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Ni L, Viner J, Phuong C, Liu SJ, Yee E, Petrofsky M, Kwon DH, Daras M, Brondfield S, Boreta L. Provider Perceptions of a Novel Inpatient Co-Rounding Model Integrating Medical Oncology, Neuro-Oncology, and Radiation Oncology for the Care of Patients with Advanced Cancer. Int J Radiat Oncol Biol Phys 2023; 117:S61. [PMID: 37784538 DOI: 10.1016/j.ijrobp.2023.06.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Patients (pts) with advanced cancer require interdisciplinary care. Although tumor boards are well-established in the outpatient setting, few studies have evaluated interventions for improving consultative care coordination for hospitalized pts with cancer. The purpose of this study was to evaluate a novel inpatient co-rounding model of care in which medical-, neuro-, and radiation-oncology consult teams rounded jointly, with the hypothesis that primary referring team perception of the alignment of the recommendations from these consult services would improve post-implementation. MATERIALS/METHODS An inpatient co-rounding model was implemented in September 2021 for hospitalized pts with solid malignancies at a tertiary medical center. Attending physicians, nurse practitioners, fellows, and residents from oncologic consulting services met virtually twice weekly to discuss pt care. Providers from the two most common primary services for pts with cancer at this hospital (hospital medicine and neurosurgery) were surveyed via institutional email listservs. The survey included Likert-type questions about the quality of inpatient consultation and the alignment of recommendations across three consulting oncological specialty services. The pre-intervention survey was distributed prior to model implementation, and the post-intervention survey was distributed 9 months later. Wilcoxon rank-sum tests were used to compare responses from the pre-and post-intervention surveys. RESULTS At each session, a median of 6 providers attended (range, 4-8 providers), and a median of 6 pts were discussed (range, 4-8 pts). Among 331 providers surveyed, 119 completed the pre-intervention survey (36% response rate), and 34 completed the post-intervention survey (10% response rate). Respondents were 81 (53%) internal medicine attending physicians/hospitalists, 55 (36%) internal medicine resident physicians, 6 (4%) neurosurgery advanced practice providers, 6 (4%) neurosurgery attending physicians, and 5 (3%) neurosurgery resident physicians. When asked to rate agreement with the statement that consultant recommendations from medical-, neuro-, and radiation-oncology were aligned, respondents were significantly more likely to perceive alignment 9 months post-implementation (67% strongly agree) compared to pre-implementation (23% strongly agree, p = 0.0001). There was high satisfaction with the quality of medical-, neuro-, and radiation-oncology consultations at both time points, with no statistical difference pre- vs. post-implementation of the co-rounding model. CONCLUSION A novel inpatient co-rounding model of care was successfully launched between medical-, neuro-, and radiation-oncology. Primary teams perceived greater alignment in recommendations between these consulting services after project implementation. Future directions include evaluating the impact of this co-rounding model on patient outcomes.
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Affiliation(s)
- L Ni
- University of California San Francisco, Department of Radiation Oncology, San Francisco, CA
| | - J Viner
- University of California San Francisco, Department of Neurology, Division of Neurologic Oncology, San Francisco, CA
| | - C Phuong
- University of California San Francisco, Department of Radiation Oncology, San Francisco, CA
| | - S J Liu
- University of California San Francisco, Department of Radiation Oncology, San Francisco, CA
| | - E Yee
- University of California San Francisco, Department of Radiation Oncology, San Francisco, CA
| | - M Petrofsky
- University of California San Francisco, Department of Medicine, Division of Hematology/Oncology, San Francisco, CA
| | - D H Kwon
- University of California San Francisco, Department of Medicine, Division of Hematology/Oncology, San Francisco, CA
| | - M Daras
- University of California San Francisco, Department of Neurology, Division of Neurologic Oncology, San Francisco, CA
| | - S Brondfield
- University of California San Francisco, Department of Medicine, Division of Hematology/Oncology, San Francisco, CA
| | - L Boreta
- University of California San Francisco, Department of Radiation Oncology, San Francisco, CA
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Chang JH, Lin A, Singer L, Mohamad O, Chan J, Friesner I, Zack T, Ashraf-Ganjouei A, Boreta L, Gottschalk A, Braunstein SE, Park CC, Hong JC. Identifying Common Topics in Patient Portal Messages with Unsupervised Natural Language Processing. Int J Radiat Oncol Biol Phys 2023; 117:e460-e461. [PMID: 37785473 DOI: 10.1016/j.ijrobp.2023.06.1657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Patient portal messaging is an increasingly important form of communication between patients and medical providers. This has become particularly relevant in oncology, where patients undergo intense longitudinal treatments that require frequent communication regarding symptoms, appointments, and diagnostic results. The rise in the volume of these messages has significantly increased the workload of medical providers and consequent physician burn-out. Natural language processing (NLP), particularly transformer-based models, may offer an automated approach to characterize the content of patient messages and improve message triage and routing. In this study, we employed a state-of-the-art language model (Bidirectional Encoder Representations from Transformers; BERT) to identify data-derived categories of representative topics from real-world data thereby providing basic information to build an appropriate routing system. MATERIALS/METHODS Patient-generated portal messages sent to a messaging pool for a single institution radiation oncology department from 2014 to 2023 were extracted. BERTopic, an NLP-based topic modeling technique based on BERT was optimized for topic modeling of patient messages. Uniform Manifold Approximation and Projection (UMAP) was used to reduce dimensionality and visualize topic relationships across messages. The BERTopic-identified topic categories were subsequently labeled manually by one of the physician investigators. Differences of number of messages over time were assessed using t-tests. RESULTS A total of 47,492 messages were retrieved. The average number of messages per month from a single patient ranged from 1 to 18 (median 1.67, interquartile range 1.0-2.4). The total volume of patient messages showed a ten-fold increase over the study period, with 101 messages per month sent in 2014 and 999 messages per month in 2022 (p<0.001). BERTopic initially identified 35 topics whose relationships and degrees of overlap were visualized by UMAP. Due to physician-identified similarities, these topics were reduced into 13 categories. The most frequent topic category was messages about laboratory tests or imaging studies: 24.3%, followed by messages expressing appreciation: 18.9%, scheduling discussions: 15.6%, symptom-related messages: 11%, and treatment-related messages: 10.7%. CONCLUSION Patient portal messages sent to a single institution radiation oncology department have increased dramatically in volume since implementation, corresponding to a broader national trend. NLP successfully identified common subject themes across patient messages, many of which are related to scheduling. This presents potential opportunities to apply NLP to automate message routing in the future.
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Affiliation(s)
- J H Chang
- University of California San Francisco, Department of Radiation Oncology, San Francisco, CA; Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - A Lin
- University of California San Francisco, Department of Hematology and Oncology, San Francisco, CA
| | - L Singer
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | - O Mohamad
- University of California San Francisco, Department of Radiation Oncology, San Francisco, CA
| | - J Chan
- University of California San Francisco, Department of Radiation Oncology, San Francisco, CA
| | - I Friesner
- University of California San Francisco, Department of Radiation Oncology, San Francisco, CA; University of California, San Francisco, Bakar Computational Health Sciences Institute, San Francisco, CA
| | - T Zack
- University of California San Francisco, San Francisco, CA
| | - A Ashraf-Ganjouei
- University of California San Francisco, Department of Radiation Oncology, San Francisco, CA; University of California, San Francisco, Bakar Computational Health Sciences Institute, San Francisco, CA
| | - L Boreta
- University of California San Francisco, Department of Radiation Oncology, San Francisco, CA
| | - A Gottschalk
- University of California San Francisco, Department of Radiation Oncology, San Francisco, CA
| | - S E Braunstein
- University of California San Francisco, Department of Radiation Oncology, San Francisco, CA
| | - C C Park
- University of California San Francisco, Department of Radiation Oncology, San Francisco, CA
| | - J C Hong
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA; University of California, San Francisco, Bakar Computational Health Sciences Institute, San Francisco, CA
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Qian AS, Friesner I, Chen JJ, Boreta L, Braunstein SE, Hong JC. Natural Language Processing Identification of Symptoms in Emergency Department Visits in Patients Receiving Radiation. Int J Radiat Oncol Biol Phys 2023; 117:S144. [PMID: 37784369 DOI: 10.1016/j.ijrobp.2023.06.558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Patients undergoing radiotherapy (RT) for cancer often require emergency department (ED) attention with possible hospitalization. Designing strategies to mitigate hospital admissions requires understanding the causal symptoms to tailor interventional strategies. Natural language processing (NLP) has previously been shown to accurately identify documented symptoms and may help characterize factors contributing to admission. The objective of this study was to use NLP to identify documented symptoms during ED visits and their association with subsequent hospital admission of patients undergoing RT. MATERIALS/METHODS A de-identified, single tertiary-care institution cohort of patients who received radiation between 2013 and 2022 was identified from the electronic health record using International Classification of Disease (ICD) and Current Procedural Terminology (CPT) codes. We applied a previously validated clinical Text Analysis and Knowledge Extraction System (cTAKES)-based NLP pipeline to extract Common Terminology Criteria for Adverse Events (CTCAE) encoded symptoms from ED encounter clinical notes. Chi-squared testing was used to compare demographics, and logistic regression was used to identify symptoms associated with subsequent admission from ED visits. RESULTS We identified 14,007 patients who received radiation, of whom 270 (1.9%) experienced 302 ED visits during their radiation course. 141 (46.7%) of ED visits resulted in an admission. Among patients with an ED encounter, there were no differences in admission rates based on primary language (p = 0.771), sex (p = 0.824), marital status (p = 0.753), race (p = 0.222), or age (p = 0.123). In admitted patients, the top 5 symptoms were pain (94.3%), nausea (92.1%), vomiting (73.7%), constipation (70.9%), and weakness (63.8%). In patients who did not require admission, the most common symptoms were pain (84.5%), nausea (67.1%), vomiting (47.2%), headache (36.6%), and weakness (35.4%). The 10 symptoms most associated with admission from the ED based on logistic regression were malaise (OR 21.7, [95% CI 10.1 - 51.0]), lethargy (19.1, [8.5 - 51.3]), flushing (15.7, [8.6 - 30.4]), agitation (12.4, [3.5 - 78.7]), somnolence (10.3, [4.7 - 25.9]), fall (8.5, [3.7 - 23.2]), fatigue (7.8, [4.6 - 13.4]), constipation (6.9, [4.2 - 11.6]), nausea (5.8, [3.0 - 12.2]), and swelling (5.4, [3.3 - 9.1]). CONCLUSION Admitted and non-admitted ED patients with cancer seen in the ED during radiotherapy are documented to experience similar symptoms, but certain symptoms are associated with a higher risk of hospital admission. NLP may offer a mechanism for early, automated identification to facilitate supportive interventions for patients at high risk for admission during radiotherapy.
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Affiliation(s)
- A S Qian
- University of California, San Francisco, San Francisco, CA
| | - I Friesner
- University of California San Francisco, Department of Radiation Oncology, San Francisco, CA
| | - J J Chen
- University of California, San Francisco, San Francisco, CA
| | - L Boreta
- University of California San Francisco, Department of Radiation Oncology, San Francisco, CA
| | - S E Braunstein
- University of California San Francisco, Department of Radiation Oncology, San Francisco, CA
| | - J C Hong
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
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Massachi J, Boreta L, Braunstein S. Outcomes of SBRT for Symptomatic Benign Tumors of the Spine. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Vasudevan H, Delley C, Aabedi A, Nguyen M, Morshed R, Young J, Demaree B, Diwanji D, Hervey-Jumper S, Boreta L, Fogh S, Nakamura J, Theodosopoulos P, Phillips J, Daras M, Tsai K, Sneed P, Aghi M, Raleigh D, Braunstein S, Abate A. Mutational Analysis and Single Cell Sequencing of Melanoma Brain Metastases. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ni L, Phuong C, Chen J, Chen W, Daras M, Raleigh D, Nakamura J, Boreta L, Sneed P, Braunstein S. Volumetric Response of Brain Metastases in EGFR-Positive NSCLC Treated with CNS-Penetrant Tyrosine Kinase Inhibitors with or without Radiation Therapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Chen K, Raleigh D, Sneed P, Fogh S, Nakamura J, Boreta L, Reddy A, Banerjee A, Mueller S, Auguste K, Gupta N, Braunstein S. Radiosurgery for Primary and Metastatic CNS Malignancies in the Pediatric Population. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Chen J, Friesner I, Chang C, Ni L, Braunstein S, Boreta L, Hong J. Natural Language Processing of Symptoms Preceding Diagnosis and Palliative Radiotherapy for Bone Metastases. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Thomas H, Boreta L, Braunstein S, Lonergan P, Washington S, Branagan L, Morin O, Yom S, Park C, Odisho A, Hong J. Acclimation to Telehealth in Radiation Oncology During COVID-10 Response: Demographic Trends and Challenges. Int J Radiat Oncol Biol Phys 2021. [PMCID: PMC8536231 DOI: 10.1016/j.ijrobp.2021.07.1013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Chen W, Lafreniere M, Phuong C, Lometti M, Morin O, Ziemer B, Vasudevan H, Hervey-Jumper S, Theodosopoulos P, Magill S, Fogh S, Nakamura J, Boreta L, Sneed P, McDermott M, Raleigh D, Braunstein S. Salvage Resection and Intracranial Cesium-131 Brachytherapy for Brain Tumors. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Chen W, Baal U, Baal J, Pai J, Vasudevan H, Boreta L, Braunstein S, Raleigh D. Efficacy and Safety of Stereotactic Radiosurgery for Brainstem Metastases: A Systematic Review and Comparative Meta-Analysis. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Chew J, Sinha S, Liu S, Fogh S, Boreta L, Raleigh D, Ma L, Braunstein S. Consideration of Time From Planning to Treatment for Frameless Fractionated Stereotactic Radiosurgery in Patients With Intact Large Brain Metastases. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Nano T, Morin O, Ziemer B, Raleigh D, Boreta L, Nakamura J, Fogh S, Sneed P, Harvey-Jumper S, Theodosopoulos P, Braunstein S, Ma L. PH-0378 How to achieve the sharpest dose fall-off for hypo-fractionated radiosurgery of large brain lesions? Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07309-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cho N, Raleigh D, Ziemer B, Nano T, Theodosopoulos P, Sneed P, Boreta L, Braunstein S, MA L. PO-1738 Reducing Dose Hot Spots for Hypofractionated Gamma Knife Radiosurgery via Hundreds of Isocenters. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08189-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Zhang M, Li Y, Susko M, Boreta L, Braunstein S. Standardized Protocol for Therapeutic Response after Palliative Radiation Therapy for Patients with Painful Bone Metastases: A Prospective Study. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chen K, Wu S, Yee E, Braunstein S, Boreta L. Whole Brain Radiation for Brain Metastases at a Tertiary Hospital with High-Volume Radiosurgical Practice. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Susko M, Vasudevan H, Nakamura J, Raleigh D, Boreta L, Fogh S, Theodosopoulos P, McDermott M, Tsai K, Sneed P, Braunstein S. Outcomes Of Systemic Therapy With Or Without Focal Radiotherapy Following Resection Of Melanoma Brain Metastases. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wu S, Yee E, Fogh S, Boreta L, Hong J, Braunstein S. Classification of Patients at Imminent Risk of Death at the Time of Palliative Radiotherapy Consultation. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Craig A, Susko M, Vasudevan H, Ziemer B, Raleigh D, Boreta L, Gottschalk A, Nakamura J, Braunstein S. Outcomes And Risk For Acute Toxicity After Spine Radiotherapy In Conjunction With Immunotherapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Thomas H, Susko M, Lazar A, Craig A, Boreta L, Morin O, Braunstein S. Evaluation of Hematologic Toxicity of Stereotactic Body Radiation Therapy (SBRT) to Spinal Metastases. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Boreta L, Lazar A, Wu S, Chan J, Choi S, Yu Y, Szilagyi J, Sherertz T, Holmes S, Yom S. Structural Vulnerability Associated with Radiation Treatment Gaps in Head and Neck Cancer Patients. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Boreta L, Fogh S, Braunstein S. Impact of Department-Wide Peer Review on Practice Patterns in Radiation Oncology. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Boreta L, Xu M, Wu S, Wu A, Nguyen H, Chang A, Roach M, Spratt D, Feng F, Carroll P, Hope T. Location of Recurrence by Gallium-68 PSMA PET Scan in Prostate Cancer Patients Eligible for Salvage Radiation Therapy. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Magnuson W, Amini A, Patil T, Kavanagh B, Camidge D, Braunstein S, Boreta L, Attia A, Rana N, Contessa J, Gettinger S, Lester-Coll N, Yu J, Chiang V. Deferring Radiation Therapy for Brain Metastases in Patients With EGFR-Mutant Non-Small Cell Lung Cancer: A Multi-Institutional Analysis. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Singer L, Boreta L, Braunstein S, Fogh S. A Quality Improvement Study to Improve Assessment of Patient Readiness to Quit Tobacco Prior to Treatment With Radiation Therapy. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Katz J, Zhang Y, Boreta L, Woolley Levine S, Schuff N, Weiner M. A Longtudinal Study Comparing Advanced Imaging Techniques for Detecting Progression in ALS (P03.165). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p03.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Schuff N, Woerner N, Boreta L, Kornfield T, Shaw LM, Trojanowski JQ, Thompson PM, Jack CR, Weiner MW. MRI of hippocampal volume loss in early Alzheimer's disease in relation to ApoE genotype and biomarkers. Brain 2009; 132:1067-77. [PMID: 19251758 PMCID: PMC2668943 DOI: 10.1093/brain/awp007] [Citation(s) in RCA: 409] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Revised: 11/24/2008] [Accepted: 12/31/2008] [Indexed: 11/22/2022] Open
Abstract
Hippocampal volume change over time, measured with MRI, has huge potential as a marker for Alzheimer's disease. The objectives of this study were: (i) to test if constant and accelerated hippocampal loss can be detected in Alzheimer's disease, mild cognitive impairment and normal ageing over short periods, e.g. 6-12 months, with MRI in the large multicentre setting of the Alzheimer's Disease Neuroimaging Initiative (ADNI); (ii) to determine the extent to which the polymorphism of the apolipoprotein E (ApoE) gene modulates hippocampal change; and (iii) to determine if rates of hippocampal loss correlate with cerebrospinal fluid (CSF) biomarkers of Alzheimer's disease, such as the beta-amyloid (Abeta(1-42)) and tau proteins (tau). The MRI multicentre study included 112 cognitive normal elderly individuals, 226 mild cognitive impairment and 96 Alzheimer's disease patients who all had at least three successive MRI scans, involving 47 different imaging centres. The mild cognitive impairment and Alzheimer's disease groups showed hippocampal volume loss over 6 months and accelerated loss over 1 year. Moreover, increased rates of hippocampal loss were associated with presence of the ApoE allele epsilon4 gene in Alzheimer's disease and lower CSF Abeta(1-42) in mild cognitive impairment, irrespective of ApoE genotype, whereas relations with tau were only trends. The power to measure hippocampal change was improved by exploiting correlations statistically between successive MRI observations. The demonstration of considerable hippocampal loss in mild cognitive impairment and Alzheimer's disease patients over only 6 months and accelerated loss over 12 months illustrates the power of MRI to track morphological brain changes over time in a large multisite setting. Furthermore, the relations between faster hippocampal loss in the presence of ApoE allele epsilon4 and decreased CSF Abeta(1-42) supports the concept that increased hippocampal loss is an indicator of Alzheimer's disease pathology and a potential marker for the efficacy of therapeutic interventions in Alzheimer's disease.
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Affiliation(s)
- N Schuff
- Department of Veterans Affairs Medical Center, San Francisco, CA, USA.
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