Mayo Clinic - AuthorCitation

Estimating patient dose from CT exams that use automatic exposure control: Development and validation of methods to accurately estimate tube current values

McMillan, Kyle, Bostani, Maryam, Cagnon, Christopher H., Yu, Lifeng , Cagnon, Chris H., Yu, Lifeng , Leng, Shuai , McCollough, Cynthia H. , McNitt‐Gray, Michael F.

Medical Physics | May 6, 2017 | Volume: 44 | Issue: 8 | Pages: 4262-4275

PurposeThe vast majority of body CT exams are performed with automatic exposure control (AEC), which adapts the mean tube current to the patient size and modulates the tube current either angularly, longitudinally or both. However, most radiation dose estimation tools are based on fixed tube current scans. Accurate estimates of patient dose from AEC scans require knowledge of the tube current values, which is usually unavailable. The purpose of this work was to develop and validate methods to accurately estimate the tube current values prescribed by one manufacturer's AEC system to enable accurate estimates of patient dose.MethodsMethods were developed that took into account available patient attenuation information, user selected image quality reference parameters and x‐ray system limits to estimate tube current values for patient scans. Methods consistent with AAPM Report 220 were developed that used patient attenuation data that were: (a) supplied by the manufacturer in the CT localizer radiograph and (b) based on a simulated CT localizer radiograph derived from image data. For comparison, actual tube current values were extracted from the projection data of each patient. Validation of each approach was based on data collected from 40 pediatric and adult patients who received clinically indicated chest (n = 20) and abdomen/pelvis (n = 20) scans on a 64 slice multidetector row CT (Sensation 64, Siemens Healthcare, Forchheim, Germany). For each patient dataset, the following were collected with Institutional Review Board (IRB) approval: (a) projection data containing actual tube current values at each projection view, (b) CT localizer radiograph (topogram) and (c) reconstructed image data. Tube current values were estimated based on the actual topogram (actual‐topo) as well as the simulated topogram based on image data (sim‐topo). Each of these was compared to the actual tube current values from the patient scan. In addition, to assess the accuracy of each method in estimating patient organ doses, Monte Carlo simulations were performed by creating voxelized models of each patient, identifying key organs and incorporating tube current values into the simulations to estimate dose to the lungs and breasts (females only) for chest scans and the liver, kidney, and spleen for abdomen/pelvis scans. Organ doses from simulations using the actual tube current values were compared to those using each of the estimated tube current values (actual‐topo and sim‐topo).ResultsWhen compared to the actual tube current values, the average error for tube current values estimated from the actual topogram (actual‐topo) and simulated topogram (sim‐topo) was 3.9% and 5.8% respectively. For Monte Carlo simulations of chest CT exams using the actual tube current values and estimated tube current values (based on the actual‐topo and sim‐topo methods), the average differences for lung and breast doses ranged from 3.4% to 6.6%. For abdomen/pelvis exams, the average differences for liver, kidney, and spleen doses ranged from 4.2% to 5.3%.ConclusionsStrong agreement between organ doses estimated using actual and estimated tube current values provides validation of both methods for estimating tube current values based on data provided in the topogram or simulated from image data.

A Practical Framework for Understanding and Reducing Medical Overuse: Conceptualizing Overuse Through the Patient‐Clinician Interaction

Morgan, Daniel J., Leppin, Aaron L. , Smith, Cynthia D. , Korenstein, Deborah R.

Journal of Hospital Medicine | May 3, 2017 | Volume: 12 | Issue: 5 | Pages: 346-351

10.12788/jhm.2738 | PMID 28459906

Overuse of medical services is an increasingly recognized driver of poor‐quality care and high cost. A practical framework is needed to guide clinical decisions and facilitate concrete actions that can reduce overuse and improve care. We used an iterative, expert‐informed, evidence‐based process to develop a framework for conceptualizing interventions to reduce medical overuse. Given the complexity of defining and identifying overused care in nuanced clinical situations and the need to define care appropriateness in the context of an individual patient, this framework conceptualizes the patient–clinician interaction as the nexus of decisions regarding inappropriate care. This interaction is influenced by other utilization drivers, including healthcare system factors, the practice environment, the culture of professional medicine, the culture of healthcare consumption, and individual patient and clinician factors. The variable strength of the evidence supporting these domains highlights important areas for further investigation.

Predictive Associations of Music, Anxiety, and Sedative Exposure on Mechanical Ventilation Weaning Trials

Hetland, Breanna , Lindquist, Ruth , Weinert, Craig , Peden‐McAlpine, Cynthia , Savik, Kay, Weinert, Craig R, CHLAN, LINDA, Chlan, Linda L.

American Journal of Critical Care | May 1, 2017 | Volume: 26 | Issue: 3 | Pages: 210-220

10.4037/ajcc2017468 | PMID 28461543

Background Weaning from mechanical ventilation requires increased respiratory effort, which can heighten anxiety and later prolong the need for mechanical ventilation. Objectives To examine the predictive associations of music intervention, anxiety, sedative exposure, and patients’ characteristics on time to initiation and duration of weaning trials of patients receiving mechanical ventilation. Methods A descriptive, correlational design was used for a secondary analysis of data from a randomized trial. Music listening was defined as self-initiated, patient-directed music via headphones. Anxiety was measured daily with a visual analog scale. Sedative exposure was operationalized as a daily sedation intensity score and a sedative dose frequency. Analyses consisted of descriptive statistics, graphing, survival analysis, Cox proportional hazards regression, and linear regression. Results Of 307 patients, 52% were women and 86% were white. Mean age was 59.3 (SD, 14.4) years, mean Acute Physiology and Chronic Health Evaluation III score was 62.9 (SD, 21.6), mean duration of ventilatory support was 8 (range, 1–52) days, and mean stay in the intensive care unit was 18 (range, 2–71) days. Music listening, anxiety levels, and sedative exposure did not influence time to initial weaning trial or duration of trials. Clinical factors of illness severity, days of weaning trials, and tracheostomy placement influenced weaning patterns in this sample. Conclusions Prospective studies of music intervention and other psychophysiological factors during weaning from mechanical ventilation are needed to better understand factors that promote successful weaning.

Consistency of Renal Stone Volume Measurements Across CT Scanner Model and Reconstruction Algorithm Configurations

Huang, Alice E. , Montoya, Juan , Shiung, Maria, Montoya, Juan C, Leng, Shuai , McCollough, Cynthia H.

American Journal of Roentgenology | April 12, 2017 | Volume: 209 | Issue: 1 | Pages: 116-121

10.2214/ajr.16.16940 | PMID 28402129

Taxonomy for Education and Training in Clinical Neuropsychology : past, present, and future

Sperling, Scott A. , Cimino, Cynthia R., Stricker, Nikki H. , Heffelfinger, Amy , Gess, Jennifer L. , Osborn, Katie E. , Roper, Brad L. , Stricker, Nikki H , Sperling, Scott , Heffelfinger, Amy

The Clinical Neuropsychologist | April 10, 2017 | Volume: 31 | Issue: 5 | Pages: 817-828

10.1080/13854046.2017.1314017 | PMID 28391739

HA, Guess, CJ, Girman, SJ, Jacobsen, MM, Lieber, Ha, Guess, Girman, Cynthia J. , Jacobsen, S. J.

The Japanese Journal of Urology | April 6, 2017 | Volume: 88 | Issue: 2 | Pages: 316

10.5980/jpnjurol.88.316_4

CJ, Girman, HA, Guess, MM, Lieber, Girman, Cynthia J. , Ha, Guess

The Japanese Journal of Urology | April 6, 2017 | Volume: 87 | Issue: 2 | Pages: 468

10.5980/jpnjurol.87.468_1

Efficacy of the PARP Inhibitor Veliparib with Carboplatin or as a Single Agent in Patients with Germline BRCA1 - or BRCA2 -Associated Metastatic Breast Cancer: Ca

Somlo, George, Frankel, Paul , Cynthia, X. , García, Agustin A. , Cigler, Tessa, Cream, Leah, Harvey, Harold A., Sparano, Joseph A. , Nanda, Rita , Chew, Helen K. , Moynihan, Timothy J. , Hurria, Arti , Mortimer, Joanne , Sand, Sharon , Herzog, Josef , Tongeren, Lily R. Van, Ferry‐Galow, Katherine V., Chen, Alice P. , Ruel, Christopher , Newman, Edward M. , Gandara, David R. , Weitzel, Jeffrey N. , Arun, Banu , Vahdat, Linda T. , Goetz, Matthew P. , Beumer, Jan Hendrik , Piekarz, Richard , Weitzel, Jeffrey N , Sparano, Joseph A , Gandara, David

Clinical Cancer Research | March 29, 2017 | Volume: 23 | Issue: 15 | Pages: 4066-4076

10.1158/1078-0432.ccr-16-2714 | PMID 28356425

Abstract Purpose: We aimed to establish the MTD of the poly (ADP-ribose) (PAR) polymerase inhibitor, veliparib, in combination with carboplatin in germline BRCA1- and BRCA2- (BRCA)-associated metastatic breast cancer (MBC), to assess the efficacy of single-agent veliparib, and of the combination treatment after progression, and to correlate PAR levels with clinical outcome. Experimental Design: Phase I patients received carboplatin (AUC of 5–6, every 21 days), with escalating doses (50-20 mg) of oral twice-daily (BID) veliparib. In a companion phase II trial, patients received single-agent veliparib (400 mg BID), and upon progression, received the combination at MTD. Peripheral blood mononuclear cell PAR and serum veliparib levels were assessed and correlated with outcome. Results: Twenty-seven phase I trial patients were evaluable. Dose-limiting toxicities were nausea, dehydration, and thrombocytopenia [MTD: veliparib 150 mg po BID and carboplatin (AUC of 5)]. Response rate (RR) was 56%; 3 patients remain in complete response (CR) beyond 3 years. Progression-free survival (PFS) and overall survival (OS) were 8.7 and 18.8 months. The PFS and OS were 5.2 and 14.5 months in the 44 patients in the phase II trial, with a 14% RR in BRCA1 (n = 22) and 36% in BRCA2 (n = 22). One of 30 patients responded to the combination therapy after progression on veliparib. Higher baseline PAR was associated with clinical benefit. Conclusions: Safety and efficacy are encouraging with veliparib alone and in combination with carboplatin in BRCA-associated MBC. Lasting CRs were observed when the combination was administered first in the phase I trial. Further investigation of PAR level association with clinical outcomes is warranted. Clin Cancer Res; 23(15); 4066–76. ©2017 AACR.

Spotlight on the Pediatric Pain Psychology Special Interest Group

Harbeck‐Weber, Cynthia , Benore, Ethan, Logan, Deirdre E. , Banez, Gerard A., Harbeck‐Weber, Cynthia , Bhandari, Rashmi P.

Clinical Practice in Pediatric Psychology | March 16, 2017 | Volume: 5 | Issue: 1 | Pages: 15-16

10.1037/cpp0000177

Pediatric Pain Psychology: Guidelines for Advanced Subspecialty Training

Benore, Ethan, Bhandari, Rashmi P. , Harbeck‐Weber, Cynthia , Logan, Deirdre E. , Banez, Gerard A., Harbeck‐Weber, Cynthia , Bhandari, Rashmi Parekh

Clinical Practice in Pediatric Psychology | March 16, 2017 | Volume: 5 | Issue: 1 | Pages: 17-35

10.1037/cpp0000174

This article describes our shared expertise and collaborative efforts to develop guidelines and recommendations for subspecialized training in pediatric pain psychology. First, we review the competency goals and standards relevant to subspecialized training in pediatric pain psychology. Next, we detail our shared understanding of competencies in pediatric pain psychology and the training experiences to foster their development. Third, we highlight collaborative activities of our subspecialized training programs in order to demonstrate ways each program can optimize training curriculum. We conclude with a reflection of the current state of subspecialized training, directions for further development, and implications for other subspecialty programs.

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