Citations

Abstract Background Highly modulated radiotherapy delivery demands functional multileaf collimator (MLC) quality assurance (QA) with the ability to measure very low doses during short (<1 s) temporal segments of beam delivery. A radiochromic film with adequate sensitivity in the few‐cGy range is therefore needed. LD‐V1 film was designed for 2–20 cGy measurements in diagnostic kV energy ranges, but its performance for megavoltage (MV) beam qualities has not been well characterized. Purpose To demonstrate the feasibility of LD‐V1 film for low‐dose MV measurements and characterize its signal dependence under conditions relevant for clinical QA. Methods A 6 MV calibration curve was generated using eight dose levels between 0 and 40 cGy and compared with EBT4 film irradiated under identical conditions. Film characteristics evaluated included dose response, scanner and film signal uniformity, scan repeatability, energy dependence, post‐exposure signal evolution, scanning‐orientation dependence, and one‐dimensional (1‐D) profile visualization. Results LD‐V1 demonstrated higher net optical density (OD) and significantly less measurement uncertainty compared to EBT4 at dose levels less than 40 cGy. Significant energy dependence between kV and MV beam qualities was seen. Average net OD differences of 6.3% were seen between landscape and portrait scanning orientations. Post‐irradiation signal growth followed a logarithmic trend, stabilizing at ∼24 h. Scan‐to‐scan variation was <0.1%. Film‐signal uniformity was within 3.9%. 1‐D profiles showed discernible dose fall‐off for doses as low as 10 cGy. Conclusions LD‐V1 demonstrates suitability for low‐dose MV measurements and exhibits improved low‐dose sensitivity relative to EBT4, indicating its potential value for MLC QA in highly dynamic treatment deliveries. Nonetheless, its pronounced energy and scanning‐orientation dependence underscores the need for rigorous and consistent calibration and handling procedures.

Abstract The Bridging the Gaps (BTG) in Leukemia, Lymphoma and Multiple Myeloma Consensus Conference 2025 brought together a multidisciplinary group of oncology experts to address the complexities of lymphoma management, focusing on mantle cell lymphoma (MCL), chronic lymphocytic leukemia (CLL), and diffuse large B‐cell lymphoma (DLBCL). This article presents consensus recommendations developed through a modified Delphi process, which emphasize the need for tailored therapeutic strategies in light of recent advancements in treatment options. Key recommendations include the screening for high‐risk features in MCL, use of the BOVen regimen (zanubrutinib, obinutuzumab, and venetoclax) for TP53 ‐aberrant cases, and integration of chimeric antigen receptor T‐cell therapy for patients with mantle cell lymphoma that is refractory to covalent Bruton tyrosine kinase inhibitors. For CLL, recommendations include consideration of time‐limited therapies for younger patients and a “watch and wait” strategy for asymptomatic patients despite the improved activity and safety of current treatment regimens. For DLBCL, this article highlights the challenges in treatment sequencing and the role of circulating tumor DNA and minimal residual disease testing in monitoring disease progression. Overall, the conference describes the importance of ongoing research to refine management strategies and improve patient outcomes in lymphoma care, addressing the gaps in clinical practice where high‐level evidence is lacking.

Background Psychiatric comorbidities are increasingly recognised in demyelinating diseases, yet their frequency and timing in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are not well defined. We aimed to characterise the spectrum and temporal pattern of psychiatric illness in MOGAD and compare to multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) with aquaporin-4 antibody (AQP4-IgG). Methods We conducted a cross-sectional study of patients with MOGAD (n=388), age-matched and sex-matched MS (n=257) and AQP4-IgG-positive NMOSD (n=58) evaluated at Mayo Clinic (1991–2025). Psychiatric diagnoses, timing relative to the first attack and patient-reported outcomes were extracted from electronic health records (EHRs). Complementary analyses were conducted using the NeuroBlu real-world EHR database. Results Among 388 patients with MOGAD, 54.8% had ≥1 psychiatric disorder, most commonly anxiety (47.7%), depression (36.6%) and attention-deficit/hyperactivity disorder (ADHD, 9%). After the first attack, 33.3% of patients with MOGAD developed a new psychiatric disorder, often within the first year. MOGAD showed a lower frequency of depression versus MS (36.6% vs 47.5%, p=0.02) but similar rates of anxiety and ADHD. Temporal patterns differed: psychiatric disorders often appeared years before onset in MS but clustered shortly after onset in MOGAD. NeuroBlu analyses supported high rates of psychiatric disorders across the three conditions. Conclusion Psychiatric comorbidities are common in MOGAD, particularly depression and anxiety, typically emerging close after onset, whereas in MS they often preceded onset by years. These findings underscore the need for routine psychiatric screening in MOGAD and highlight unresolved questions regarding whether, and to what extent, MOG-IgG-mediated inflammatory demyelination contributes to psychiatric vulnerability.

Objective We investigated potential racial disparities in the effects of audiometric hearing loss and its treatment on dementia and mortality among 3,602 older adults aged 68–89 years, 22% of whom were self-identified Black race. Methods Adjudicated all-cause dementia was determined using neurocognitive test data, proxy reports, and surveillance of hospital records and death certificates. Audiometric hearing loss, defined as the better-ear averaged pure-tone threshold (0.5–4 kHz), was categorized using clinical cutpoints. Multivariable-adjusted Cox proportional hazards models included hearing loss–race interaction terms. Results Dementia risk associated with moderate-to-severe hearing loss did not differ by race [Black participants: hazard ratio (HR): 1.66; 95% confidence interval (CI): 1.05, 2.61; White participants: HR: 1.71; 95% CI: 1.16, 2.51; P -interaction = 0.92]. However, moderate-to-severe hearing loss was associated with a 2.3-fold increase in mortality among Black participants only (95% CI: 1.17, 4.60). Conclusions Our findings emphasize the importance of including minoritized populations in hearing treatment research to build an evidence base for policy development and clinical decision-making. Hearing loss affects the health of both Black and White Americans. Racial disparities in hearing healthcare should be addressed to advance health equity for all older adults.

Objective: To systematically review studies evaluating systemic medical therapies for sporadic vestibular schwannoma (VS) and perform meta-analyses to assess associations with tumor control. Study design: Systematic review and meta-analysis. Setting: Not applicable. Patients: Sporadic VS patients. Interventions: Systemic medical therapies. Main outcome measures: Tumor growth. Results: Nine retrospective studies met criteria: 5 on nonsteroidal anti-inflammatory drugs (NSAIDs), 3 on metformin, and 1 on losartan (all level 3 evidence). A meta-analysis of ORs from 5 studies demonstrated no significant association between aspirin use and tumor growth (pooled OR: 0.77; 95% CI: 0.48-1.23; I²: 76%). Conversely, a meta-analysis of ORs from 3 studies on metformin showed significantly lower odds of tumor growth (pooled OR: 0.46; 95% CI: 0.30-0.72; I²: 0%). The study on losartan did not identify a statistically significant association of losartan with tumor growth. Less than half of the studies reported HRs to appropriately reflect the inherently time-dependent nature of tumor growth. Conclusions: Evidence for systemic therapies in sporadic VS remains preliminary. Our meta-analysis of ORs demonstrates that NSAID use is not significantly associated with tumor growth, metformin users had lower odds of tumor growth, and evidence for losartan remains limited; however, all available studies provide only level 3 evidence. At present, there is insufficient data to recommend routine use of aspirin, metformin, or losartan with the intent of mitigating VS tumor growth during wait-and-scan management. High-quality prospective studies with appropriate time-to-event methodology to assess tumor growth are required to establish the clinical utility of systemic therapies in the management of patients with sporadic VS.

Background: Although cochlear implant surgery, along with subsequent speech therapy, is the gold standard for rehabilitating children with severe to profound hearing loss, it is an expensive process. The motivation and involvement of caregivers play a crucial role in achieving successful outcomes following implantation. However, there is a lack of research in India examining the specific challenges faced by caregivers in this context. This pilot study was designed to explore and assess the burden experienced by caregivers of children who have undergone cochlear implantation. Materials and Methods: A pilot observational study was conducted at a tertiary hospital in South India, involving children with bilateral severe to profound hearing loss. The study included children who underwent cochlear implantation and subsequent auditory rehabilitation through the state comprehensive health insurance scheme. Caregivers were interviewed using a semi-structured questionnaire, and their responses were evaluated using the social burden scale and the caregiver burden scale. Results: Twenty cochlear implantees were included in the study. On the social burden scale, 26% of caregivers reported experiencing a severe overall burden, while 71% indicated a moderate burden. According to the caregiver burden scale, most caregivers experienced a mild-to-moderate burden in the emotional domain, whereas the physical, social, and financial domains were associated with low-to-mild levels of burden. Conclusions: Caregivers of cochlear implantees experience a significant degree of emotional and social burden. Therefore, enhancing both financial and psychological support for caregivers is essential. Such improvements will contribute to more effective and comprehensive hearing rehabilitation programs.