Consistent tumor measurement reporting in serial CT scans: A pilot study.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 99-99
Author(s):  
Terri P. Wolf ◽  
Dana Ann Little ◽  
Scott Christensen ◽  
Natasha Perkins
Keyword(s):  
Quality Improvement ◽  
Pilot Study ◽  
Response To Therapy ◽  
Ct Scans ◽  
Medical Provider ◽  
Cancer Centers ◽  
Radiology Reports ◽  
Report Quality ◽  
Serial Ct ◽  
Measurement Consistency

99 Background: Oncologists in community cancer centers affiliated with the UC Davis Cancer Care Network reported quality concerns with inconsistently measured lesions on serial Computed Tomography (CT) scan reports. Radiologic imaging is an important tool in diagnosis, staging, and assessment of response to therapy in cancer treatment cancer. Accurate assessment of oncologic therapeutic efficacy is dependent on reliable radiology and report quality. The primary objective of this pilot study was to validate oncologist concerns about tumor measurement consistency in radiology reports through an audit. The secondary objective was to identify areas for quality improvement and establish process and time requirements for auditing. Two of four affiliated cancer centers (CC1 and CC2) were selected for a pilot assessment. Methods: CC1 and CC2 identified charts with CT scans in the audit timeframes. Auditors reviewed charts for serial CT scans and measureable disease in the audit date range and created a list of eligible charts. Auditors randomized the list and a sample of 61 (CC1) and 66 (CC2) charts were audited. Auditors reviewed CT orders, radiology reports for consistent lesion measurement, comparison to previous scan, addenda, service dates, radiology facilities, reading radiologist, and medical provider placing order. Results: This audit demonstrated deficiencies with lesion measurement consistency at both CC1 and CC2. At CC1 64% of radiology reports were consistently measured and at CC2 57% were consistently measured. Both CC1 and CC2 had identifiable areas for process and quality improvement. The audit required 86 hours at CC1 and 83 hours at CC2. The audit identified deficiencies in order clarity and information flow from the cancer center to the reading radiologist. At CC1 a radiologist reviewed the audited charts and reported an 85% concurrence with the auditors. A literature search did not provide benchmarks for measurement consistency in radiology reports. Conclusions: Oncologists complaints were verified regarding lesion measurement inconsistencies. This pilot demonstrated the need for quality oversight and implementation of standardized measurement (RECIST) criteria and tumor logs in the non-clinical trial environment.

A Pilot Study for Using 3′-Deoxy-3′-[18f]Fluorothymidine Positron Emission Tomography ([18F]FLT PET/CT) Imaging for Early Assessment of Response to Induction Chemotherapy in Acute Myeloid Leukemia (AML)

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 2550-2550
Author(s):  
Mark B. Juckett ◽  
Matt Vanderhoek ◽  
Scott Perlman ◽  
Robert Nickles ◽  
Robert Jeraj
Keyword(s):  
Bone Marrow ◽  
Pilot Study ◽  
Induction Chemotherapy ◽  
Response To Therapy ◽  
Whole Body ◽  
Ct Scans ◽  
Early Assessment ◽  
Flt Pet ◽  
Pet Ct ◽  
Normal Controls

Abstract Background: AML patients that are treated with induction chemotherapy undergo an early bone marrow assessment approximately 10–14 days after beginning treatment to determine the response to therapy. This bone marrow assessment is an imperfect measure of disease response and lacks sensitivity and specificity in determining subsequent remission. A more accurate assessment of chemotherapy responsiveness performed early during induction chemotherapy could allow better prediction of later remission and earlier change in therapy to improve outcome among patients that are not responding well to treatment. Thymidine uptake can be used to assess chemotherapy sensitivity in vitro, and we hypothesized that this would also be true in vivo. We performed a pilot study of [18F] FLT PET/CT scans to predict response to induction chemotherapy among patients with AML. Methods: Eight patients with AML were treated with induction chemotherapy and whole body [18F]FLT PET/CT scans were performed at different time points (pre-treatment, day 1, 3, 4, 5 and 14) using approximately 5 mCi of [18F]FLT. Two patients had scans before treatment and day 14. Ten adult subjects without hematologic disease also underwent [18F] FLT PET/CT and these studies were used as normal controls. The CT images were used to reconstruct a skeletal mask that was then used to extract the bone marrow [18F]FLT signal from the PET images. The scans from those with normal bone marrow were used to establish baseline assessment parameters. The images from the scans could be quantified by computer analysis into bone marrow standardized uptake values (SUV). The bone marrow SUV were compared between the AML patients (responders vs. non-responders) relative to normal controls. The mean SUV values (SUVmean), max SUV values (SUVmax) and coefficient of variation (CV) were used in the comparison. Results: The PET/CT was well tolerated and no adverse events were noted, although one patient did not complete the scan due to the development of epistaxis. Of the seven patients who completed the scan, 3 patients entered a complete remission after a single course of induction (responders) and 4 patients either required two induction courses to achieve remission or had refractory disease (non-responders). The responders had recovery of an ANC > 500 by day 22, 28, and 35 suggesting the [18F]FLT did not delay bone marrow regeneration. The fall in the bone marrow SUV occurred quickly and as early as day 1 after the beginning of chemotherapy among responders. Both mean and maximum total bone marrow SUV was significantly lower in responders compared to non-responders: SUVmean: 0.76±0.04 vs. 1.23±0.22, SUVmax: 3.6±0.01 vs 7.7±2.2. In addition, it was noted that the variation in SUV throughout the skeleton was more uniform in responders than non-responders resulting in a difference in CV: 0.29±0.01 vs 0.54±0.10. The differences in SUV and signal variation in the bone marrow were easily apparent when viewing the images from the scans. The significant heterogeneity in axial skeletal uptake among non-responders was notable and suggests that chemotherapy responsiveness is not uniform throughout the bone marrow and that there likely are islands of persistent/unresponsive disease during therapy. It is not clear whether the variation is due to islands of drug resistance, differences in blood flow, or rates of response. This non-uniformity of marrow uptake among non-responders may explain the poor predictive value of the day 10–14 bone marrow aspirate drawn at the iliac crest. Conclusion: In our small pilot study, [18F]FLT PET/CT could distinguish between responders and non-responders among patients undergoing induction chemotherapy for AML possibly as early as one day following the beginning of treatment. Also, the scans suggest that response to chemotherapy in AML does not occur uniformly throughout the bone marrow space and that in non-responders, there are islands of disease that persist after chemotherapy. These finding warrant further study of [18F]FLT PET/CT as a tool for early response assessment in AML.

Quality Improvement Pilot Study of the Living Your Best Weight Program: A Health at Every Size Approach

2020 ◽  
Vol 81 (2) ◽  
pp. 91-93
Author(s):  
Anna Angelinas ◽  
Roseann Nasser ◽  
Amanda Geradts ◽  
Justine Herle ◽  
Kristen Schott ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Pilot Study ◽  
Response Rate ◽  
Participant Satisfaction ◽  
Health At Every Size ◽  
Outpatient Program ◽  
To Receive

Purpose: Living Your Best Weight (LYBW) is an outpatient program based on Health at Every Size (HAES) principles for adults interested in managing their weight. The purpose of this pilot study was to determine perceptions of participants and their satisfaction with the LYBW program. Methods: A survey was developed to determine participant satisfaction of the LYBW program. Fifty-six participants who completed the LYBW program from June 2017 to February 2018 were contacted via telephone and invited to participate in the study. Forty-five participants agreed to receive the survey by mail or email. Results: Thirty-four participants completed the survey for a response rate of 61%. The average age of respondents was 52 years. Seventy-nine percent of respondents agreed that the program helped them to focus on health instead of weight. Eighty-two percent agreed that the program helped them respond to internal cues of hunger and fullness, and 94% were satisfied with the program. Conclusion: Participants reported that they were satisfied with the LYBW program and perceived improvements in their health. Future programming may benefit from using a HAES-based approach with adults.

scholarly journals Morbidity and Mortality Revisited: Applying a New Quality Improvement Paradigm in Oncology

2015 ◽  
Vol 11 (3) ◽  
pp. e428-e433 ◽  
Author(s):  
Daniel G. Stover ◽  
Jessica A. Zerillo
Keyword(s):  
Quality Improvement ◽  
Morbidity And Mortality ◽  
Community Based ◽  
Cancer Centers ◽  
Oncology Practice

Using a quality improvement (QI) paradigm, the authors conducted 11 multidisciplinary conferences throughout 2013-2014 at two tertiary academic cancer centers and a satellite community-based oncology practice. They present their approach including key components and an example case.

In ovo imaging using ostrich eggs – physiological embryonal development on serial CT scans

2021 ◽  
Author(s):  
T Winkens ◽  
A Christl ◽  
C Kühnel ◽  
F Ndum ◽  
M Freesmeyer
Keyword(s):  
Ct Scans ◽  
In Ovo ◽  
Embryonal Development ◽  
Serial Ct

Short Observation Period and Aggressive Discharge of Patients With Head Injury and Serial CT Scans

2021 ◽  
pp. 000313482110635
Author(s):  
Jordan Perkins ◽  
Jacob Shreffler ◽  
Danielle Kamenec ◽  
Alexandra Bequer ◽  
Corey Ziemba ◽  
...  
Keyword(s):  
Ct Scanning ◽  
Ct Scans ◽  
New Findings ◽  
Serial Ct ◽  
Radiographic Interpretation ◽  
Evidence Based Guidelines ◽  
Head Computed Tomography ◽  
Repeat Imaging ◽  
Observation Period ◽  
Negative Conversion

Background: Many patients undergo two head computed tomography (CT) scans after mild traumatic brain injury (TBI). Radiographic progression without clinical deterioration does not usually alter management. Evidence-based guidelines offer potential for limited repeat imaging and safe discharge. This study characterizes patients who had two head CTs in the Emergency Department (ED), determines the change between initial and repeat CTs, and describes timing of repeat scans. Methods: This retrospective series includes all patients with head CTs during the same ED visit at an urban trauma center between May 1st, 2016 and April 30th, 2018. Radiographic interpretation was coded as positive, negative, or equivocal. Results: Of 241 subjects, the number of positive, negative, and equivocal initial CT results were 154, 50, and 37, respectively. On repeat CT, 190 (78.8%) interpretations were congruent with the original scan. Out of the 21.2% of repeat scans that diverged from the original read, 14 (5.8%) showed positive to negative conversion, 1 (.4%) showed positive to equivocal conversion, 2 (.88%) showed negative to positive conversion, 20 (8.3%) showed equivocal to negative conversion, and 14 (5.8%) showed equivocal to positive conversion. Average time between scans was 4.4 hours, and median length of stay was 10.2 hours. Conclusions: In this retrospective review, most repeat CT scans had no new findings. A small percentage converted to positive, rarely altering clinical management. This study demonstrates the need for continued prospective research to update clinical guidelines that could reduce admission and serial CT scanning for mild TBI.

scholarly journals A Collaborative Model for Facilitating the Delivery of Smoking Cessation Treatments to Cancer Patients: Results From Three Oncology Practices in South Carolina

2018 ◽  
Vol 14 (2) ◽  
pp. 112-124
Author(s):  
Daniel J. Kilpatrick ◽  
Kathleen B. Cartmell ◽  
Abdoulaye Diedhiou ◽  
K. Michael Cummings ◽  
Graham W. Warren ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
South Carolina ◽  
Quality Improvement ◽  
Collaborative Learning ◽  
Cancer Patients ◽  
Tobacco Use ◽  
Tobacco Cessation ◽  
Dissemination And Implementation ◽  
Evidence Based ◽  
Cancer Centers

Introduction: Continued smoking by cancer patients causes adverse cancer treatment outcomes, but few patients receive evidence-based smoking cessation as a standard of care.Aim: To evaluate practical strategies to promote wide-scale dissemination and implementation of evidence-based tobacco cessation services within state cancer centers.Methods: A Collaborative Learning Model (CLM) for Quality Improvement was evaluated with three community oncology practices to identify barriers and facilitate practice change to deliver evidence-based smoking cessation treatments to cancer patients using standardized assessments and referrals to statewide smoking cessation resources. Patients were enrolled and tracked through an automated data system and received follow-up cessation support post-enrollment. Monthly quantitative reports and qualitative data gathered through interviews and collaborative learning sessions were used to evaluate meaningful quality improvement changes in each cancer center.Results: Baseline practice evaluation for the CLM identified the lack of tobacco use documentation, awareness of cessation guidelines, and awareness of services for patients as common barriers. Implementation of a structured assessment and referral process demonstrated that of 1,632 newly registered cancer patients,1,581 (97%) were screened for tobacco use. Among those screened, 283 (18%) were found to be tobacco users. Of identified tobacco users, 207 (73%) were advised to quit. Referral of new patients who reported using tobacco to an evidence-based cessation program increased from 0% at baseline across all three cancer centers to 64% (range = 30%–89%) during the project period.Conclusions: Implementation of quality improvement learning collaborative models can dramatically improve delivery of guideline-based tobacco cessation treatments to cancer patients.

scholarly journals Translating research into clinical practice: quality improvement to halve non-adherence to methotrexate

Rheumatology ◽  
2020 ◽  
Vol 60 (1) ◽  
pp. 125-131
Author(s):  
Anne Barton ◽  
Meghna Jani ◽  
Christine Bundy ◽  
James Bluett ◽  
Stephen McDonald ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Clinical Practice ◽  
Motivational Interviewing ◽  
Cost Savings ◽  
Serum Levels ◽  
Response To Therapy ◽  
Self Report ◽  
Time Points ◽  
Remission Rates ◽  
Consistent Information

Abstract Objective MTX remains the cornerstone for therapy for RA, yet research shows that non-adherence is significant and correlates with response to therapy. This study aimed to halve self-reported non-adherence to MTX at the Kellgren Centre for Rheumatology. Methods An anonymous self-report adherence questionnaire was developed and data collected for 3 months prior to the introduction of interventions, and then regularly for the subsequent 2.5 years. A series of interventions were implemented, including motivational interviewing training, consistent information about MTX and development of a summary bookmark. Information on clinic times was collected for consultations with and without motivational interviewing. Surveys were conducted to ascertain consistency of messages about MTX. A biochemical assay was used to test MTX serum levels in patients at two time points: before and 2.8 years following introduction of the changes. Remission rates at 6 and 12 months post-MTX initiation were retrieved from patient notes and cost savings estimated by comparing actual numbers of new biologic starters compared with expected numbers based on the numbers of consultants employed at the two time points. Results Between June and August 2016, self-reported non-adherence to MTX was 24.7%. Following introduction of the interventions, self-reported non-adherence rates reduced to an average of 7.4% between April 2018 and August 2019. Clinic times were not significantly increased when motivational interviewing was employed. Consistency of messages by staff across three key areas (benefits of MTX, alcohol guidance and importance of adherence) improved from 64% in September 2016 to 94% in January 2018. Biochemical non-adherence reduced from 56% (September 2016) to 17% (June 2019), whilst remission rates 6 months post-initiation of MTX improved from 13% in 2014/15 to 37% in 2017/18, resulting is estimated cost savings of £30 000 per year. Conclusion Non-adherence to MTX can be improved using simple measures including focussing on the adherence and the benefits of treatment, and providing consistent information across departments.

Machine learning for lung texture analysis on thin-section CT: Capability for assessments of disease severity and therapeutic effect for connective tissue disease patients in comparison with expert panel evaluations

2021 ◽  
pp. 028418512110449
Author(s):  
Yoshiharu Ohno ◽  
Kota Aoyagi ◽  
Daisuke Takenaka ◽  
Takeshi Yoshikawa ◽  
Yasuko Fujisawa ◽  
...  
Keyword(s):  
Machine Learning ◽  
Texture Analysis ◽  
Disease Severity ◽  
Thin Section ◽  
Ct Scans ◽  
Normal Lung ◽  
Quantitative Index ◽  
Serial Ct ◽  
Ct Texture Analysis

Background The need for quantitative assessment of interstitial lung involvement on thin-section computed tomography (CT) has arisen in interstitial lung diseases including connective tissue disease (CTD). Purpose To evaluate the capability of machine learning (ML)-based CT texture analysis for disease severity and treatment response assessments in comparison with qualitatively assessed thin-section CT for patients with CTD. Material and Methods A total of 149 patients with CTD-related ILD (CTD-ILD) underwent initial and follow-up CT scans (total 364 paired serial CT examinations), pulmonary function tests, and serum KL-6 level tests. Based on all follow-up examination results, all paired serial CT examinations were assessed as “Stable” (n = 188), “Worse” (n = 98) and “Improved” (n = 78). Next, quantitative index changes were determined by software, and qualitative disease severity scores were assessed by consensus of two radiologists. To evaluate differences in each quantitative index as well as in disease severity score between paired serial CT examinations, Tukey's honestly significant difference (HSD) test was performed among the three statuses. Stepwise regression analyses were performed to determine changes in each pulmonary functional parameter and all quantitative indexes between paired serial CT scans. Results Δ% normal lung, Δ% consolidation, Δ% ground glass opacity, Δ% reticulation, and Δdisease severity score showed significant differences among the three statuses ( P < 0.05). All differences in pulmonary functional parameters were significantly affected by Δ% normal lung, Δ% reticulation, and Δ% honeycomb (0.16 ≤r2 ≤0.42; P < 0.05). Conclusion ML-based CT texture analysis has better potential than qualitatively assessed thin-section CT for disease severity assessment and treatment response evaluation for CTD-ILD.

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