Citations

Radiation segmentectomy is a dynamic image-guided therapy for hepatic malignancies that uses yttrium 90 transarterial radioembolization to deliver high radiation doses to targeted hepatic segments, achieving high and sustained response rates.

Context.— After-death care can be complicated and time-consuming for clinical staff, and frustrating for bereaved families. Delays and errors can have damaging legal and reputational consequences for hospitals. Offices of Decedent Affairs (ODAs) have been proposed as a solution, and their potential benefits have been described in several single institution reports. The literature lacks a contemporary and comprehensive review of existing ODAs and their approaches. Objective.— To describe the process of establishing a new ODA and to provide a snapshot of the spectrum of structure, function, and impact of existing ODAs in the United States. Design.— A survey was administered to 11 established ODAs spread across the continental United States. Programs were identified through the College of American Pathologists Autopsy Committee and a Medical Autopsy Listserv. Results.— Eleven ODAs returned the survey, representing more than 190 cumulative years of experience in decedent care in the hospital setting (median, 10 years). There was a wide range in staffing (both staff size and background) as well as scope of services offered. The median ratio of hospital deaths to full-time equivalent (FTE) staffing was 360 deaths per FTE. Respondents reported that ODAs unburden clinical providers and facilitate decedent management. Some respondents reported a quicker turnover of hospital beds and shorter intervals between pronouncement of death and autopsy. ODAs increased autopsy rates when the autopsy services were part of the ODA. Conclusions.— This survey provides practical information for hospitals considering establishing a new ODA and useful benchmarks for existing ODA programs.

Context.— Decedent Affairs Offices and Programs can serve as an avenue to assist medical centers in facilitating efficient and comprehensive decedent management, despite a paucity of literature on their roles, establishment, and efficacy. Objective.— To characterize the motivations and rationales for establishing Decedent Affairs Offices. Design.— A survey was administered to 11 established Decedent Affairs Offices/Programs, identified through the College of American Pathologists Autopsy Committee and a Medical Autopsy Listserv. The questions comprehensively cover establishment, operations, and outcomes data available by institution. Results.— Survey respondents reported the rationale for starting their programs and the benefits such offices can have. Conclusions.— Decedent Affairs Offices and Programs provide a useful option to medical centers to navigate the increasingly complex task of comprehensive decedent management. The present survey helps to delineate the similarities and differences between these programs at 11 institutions, to aid nascent programs in their establishment and growth over time.

BACKGROUND: To reduce technical variation in cancer surgery, the Commission on Cancer (CoC) recently implemented 6 operative standards as part of its national cancer center accreditation process. CoC sites are evaluated for compliance with these standards through scheduled visits conducted by trained site reviewers. We characterized site reviewers’ perspectives on the implementation of the operative standards. STUDY DESIGN: Twenty interviews were conducted with CoC site reviewers using a semistructured interview guide based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Themes were identified using thematic analysis mapped to the updated Consolidated Framework for Implementation Research. RESULTS: Site reviewers viewed the operative standards as an effective starting point for improving technical quality and were optimistic the standards would lead to positive change. Compliance was associated with supportive site leadership, effective interdisciplinary communication, and the availability of adequate personnel and institutional resources. In contrast, resistance from surgeons was identified as a key barrier. CoC site reviewers interpret their role as extending beyond assessing compliance, viewing themselves as advocates, educators, and partners to the sites. CONCLUSIONS: Overall, CoC site reviewers perceive the operative standards favorably. To enhance implementation of the operative standards, efforts should focus on modifiable institutional and individual-level factors, such as leadership support and surgeon engagement. Additionally, the multifaceted role of the site reviewers presents a valuable opportunity to improve compliance by formalizing the supportive relationship between reviewers and sites.

ABSTRACT Peptide receptor radionuclide therapy (PRRT) has transformed the management of neuroendocrine tumors and other malignancies by enabling targeted radiation delivery while minimizing systemic toxicity. However, incidental renal radiation exposure presents a significant risk of radiation nephropathy, and this risk varies based on the unique characteristics of the radionuclide and its decay phenomenon as well as the peptide being utilized. This review explores the historical development of PRRT, the physics of radionuclide therapy as necessary for a practicing nephrologist, and key mechanisms of radiation-related kidney injury. We detail renal handling of radionuclides, dose thresholds and pathological features of PRRT-induced nephropathy. Furthermore, we discuss both current and prospective strategies to reduce renal toxicity—such as amino acid infusions, receptor saturation, cleavable linkers and emerging protective agents. Special considerations for PRRT in patients with chronic kidney disease and those on dialysis are highlighted. As PRRT applications expand, multidisciplinary collaboration is essential to optimize renal safety.

Abstract The Centiloid scale is the standard for Amyloid (Aβ) PET quantification, widely used in research, clinical settings, and trial stratification. However, variability between tracers and scanners remains a challenge. This study introduces DeepSUVR, a deep learning method to correct Centiloid quantification, by penalising implausible longitudinal trajectories during training. The model was trained using data from 2,098 participants (6,762 Aβ PET scans) in AIBL/ADNI and validated using 15,806 Aβ PET scans from 10,543 participants across 10 external datasets. DeepSUVR increased correlation between tracers, and reduced variability in the Aβ-negatives. It showed the strongest association with cognition, highest AUC against visual reads and best longitudinal consistency between studies. DeepSUVR also increased the effect size for detecting lower Centiloid increase per year in the A4 study. DeepSUVR advances Aβ PET quantification, outperforming standard approaches, which is particularly important for consistent decision making and to detect subtle and early changes in clinical interventions.