus.29831