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Loukas C, Seimenis I, Prevezanou K, Schizas D. Prediction of remaining surgery duration in laparoscopic videos based on visual saliency and the transformer network. Int J Med Robot 2024; 20:e2632. [PMID: 38630888 DOI: 10.1002/rcs.2632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/26/2024] [Accepted: 04/07/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Real-time prediction of the remaining surgery duration (RSD) is important for optimal scheduling of resources in the operating room. METHODS We focus on the intraoperative prediction of RSD from laparoscopic video. An extensive evaluation of seven common deep learning models, a proposed one based on the Transformer architecture (TransLocal) and four baseline approaches, is presented. The proposed pipeline includes a CNN-LSTM for feature extraction from salient regions within short video segments and a Transformer with local attention mechanisms. RESULTS Using the Cholec80 dataset, TransLocal yielded the best performance (mean absolute error (MAE) = 7.1 min). For long and short surgeries, the MAE was 10.6 and 4.4 min, respectively. Thirty minutes before the end of surgery MAE = 6.2 min, 7.2 and 5.5 min for all long and short surgeries, respectively. CONCLUSIONS The proposed technique achieves state-of-the-art results. In the future, we aim to incorporate intraoperative indicators and pre-operative data.
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Affiliation(s)
- Constantinos Loukas
- Laboratory of Medical Physics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Seimenis
- Laboratory of Medical Physics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantina Prevezanou
- Laboratory of Medical Physics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Schizas
- 1st Department of Surgery, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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2
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Kokkinos V, Seimenis I. Concordance of verbal memory and language fMRI lateralization in people with epilepsy. J Neuroimaging 2024; 34:95-107. [PMID: 37968766 DOI: 10.1111/jon.13171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/29/2023] [Accepted: 11/01/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND AND PURPOSE This work investigates verbal memory functional MRI (fMRI) versus language fMRI in terms of lateralization, and assesses the validity of performing word recognition during the functional scan. METHODS Thirty patients with a diagnosis of epilepsy underwent verbal memory, visuospatial memory, and language fMRI. We used word encoding, word recognition, image encoding, and image recognition memory tasks, and semantic description, reading comprehension, and listening comprehension language tasks. We used three common lateralization metrics: network spatial distribution, maximum statistical value, and laterality index (LI). RESULTS Lateralization of signal spatial distribution resulted in poor similarity between verbal memory and language fMRI tasks. Signal maximum lateralization showed significant (>.8) but not perfect (1) similarity. Word encoding LI showed significant correlation only with listening comprehension LI (p = .016). Word recognition LI was significantly correlated with expressive language semantic description LI (p = .024) and receptive language reading and listening comprehension LIs (p = .015 and p = .019, respectively). There was no correlation between LIs of the visuospatial tasks and LIs of the language tasks. CONCLUSIONS Our results support the association between language and verbal memory lateralization, optimally determined by LI quantification, and the introduction of quantitative means for language fMRI interpretation in clinical settings where verbal memory lateralization is imperative.
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Affiliation(s)
- Vasileios Kokkinos
- Comprehensive Epilepsy Center, Northwestern Memorial Hospital, Chicago, Illinois, USA
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Medicine, School of Health Sciences, Democritus University of Thrace, Alexandroupoli, Greece
| | - Ioannis Seimenis
- Department of Medicine, School of Health Sciences, Democritus University of Thrace, Alexandroupoli, Greece
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
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3
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Kalatzis D, Spyratou E, Karnachoriti M, Kouri MA, Stathopoulos I, Danias N, Arkadopoulos N, Orfanoudakis S, Seimenis I, Kontos AG, Efstathopoulos EP. Extended Analysis of Raman Spectra Using Artificial Intelligence Techniques for Colorectal Abnormality Classification. J Imaging 2023; 9:261. [PMID: 38132679 PMCID: PMC10744297 DOI: 10.3390/jimaging9120261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/06/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023] Open
Abstract
Raman spectroscopy (RS) techniques are attracting attention in the medical field as a promising tool for real-time biochemical analyses. The integration of artificial intelligence (AI) algorithms with RS has greatly enhanced its ability to accurately classify spectral data in vivo. This combination has opened up new possibilities for precise and efficient analysis in medical applications. In this study, healthy and cancerous specimens from 22 patients who underwent open colorectal surgery were collected. By using these spectral data, we investigate an optimal preprocessing pipeline for statistical analysis using AI techniques. This exploration entails proposing preprocessing methods and algorithms to enhance classification outcomes. The research encompasses a thorough ablation study comparing machine learning and deep learning algorithms toward the advancement of the clinical applicability of RS. The results indicate substantial accuracy improvements using techniques like baseline correction, L2 normalization, filtering, and PCA, yielding an overall accuracy enhancement of 15.8%. In comparing various algorithms, machine learning models, such as XGBoost and Random Forest, demonstrate effectiveness in classifying both normal and abnormal tissues. Similarly, deep learning models, such as 1D-Resnet and particularly the 1D-CNN model, exhibit superior performance in classifying abnormal cases. This research contributes valuable insights into the integration of AI in medical diagnostics and expands the potential of RS methods for achieving accurate malignancy classification.
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Affiliation(s)
- Dimitris Kalatzis
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.K.); (E.S.); (M.A.K.); (I.S.)
| | - Ellas Spyratou
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.K.); (E.S.); (M.A.K.); (I.S.)
- Department of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Maria Karnachoriti
- Department of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
- School of Applied Mathematical and Physical Sciences, National Technical University Athens, 15780 Athens, Greece;
| | - Maria Anthi Kouri
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.K.); (E.S.); (M.A.K.); (I.S.)
- Medical Physics Program, University of Massachusetts Lowell, Lowell, MA 01854, USA
| | - Ioannis Stathopoulos
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.K.); (E.S.); (M.A.K.); (I.S.)
| | - Nikolaos Danias
- 4th Department of Surgery, School of Medicine, Attikon University Hospital, University of Athens, 12462 Athens, Greece; (N.D.); (N.A.)
| | - Nikolaos Arkadopoulos
- 4th Department of Surgery, School of Medicine, Attikon University Hospital, University of Athens, 12462 Athens, Greece; (N.D.); (N.A.)
| | - Spyros Orfanoudakis
- Alpha Information Technology S.A., Software & System Development, 68131 Alexandroupolis, Greece;
| | - Ioannis Seimenis
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Athanassios G. Kontos
- School of Applied Mathematical and Physical Sciences, National Technical University Athens, 15780 Athens, Greece;
| | - Efstathios P. Efstathopoulos
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.K.); (E.S.); (M.A.K.); (I.S.)
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Kouri MA, Karnachoriti M, Spyratou E, Orfanoudakis S, Kalatzis D, Kontos AG, Seimenis I, Efstathopoulos EP, Tsaroucha A, Lambropoulou M. Shedding Light on Colorectal Cancer: An In Vivo Raman Spectroscopy Approach Combined with Deep Learning Analysis. Int J Mol Sci 2023; 24:16582. [PMID: 38068905 PMCID: PMC10706261 DOI: 10.3390/ijms242316582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
Raman spectroscopy has emerged as a powerful tool in medical, biochemical, and biological research with high specificity, sensitivity, and spatial and temporal resolution. Recent advanced Raman systems, such as portable Raman systems and fiber-optic probes, provide the potential for accurate in vivo discrimination between healthy and cancerous tissues. In our study, a portable Raman probe spectrometer was tested in immunosuppressed mice for the in vivo localization of colorectal cancer malignancies from normal tissue margins. The acquired Raman spectra were preprocessed, and principal component analysis (PCA) was performed to facilitate discrimination between malignant and normal tissues and to highlight their biochemical differences using loading plots. A transfer learning model based on a one-dimensional convolutional neural network (1D-CNN) was employed for the Raman spectra data to assess the classification accuracy of Raman spectra in live animals. The 1D-CNN model yielded an 89.9% accuracy and 91.4% precision in tissue classification. Our results contribute to the field of Raman spectroscopy in cancer diagnosis, highlighting its promising role within clinical applications.
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Affiliation(s)
- Maria Anthi Kouri
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.A.K.); (E.S.); (D.K.); (E.P.E.)
- Medical Physics Program, Department of Physics and Applied Physics, Kennedy College of Sciences, University of Massachusetts Lowell, 265 Riverside St., Lowell, MA 01854, USA
| | - Maria Karnachoriti
- Physics Department, School of Applied Mathematical and Physical Sciences, National Technical University of Athens, Iroon Politechniou 9, 15780 Athens, Greece; (M.K.); (S.O.)
| | - Ellas Spyratou
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.A.K.); (E.S.); (D.K.); (E.P.E.)
| | - Spyros Orfanoudakis
- Physics Department, School of Applied Mathematical and Physical Sciences, National Technical University of Athens, Iroon Politechniou 9, 15780 Athens, Greece; (M.K.); (S.O.)
| | - Dimitris Kalatzis
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.A.K.); (E.S.); (D.K.); (E.P.E.)
| | - Athanassios G. Kontos
- Physics Department, School of Applied Mathematical and Physical Sciences, National Technical University of Athens, Iroon Politechniou 9, 15780 Athens, Greece; (M.K.); (S.O.)
| | - Ioannis Seimenis
- Medical School, National and Kapodistrian University of Athens, 75 Mikras Assias Str., 11527 Athens, Greece;
| | - Efstathios P. Efstathopoulos
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.A.K.); (E.S.); (D.K.); (E.P.E.)
| | - Alexandra Tsaroucha
- Laboratory of Bioethics, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Maria Lambropoulou
- Laboratory of Histology-Embryology, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
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Kokkinos V, Chatzisotiriou A, Seimenis I. Functional Magnetic Resonance Imaging and Diffusion Tensor Imaging-Tractography in Resective Brain Surgery: Lesion Coverage Strategies and Patient Outcomes. Brain Sci 2023; 13:1574. [PMID: 38002534 PMCID: PMC10670090 DOI: 10.3390/brainsci13111574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/04/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Diffusion tensor imaging (DTI)-tractography and functional magnetic resonance imaging (fMRI) have dynamically entered the presurgical evaluation context of brain surgery during the past decades, providing novel perspectives in surgical planning and lesion access approaches. However, their application in the presurgical setting requires significant time and effort and increased costs, thereby raising questions regarding efficiency and best use. In this work, we set out to evaluate DTI-tractography and combined fMRI/DTI-tractography during intra-operative neuronavigation in resective brain surgery using lesion-related preoperative neurological deficit (PND) outcomes as metrics. We retrospectively reviewed medical records of 252 consecutive patients admitted for brain surgery. Standard anatomical neuroimaging protocols were performed in 127 patients, 69 patients had additional DTI-tractography, and 56 had combined DTI-tractography/fMRI. fMRI procedures involved language, motor, somatic sensory, sensorimotor and visual mapping. DTI-tractography involved fiber tracking of the motor, sensory, language and visual pathways. At 1 month postoperatively, DTI-tractography patients were more likely to present either improvement or preservation of PNDs (p = 0.004 and p = 0.007, respectively). At 6 months, combined DTI-tractography/fMRI patients were more likely to experience complete PND resolution (p < 0.001). Low-grade lesion patients (N = 102) with combined DTI-tractography/fMRI were more likely to experience complete resolution of PNDs at 1 and 6 months (p = 0.001 and p < 0.001, respectively). High-grade lesion patients (N = 140) with combined DTI-tractography/fMRI were more likely to have PNDs resolved at 6 months (p = 0.005). Patients with motor symptoms (N = 80) were more likely to experience complete remission of PNDs at 6 months with DTI-tractography or combined DTI-tractography/fMRI (p = 0.008 and p = 0.004, respectively), without significant difference between the two imaging protocols (p = 1). Patients with sensory symptoms (N = 44) were more likely to experience complete PND remission at 6 months with combined DTI-tractography/fMRI (p = 0.004). The intraoperative neuroimaging modality did not have a significant effect in patients with preoperative seizures (N = 47). Lack of PND worsening was observed at 6 month follow-up in patients with combined DTI-tractography/fMRI. Our results strongly support the combined use of DTI-tractography and fMRI in patients undergoing resective brain surgery for improving their postoperative clinical profile.
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Affiliation(s)
- Vasileios Kokkinos
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02215, USA
| | | | - Ioannis Seimenis
- Department of Medicine, School of Health Sciences, Democritus University of Thrace, 387479 Alexandroupolis, Greece;
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6
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Velonis M, Papanastasiou E, Hatziioannou K, Siountas A, Kamperis E, Papavasileiou P, Koukourakis MI, Seimenis I. Dose optimization of 2D X-ray image acquisition protocols in image-guided radiotherapy. Phys Med 2023; 115:103161. [PMID: 37847953 DOI: 10.1016/j.ejmp.2023.103161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 09/06/2023] [Accepted: 10/06/2023] [Indexed: 10/19/2023] Open
Abstract
PURPOSE In contemporary radiotherapy, patient positioning accuracy relies on kV imaging. This study aims at optimizing planar kV image acquisition protocols regarding patient dose without degrading image quality. MATERIALS AND METHODS An image quality test-object was placed in-between PMMA plates, suitably arranged to model head or pelvis. Constructed phantoms were imaged using default protocols, the resultant image quality was assessed and the corresponding radiation dose was measured. The process was repeated using numerous kV/mAs combinations to identify those acquisition settings providing images at lower dose than the default protocols but without deterioration in image quality. Default and dose-optimized protocols were then tested on an anthropomorphic phantom and on 51 patients during two successive treatment sessions. Image quality was independently assessed by two readers. Organ and effective doses were estimated using a Monte Carlo simulation software. RESULTS Low-contrast detectability exhibited a stronger dependence on kV/mAs settings, compared to high-contrast resolution. Dose-optimized protocols resulted in significant dose reductions (anteroposterior-head 48.0 %, lateral-head 30.0 %, anteroposterior-pelvis 28.4 %, lateral-pelvis 27.0 %) compared to the default ones, without compromising image quality. Optimized protocols decreased effective doses by 54 % and 29.6 % in head and pelvic acquisitions, respectively. Regarding image quality, anthropomorphic and patient images acquired using the dose-optimized protocols were subjectively evaluated equivalent to those obtained with the corresponding default settings, indicating that the proposed protocols may be routinely used. CONCLUSIONS Given the potentially large number of radiotherapy fractions and the pertinent image acquisitions, dose-optimized protocols could significantly reduce patient dose associated with planar imaging without compromising positioning accuracy.
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Affiliation(s)
- Marios Velonis
- Department of Medicine, Faculty of Health Sciences, Democritus University of Thrace, Greece; Department of Medical Physics, Papageorgiou General Hospital, Thessaloniki, Greece.
| | - Emmanouil Papanastasiou
- Medical Physics & Digital Innovation Laboratory, Medical School, Aristotle University of Thessaloniki, Greece
| | | | - Anastasios Siountas
- Medical Physics & Digital Innovation Laboratory, Medical School, Aristotle University of Thessaloniki, Greece
| | - Efstathios Kamperis
- Department of Radiotherapy, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Periklis Papavasileiou
- Department of Biomedical Sciences, School of Health Sciences, University of West Attica, Greece
| | - Michael I Koukourakis
- Department of Medicine, Faculty of Health Sciences, Democritus University of Thrace, Greece
| | - Ioannis Seimenis
- Medical Physics Laboratory, School of Medicine, National and Kapodistrian University of Athens, Greece
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7
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Salpadimos N, Karfopoulos K, Seimenis I, Potiriadis C, Carinou E, Housiadas C. Risk assessment for the optimization of the grid of a telemetric network monitoring system. J Environ Radioact 2023; 268-269:107249. [PMID: 37494791 DOI: 10.1016/j.jenvrad.2023.107249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/11/2023] [Accepted: 07/20/2023] [Indexed: 07/28/2023]
Abstract
The goal of this work was to develop a methodology for risk assessment in case of an accident originating from a nuclear power plant, and consequently, to improve the relevant radiation monitoring network. In specific, the study involved risk estimation in Greece from a transboundary nuclear power plant accident. The tool employed was JRODOS (Java-based Real-time Decision Support), which is a system for off-site emergency management of radioactive material in the environment. This tool, widely used to generate and study scenarios for nuclear accidents worldwide, provides valuable insight to facilitate emergency preparedness and response. The probability of the plume arriving at numerous regions within the country was calculated, along with the maximum dose rates in case of transport. A risk assessment was performed, and geographical regions were prioritized in terms of risk-based environmental radioactivity burden. A total of 29 administrative districts were identified as low to medium-risk regions. Acquired results were used to determine the optimal spatial distribution of detectors for upgrading the existing monitoring network of environmental radioactivity.
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Affiliation(s)
- N Salpadimos
- Greek Atomic Energy Commission (EEAE), Greece; Medical School, National and Kapodistrian University of Athens, Greece.
| | | | - I Seimenis
- Medical School, National and Kapodistrian University of Athens, Greece
| | | | - E Carinou
- Greek Atomic Energy Commission (EEAE), Greece
| | - C Housiadas
- Greek Atomic Energy Commission (EEAE), Greece
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8
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Panagiotopoulou EK, Boboridis K, Seimenis I, Labiris G. Impact of Light Conditions on Visual Performance following Premium Pseudophakic Presbyopia Corrections. J Clin Med 2023; 12:4324. [PMID: 37445358 DOI: 10.3390/jcm12134324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/13/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
The primary objective of this study was to objectively compare the visual performance of patients following premium pseudophakic presbyopia corrections in different light combinations for near- and intermediate-vision activities of daily living (ADLs). This is a prospective, comparative study. A total of 75 patients populated three study groups: G1-patients with bilateral trifocal implantation, G2-patients with bilateral bifocal implantation, and G3-patients with bilateral monofocal implantation. All participants addressed 10 ADLs in nine combinations of light temperature (3000 K, 4000 K, and 6000 K) and light intensity (25 fc, 50 fc, and 75 fc) and declared their subjectively optimal light combination while reading. G2 and G3 had the best total ADL scores in 6000 K/75 fc, while G1 had the best total ADL score in 4000 K/75 fc. Total ADL, easy ADL, and moderate difficulty ADL scores were significantly better in G2, while difficult ADL score was significantly better in G1. The majority of all groups selected 6000 K/75 fc as the most comfortable light combination, and no group selected 3000 K and 25 fc. In conclusion, trifocal patients benefit from intense daylight, while bifocal and monofocal patients benefit from intense, cold lighting. Trifocal patients present superior near-vision capacity in difficult near-vision daily tasks, while bifocal patients present superiority in easy and moderate-difficulty ADLs.
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Affiliation(s)
| | - Kostas Boboridis
- Ophthalmology Department, AHEPA University Hospital, 54636 Thessaloniki, Greece
| | - Ioannis Seimenis
- Medical Physics Laboratory, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Georgios Labiris
- Department of Ophthalmology, University Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece
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Karnachoriti M, Stathopoulos I, Kouri M, Spyratou E, Orfanoudakis S, Lykidis D, Lambropoulou Μ, Danias N, Arkadopoulos N, Efstathopoulos EP, Raptis YS, Seimenis I, Kontos AG. Biochemical differentiation between cancerous and normal human colorectal tissues by micro-Raman spectroscopy. Spectrochim Acta A Mol Biomol Spectrosc 2023; 299:122852. [PMID: 37216817 DOI: 10.1016/j.saa.2023.122852] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/29/2023] [Accepted: 05/08/2023] [Indexed: 05/24/2023]
Abstract
Human colorectal tissues obtained by ten cancer patients have been examined by multiple micro-Raman spectroscopic measurements in the 500-3200 cm-1 range under 785 nm excitation. Distinct spectral profiles are recorded from different spots on the samples: a predominant 'typical' profile of colorectal tissue, as well as those from tissue topologies with high lipid, blood or collagen content. Principal component analysis identified several Raman bands of amino acids, proteins and lipids which allow the efficient discrimination of normal from cancer tissues, the first presenting plurality of Raman spectral profiles while the last showing off quite uniform spectroscopic characteristics. Tree-based machine learning experiment was further applied on all data as well as on filtered data keeping only those spectra which characterize the largely inseparable data clusters of 'typical' and 'collagen-rich' spectra. This purposive sampling evidences statistically the most significant spectroscopic features regarding the correct identification of cancer tissues and allows matching spectroscopic results with the biochemical changes induced in the malignant tissues.
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Affiliation(s)
- M Karnachoriti
- School of Applied Mathematical and Physical Sciences, National Technical University Athens, 15780 Zografou, Athens, Greece; Department of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - I Stathopoulos
- 2(nd) Department of Radiology, Medical School, National & Kapodistrian University of Athens, 15772 Athens, Greece
| | - M Kouri
- Department of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; 2(nd) Department of Radiology, Medical School, National & Kapodistrian University of Athens, 15772 Athens, Greece; Medical Physics Program, University of Massachusetts Lowell, MA 01854, United States
| | - E Spyratou
- Department of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; 2(nd) Department of Radiology, Medical School, National & Kapodistrian University of Athens, 15772 Athens, Greece
| | - S Orfanoudakis
- School of Applied Mathematical and Physical Sciences, National Technical University Athens, 15780 Zografou, Athens, Greece; Alpha Information Technology S.A., Software & System Development, 68131 Alexandroupolis, Greece
| | - D Lykidis
- Laboratory of Histology-Embryology, Medical Department, Democritus University of Thrace, Alexandroupolis, Greece
| | - Μ Lambropoulou
- Laboratory of Histology-Embryology, Medical Department, Democritus University of Thrace, Alexandroupolis, Greece
| | - N Danias
- 4(th) Department of Surgery, School of Medicine, Attikon University Hospital, Univ. of Athens, 12462 Athens, Greece
| | - N Arkadopoulos
- 4(th) Department of Surgery, School of Medicine, Attikon University Hospital, Univ. of Athens, 12462 Athens, Greece
| | - E P Efstathopoulos
- 2(nd) Department of Radiology, Medical School, National & Kapodistrian University of Athens, 15772 Athens, Greece
| | - Y S Raptis
- School of Applied Mathematical and Physical Sciences, National Technical University Athens, 15780 Zografou, Athens, Greece
| | - I Seimenis
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - A G Kontos
- School of Applied Mathematical and Physical Sciences, National Technical University Athens, 15780 Zografou, Athens, Greece.
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Argyropoulos GD, Christidi F, Karavasilis E, Bede P, Antoniou A, Velonakis G, Seimenis I, Kelekis N, Smyrnis N, Papakonstantinou O, Efstathopoulos E, Ferentinos P. Predominant polarity as a neurobiological specifier in bipolar disorder: Evidence from a multimodal neuroimaging study. Prog Neuropsychopharmacol Biol Psychiatry 2023; 123:110718. [PMID: 36634808 DOI: 10.1016/j.pnpbp.2023.110718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 11/28/2022] [Accepted: 01/06/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND While predominant (PP) and onset polarity (OP) have considerable clinical and treatment implications in bipolar disorder (BD), the neurobiological underpinnings of PP and OP from a radiological perspective remain largely unknown. The main objective of this study is to investigate the neuroanatomical profile of polarity subphenotypes (PP and OP) in euthymic BD patients, using a standardized multimodal neuroimaging protocol to evaluate regional gray matter (GM) volumes, cortical thickness, as well as white matter (WM) integrity of major projection, commissural and association tracts. METHODS Forty-two euthymic BD patients stratified for PP and OP and 42 healthy controls (HC) were included in this computational neuroimaging study to comprehensively characterize gray and white matter alterations. Univariate analyses of covariance (ANCOVAs) were conducted with Bonferroni corrections for each MRI modality and Cohen's d effect sizes were calculated for group comparisons. RESULTS Phenotype-associated cortical thickness abnormalities and volumetric alterations were identified, but no WM changes ascertained. Specifically, we found a main effect of OP on GM volume of left middle frontal gyrus and of OP and PP (either or both) on cortical thickness of various regions previously implicated in BD, i.e. inferior frontal gyrus-pars opercularis (left) and pars orbitalis (bilateral), left lateral orbitofrontal gyrus, bilateral medial segment of the superior frontal gyrus, left planum polare, right anterior cingulate gyrus, left anterior and posterior insula, bilateral frontal operculum (both OP and PP); left anterior and posterior orbitofrontal gyrus, left transverse temporal gyrus, right posterior insula (only OP); and right medial frontal cortex (only PP). Based on the magnitude of differences on pairwise comparisons, we found a large effect of OP on cortical thickness in a single region (left anterior orbitofrontal gyrus) (OP-M > OP-D), while PP subgroups showed large or medium effect size differences in cortical thickness (PP-M > PP-D) in a wider array of regions (right medial frontal cortex, left frontal operculum, left inferior frontal gyrus-pars opercularis, bilateral medial segment of the superior frontal gyrus). For most regions, PP-D patients showed the greatest decreases in cortical thickness compared to HC while PP-M showed the smallest, with PP-U showing an "unspecified" pattern mostly lying in-between PP-D and PP-M. CONCLUSIONS Our multimodal imaging findings suggest specific polarity BD subgroups with compromised cortical thickness; we recorded a greater impact of PP on brain structure compared to OP, which provides additional evidence that PP can be considered as a neurobiological specifier in BD.
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Affiliation(s)
- Georgios D Argyropoulos
- Research Unit of Radiology and Medical Imaging, 2nd Department of Radiology, Attikon General University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Foteini Christidi
- 2nd Department of Psychiatry, Attikon General University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; Medical Physics Laboratory, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - Efstratios Karavasilis
- Research Unit of Radiology and Medical Imaging, 2nd Department of Radiology, Attikon General University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Peter Bede
- Department of Neurology, St James's Hospital, Dublin, Ireland; Computational Neuroimaging Group, Trinity College Dublin, Ireland
| | - Anastasia Antoniou
- 2nd Department of Psychiatry, Attikon General University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Velonakis
- Research Unit of Radiology and Medical Imaging, 2nd Department of Radiology, Attikon General University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Seimenis
- Medical Physics Laboratory, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kelekis
- Research Unit of Radiology and Medical Imaging, 2nd Department of Radiology, Attikon General University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Smyrnis
- 2nd Department of Psychiatry, Attikon General University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Olympia Papakonstantinou
- Research Unit of Radiology and Medical Imaging, 2nd Department of Radiology, Attikon General University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstathios Efstathopoulos
- Research Unit of Radiology and Medical Imaging, 2nd Department of Radiology, Attikon General University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Ferentinos
- 2nd Department of Psychiatry, Attikon General University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Sharma R, Tsiamyrtzis P, Webb A, Seimenis I, Loukas C, Leiss E, Tsekos N. DEEP LEARNING IN UPSCALING LOW QUALITY MR IMAGES: A COMPARISON STUDY OF THREE UNET ARCHITECTURES WITH AND WITHOUT PRIOR EMPLOYMENT. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)03169-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Papadogiannis P, Karavasilis E, Papathanasiou M, Seimenis I, Efstathopoulos E. MRI TEXTURE ANALYSIS AS A TOOL FOR DIAGNOSIS, ASSESSMENT AND MONITORING OF MULTIPLE SCLEROSIS. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)03153-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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13
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Dimakopoulou A, Karnachoriti M, Spyratou E, Seimenis I, Venetis S, Lambropoulou M, Efstathopoulos E, Kontos A. RAMAN SPECTRA OF HUMAN COLORECTAL TISSUES BY VARYING THE EXCITATION WAVELENGTHS FROM 514 NM TO 785 NM: DEFINING THE OPTIMUM LASER LINES FOR CANCER DETECTION. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)03150-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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14
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Archontakis P, Papagiannis P, Seimenis I, Pantelis E. OPTIMIZATION OF THE IMAGING DOSE IN CYBERKNIFE CLINICAL APPLICATIONS. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)03037-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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15
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Avgoullas K, Ploussi A, Papagiannis I, Avramidis D, Tsoutsinos A, Maragou A, Efstathopoulos E, Seimenis I. EVALUATION OF ORGAN AND EFFECTIVE DOSES DURING PEDIATRIC RADIOFREQUENCY ABLATIONS USING DIFFERENT COMPUTATIONAL TOOLS. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)03114-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Velonis M, Koutchouras P, Papavasileiou P, Papanastasiou E, Zapros A, Hatziioannou K, Emfietzoglou D, Seimenis I. CHARACTERISTICS OF GAFCHROMIC XR-SP2 SELF-DEVELOPING FILMS FOR QUALITY ASSURANCE MEASUREMENTS IN KV IMAGING. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)03045-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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17
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Velonis M, Papavasileiou P, Papanastasiou E, Zapros A, Hatziioannou K, Seimenis I. CBCT DOSE ESTIMATION IN IMAGE GUIDED RADIOTHERAPY: A MONTE-CARLO STUDY. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)03100-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Koumatzidis D, Seimenis I, Constantinidis T, Adamopoulos A. CYCLIC RECURRENCE, QUARANTINE AND VACCINATION POLICIES IN EPIDEMIOLOGY MATHEMATICAL MODELS. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)03157-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Theocharis S, Pappas E, Seimenis I, Petrokokkinos L, Dellios D, Paraskevopoulou C, Kollias G, Karaiskos P. PHANTOM-BASED DISTORTION EVALUATION IN 3T T2-WEIGHTED MR IMAGES FOR CRANIAL STEREOTACTIC RADIOSURGERY AND RADIOTHERAPY TREATMENT PLANNING. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)03190-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Avgoullas K, Ploussi A, Papagiannis I, Avramidis D, Tsoutsinos A, Maragou A, Efstathopoulos E, Seimenis I. EFFECTIVE DOSE AND CANCER RISK ESTIMATION IN PEDIATRIC PATIENTS UNDERGOING RADIOFREQUENCY CATHETER ABLATION FOR SUPRAVENTRICULAR TACHYCARDIA TREATMENT. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)03113-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Karnachoriti M, Spyratou E, Orphanoudakis S, Lambropoulou M, Seimenis I, Efstathopoulos E, Raptis Y, Kontos A. RAMAN SCATTERING AS A TOOL FOR DIAGNOSIS OF COLORECTAL CANCER CURRENT STATUS AND PRACTICAL EXPERIMENTAL SOLUTIONS. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)03018-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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22
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Kouri M, Spyratou E, Benetis S, Seimenis I, Kontos A, Lambropoulou M, Efstathopoulos E. ADVANCED RAMAN SPECTROSCOPY: A ‘‘GUIDING LIGHT’’ TOWARDS CANCER DIAGNOSIS AND SURGERY. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)03017-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Gkotsis D, Vlachopoulou A, Dimos K, Despotopoulos E, Kapsalaki E, Seimenis I. EFFECTIVE AND TIME-EFFICIENT IN VIVO 1H-MRS IN NEURO-ONCOLOGY: A PRACTICAL GUIDE FOR NON-EXPERTS. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)03061-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Ntonti P, Bakirtzis M, Delibasis K, Seimenis I, Tsinopoulos I, Labiris G. Impact of personality on the decision process and on satisfaction rates in pseudophakic presbyopic correction. J Cataract Refract Surg 2022; 48:1433-1439. [PMID: 35862830 DOI: 10.1097/j.jcrs.0000000000001021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/19/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To explore the impact of personality on the decision process and satisfaction rates in pseudophakic presbyopic correction. SETTING Department of Ophthalmology, University Hospital of Alexandroupolis, Greece. DESIGN Prospective, comparative study. METHODS A consistent consultation was conducted in patients with cataract that explained the benefits and the drawbacks of bilateral trifocal correction, which was offered at no extra cost. In all participants, personality was evaluated by The Traits Personality Questionnaire 5. Data modeling with decision trees and multiple regression analysis identified the contributions of personality traits to the decision process and postoperative satisfaction. RESULTS Of 120 participants (60 men and 60 women), 81 (67.5%, 24 men, 57 women) selected premium correction. In men, low neuroticism and high extraversion were the primary personality contributors for selecting premium surgery. In women, all personality traits contributed to the selection process. Women were more demanding in the expected postoperative distant acuity than men (0.1 vs 0.2 logMAR) to present high satisfaction. For both men and women, openness to experience, conscientiousness, and extraversion are primary contributors for optimal satisfaction rates. CONCLUSIONS Men and women demonstrate differences in the selection process for premium pseudophakic surgery and differences in the expected postoperative visual acuity. It seems that the personality of the patient plays a significant role in the perceived outcome after premium surgery.
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Affiliation(s)
- Panagiota Ntonti
- From the Department of Ophthalmology, University Hospital of Alexandroupolis, Alexandroupolis, Greece (Ntonti, Bakirtzis, Labiris); Department of Computer Science and Biomedical Informatics, University of Thessaly, Lamia, Greece (Delibasis); Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece (Seimenis); Second Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece (Tsinopoulos)
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Abissi P, Lymperopoulou G, Koutoulidis V, Grigoropoulos P, Papagiannis P, Seimenis I, Fiebich M, Agrokostas V. EVALUATION OF RADIATION BURDEN AND ASSOCIATED RISK IN SMOLDERING MULTIPLE MYELOMA PATIENTS MONITORED USING REPEATED CT IMAGING. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)03047-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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26
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Christidi F, Tsiptsios D, Fotiadou A, Kitmeridou S, Karatzetzou S, Tsamakis K, Sousanidou A, Psatha EA, Karavasilis E, Seimenis I, Kokkotis C, Aggelousis N, Vadikolias K. Diffusion Tensor Imaging as a Prognostic Tool for Recovery in Acute and Hyperacute Stroke. Neurol Int 2022; 14:841-874. [PMID: 36278693 PMCID: PMC9589952 DOI: 10.3390/neurolint14040069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/17/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022] Open
Abstract
Stroke represents a major cause of mortality and long-term disability among adult populations, leaving a devastating socioeconomic impact globally. Clinical manifestation of stroke is characterized by great diversity, ranging from minor disability to considerable neurological impairment interfering with activities of daily living and even death. Prognostic ambiguity has stimulated the interest for implementing stroke recovery biomarkers, including those provided by structural neuroimaging techniques, i.e., diffusion tensor imaging (DTI) and tractography for the study of white matter (WM) integrity. Considering the necessity of prompt and accurate prognosis in stroke survivors along with the potential capacity of DTI as a relevant imaging biomarker, the purpose of our study was to review the pertinent literature published within the last decade regarding DTI as a prognostic tool for recovery in acute and hyperacute stroke. We conducted a thorough literature search in two databases (MEDLINE and Science Direct) in order to trace all relevant studies published between 1 January 2012 and 16 March 2022 using predefined terms as key words. Only full-text human studies published in the English language were included. Forty-four studies were identified and are included in this review. We present main findings and by describing several methodological issues, we highlight shortcomings and gaps in the current literature so that research priorities for future research can be outlined. Our review suggests that DTI can track longitudinal changes and identify prognostic correlates in acute and hyperacute stroke patients.
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Affiliation(s)
- Foteini Christidi
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Dimitrios Tsiptsios
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Aggeliki Fotiadou
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Sofia Kitmeridou
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Stella Karatzetzou
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Konstantinos Tsamakis
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London SE5 8AB, UK
| | - Anastasia Sousanidou
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Evlampia A. Psatha
- Department of Radiology, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | | | - Ioannis Seimenis
- Medical Physics Laboratory, School of Medicine, National and Kapodistrian University, 11527 Athens, Greece
| | - Christos Kokkotis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece
| | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece
| | - Konstantinos Vadikolias
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
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Archontakis P, Moutsatsos A, Papagiannis P, Seimenis I, Pantelis E. Spatial distribution of the imaging dose and characterization of the scatter radiation contribution in CyberKnife radiosurgery. Phys Med 2022; 103:11-17. [PMID: 36183580 DOI: 10.1016/j.ejmp.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 07/07/2022] [Accepted: 09/26/2022] [Indexed: 10/31/2022] Open
Abstract
PURPOSE The imaging dose for intra- and extra-cranial CyberKnife radiosurgery applications was calculated and the scattered radiation reaching the digital detectors was quantified and analyzed with regard to its origin. METHODS The image guidance subsystem of the CyberKnife was modeled based on vendor-provided information. The emitted X-ray energy spectrum for 120 kV was estimated using the SpekPy software tool. Monte Carlo (MC) image acquisition simulations were performed to calculate the total, primary and scattered photon fluences reaching each detector as a function of the imaged object dimensions. MC calculations of the imaging dose were performed for intra- and extra-cranial applications assuming 120 kV and 10 mAs acquisition settings. RESULTS The amount of scattered radiation reaching each detector was found to depend on the dimensions of the imaged anatomical region, contributing more than 40 % to the total photon fluence for regions more than 20 cm thick. More than 20 % of this scattered radiation originates from the contralateral imaging field. A maximum organ dose of 1.5 mGy at the nasal bones and an average dose of 0.37 mGy to the eye lenses per image pair acquisition was calculated for head applications. An entrance imaging dose of 0.4 mGy was calculated for extracranial applications. CONCLUSIONS Scattered radiation reaching each detector in the skull and spine tracking applications can be reduced by acquiring the pair of radiographs sequentially instead of simultaneously. A dose of 3.7 cGy to the eye lenses is estimated assuming 100 image pair exposures required for treatment completion.
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Affiliation(s)
- Panagiotis Archontakis
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias, 11527 Athens, Greece
| | - Argyris Moutsatsos
- Radiotherapy and Radiosurgery Department, Iatropolis Clinic, 54-56 Ethnikis Antistaseos, 15231 Athens, Greece
| | - Panagiotis Papagiannis
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias, 11527 Athens, Greece
| | - Ioannis Seimenis
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias, 11527 Athens, Greece
| | - Evaggelos Pantelis
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias, 11527 Athens, Greece; Radiotherapy and Radiosurgery Department, Iatropolis Clinic, 54-56 Ethnikis Antistaseos, 15231 Athens, Greece.
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Spyratou E, Ploussi A, Alafogiannis P, Katifelis H, Apostolopoulou S, Bagenakis G, Rammos S, Papagiannis I, Gazouli M, Seimenis I, Georgakilas AG, Efstathopoulos EP. FDXR Gene Expression after in Vivo Radiation Exposure of Pediatric Patients Undergoing Interventional Cardiology Procedures. FRONT BIOSCI-LANDMRK 2022; 27:255. [PMID: 36224003 DOI: 10.31083/j.fbl2709255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 09/11/2023]
Abstract
BACKGROUND Ferredoxin reductase (FDXR) has already been reported as a promising biomarker for estimating radiation doses in radiotherapy. This study aimed to investigate the responsiveness of FDXR on pediatric population exposed to ionizing radiation (X-rays) during pediatric interventional cardiology (IC) procedures. PATIENTS AND METHODS Peripheral blood was collected by venipuncture from 24 pediatric donors before and 24 hours after the IC procedure. To estimate the effective dose, demographic data and Air Kerma-Area Product (PKA) were recorded for each patient. The relative quantification (RQ) of the FDXR gene in irradiated patient blood samples compared to the non-irradiated blood samples was determined using qPCR analysis. The relative values of FDXR were log- transformed. RESULTS The effective dose ranged from 0.002 mSv to 8.004 mSv. Over this radiation exposure range, the FDXR gene expression varied randomly with the effective dose. Up-regulation in FDXR expression was observed in 17 patients and down-regulation in 7 patients. CONCLUSIONS Further studies in a larger cohort of pediatric patients along with the record of clinical data are needed to determine whether FDXR gene expression is an effective biomarker for radiation exposure estimation in pediatric imaging.
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Affiliation(s)
- Ellas Spyratou
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Agapi Ploussi
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Panagiotis Alafogiannis
- Physics Department, School of Applied Mathematical and Physical Sciences, National Technical University of Athens, 15780 Zografou, Athens, Greece
| | - Hector Katifelis
- Department of Basic Medical Sciences, Laboratory of Biology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Sotiria Apostolopoulou
- Paediatric Cardiology and Adult with Congenital Heart Disease Department, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Georgios Bagenakis
- Paediatric Cardiology and Adult with Congenital Heart Disease Department, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Spyridon Rammos
- Paediatric Cardiology and Adult with Congenital Heart Disease Department, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Ioannis Papagiannis
- Paediatric Cardiology and Adult with Congenital Heart Disease Department, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Maria Gazouli
- Department of Basic Medical Sciences, Laboratory of Biology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Department of Medical Physics, Medical School, National and Kapodistrian University, 11527 Athens, Greece
- Department of Sciences, Hellenic Open University, 26335 Patra, Greece
| | - Ioannis Seimenis
- Department of Medical Physics, Medical School, National and Kapodistrian University, 11527 Athens, Greece
| | - Alexandros G Georgakilas
- DNA Damage Laboratory, Department of Physics, School of Applied Mathematical and Physical Sciences, Zografou Campus, National Technical University of Athens (NTUA), 15780 Athens, Greece
| | - Efstathios P Efstathopoulos
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Department of Sciences, Hellenic Open University, 26335 Patra, Greece
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Theocharis S, Pappas EP, Seimenis I, Kouris P, Dellios D, Kollias G, Karaiskos P. Geometric distortion assessment in 3T MR images used for treatment planning in cranial Stereotactic Radiosurgery and Radiotherapy. PLoS One 2022; 17:e0268925. [PMID: 35605005 PMCID: PMC9126373 DOI: 10.1371/journal.pone.0268925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/10/2022] [Indexed: 12/31/2022] Open
Abstract
Magnetic Resonance images (MRIs) are employed in brain Stereotactic Radiosurgery and Radiotherapy (SRS/SRT) for target and/or critical organ localization and delineation. However, MRIs are inherently distorted, which also impacts the accuracy of the Magnetic Resonance Imaging/Computed Tomography (MRI/CT) co-registration process. In this phantom-based study, geometric distortion is assessed in 3T T2-weighted images (T2WIs), while the efficacy of an MRI distortion correction technique is also evaluated. A homogeneous polymer gel-filled phantom was CT-imaged before being irradiated with 26 4-mm Gamma Knife shots at predefined locations (reference control points). The irradiated phantom was MRI-scanned at 3T, implementing a T2-weighted protocol suitable for SRS/SRT treatment planning. The centers of mass of all shots were identified in the 3D image space by implementing an iterative localization algorithm and served as the evaluated control points for MRI distortion detection. MRIs and CT images were spatially co-registered using a mutual information algorithm. The inverse transformation matrix was applied to the reference control points and compared with the corresponding MRI-identified ones to evaluate the overall spatial accuracy of the MRI/CT dataset. The mean image distortion correction technique was implemented, and resulting MRI-corrected control points were compared against the corresponding reference ones. For the scanning parameters used, increased MRI distortion (>1mm) was detected at areas distant from the MRI isocenter (>5cm), while median radial distortion was 0.76mm. Detected offsets were slightly higher for the MRI/CT dataset (0.92mm median distortion). The mean image distortion correction improves geometric accuracy, but residual distortion cannot be considered negligible (0.51mm median distortion). For all three datasets studied, a statistically significant positive correlation between detected spatial offsets and their distance from the MRI isocenter was revealed. This work contributes towards the wider adoption of 3T imaging in SRS/SRT treatment planning. The presented methodology can be employed in commissioning and quality assurance programmes of corresponding treatment workflows.
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Affiliation(s)
- Stefanos Theocharis
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftherios P. Pappas
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Seimenis
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Kouris
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Dellios
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Kollias
- Medical Physics and Gamma Knife Department, Hygeia Hospital, Marousi, Greece
| | - Pantelis Karaiskos
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- * E-mail:
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Archontakis P, Papagiannis P, Seimenis I, Pantelis E. PO-1536 Imaging dose distributions from CyberKnife robotic image guided radiotherapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03500-9] [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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Christidi F, Karavasilis E, Argyropoulos GD, Velonakis G, Zouvelou V, Murad A, Evdokimidis I, Rentzos M, Seimenis I, Bede P. Neurometabolic Alterations in Motor Neuron Disease: Insights from Magnetic Resonance Spectroscopy. J Integr Neurosci 2022; 21:87. [DOI: 10.31083/j.jin2103087] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/30/2022] [Accepted: 04/15/2022] [Indexed: 11/06/2022] Open
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Koutoulidis V, Terpos E, Papanikolaou N, Fontara S, Seimenis I, Gavriatopoulou M, Ntanasis-Stathopoulos I, Bourgioti C, Santinha J, Moreira JM, Kastritis E, Dimopoulos MA, Moulopoulos LA. Comparison of MRI Features of Fat Fraction and ADC for Early Treatment Response Assessment in Participants with Multiple Myeloma. Radiology 2022; 304:137-144. [PMID: 35380497 DOI: 10.1148/radiol.211388] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background An imaging-based predictor of response could provide prognostic information early during treatment course in patients with multiple myeloma (MM). Purpose To investigate if very early changes in bone marrow relative fat fraction (rFF) and apparent diffusion coefficient (ADC) histogram metrics, occurring after one cycle of induction therapy in participants with newly diagnosed MM, could help predict overall best response status. Materials and Methods This prospective study included participants with MM who were enrolled between August 2014 and December 2017. Histogram metrics were extracted from ADC and rFF maps from MRI examinations performed before treatment and after the first treatment cycle. Participants were categorized into the very good partial response (VGPR) or better group and the less than VGPR group per the International Myeloma Working Group response criteria. ADC and rFF map metrics for predicting treatment response were compared using the Wilcoxon rank test, and the false discovery rate (FDR) was used to correct for multiple comparisons. Results A total of 23 participants (mean age, 65 years ± 11 [SD]; 13 men) were evaluated. There was no evidence of a difference in ADC metrics between the two responder groups after correcting for multiple comparisons. The rFF histogram changes between pretreatment MRI and MRI after the first treatment cycle (ΔrFF) that provided significant differences between the VGPR or better and less than VGPR groups were as follows: ΔrFF_10th Percentile (median, 0.5 [95% CI: 0, 1] vs -2.5 [95% CI: -5.1, 0.1], respectively), ΔrFF_90th Percentile (median, 2 [95% CI: 1, 6.8] vs -0.5 [95% CI: -1, 0]), ΔrFF_Mean (median, 3.4 [95% CI: 0.3, 7.6] vs -1.1 [95% CI: -1.8, -0.7]), and ΔrFF_Root Mean Squared (median, 3.2 [95% CI: 0.3, 6.1] vs -0.7 [95% CI: -1.3, -0.4]) (FDR-adjusted P = .03 for all), and the latter two also presented mean group increases in the VGPR or better group that were above the upper 95% CI limit for repeatability. Conclusion Very early changes in bone marrow relative fat fraction histogram metrics, calculated from MRI examination at baseline and after only one cycle of induction therapy, may help to predict very good partial response or better in participants with newly diagnosed multiple myeloma. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Vassilis Koutoulidis
- From the 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76 Vas. Sophias Ave, 11528 Athens, Greece (V.K., S.F., C.B., L.A.M.); Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (E.T., M.G., I.N.S., E.K., M.A.D.); Computational Clinical Imaging Group, Center for the Unknown, Champalimaud Foundation, Lisbon, Portugal (N.P., J.S., J.M.M.); and Department of Medical Physics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (I.S.)
| | - Evangelos Terpos
- From the 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76 Vas. Sophias Ave, 11528 Athens, Greece (V.K., S.F., C.B., L.A.M.); Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (E.T., M.G., I.N.S., E.K., M.A.D.); Computational Clinical Imaging Group, Center for the Unknown, Champalimaud Foundation, Lisbon, Portugal (N.P., J.S., J.M.M.); and Department of Medical Physics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (I.S.)
| | - Nikolaos Papanikolaou
- From the 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76 Vas. Sophias Ave, 11528 Athens, Greece (V.K., S.F., C.B., L.A.M.); Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (E.T., M.G., I.N.S., E.K., M.A.D.); Computational Clinical Imaging Group, Center for the Unknown, Champalimaud Foundation, Lisbon, Portugal (N.P., J.S., J.M.M.); and Department of Medical Physics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (I.S.)
| | - Sophia Fontara
- From the 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76 Vas. Sophias Ave, 11528 Athens, Greece (V.K., S.F., C.B., L.A.M.); Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (E.T., M.G., I.N.S., E.K., M.A.D.); Computational Clinical Imaging Group, Center for the Unknown, Champalimaud Foundation, Lisbon, Portugal (N.P., J.S., J.M.M.); and Department of Medical Physics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (I.S.)
| | - Ioannis Seimenis
- From the 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76 Vas. Sophias Ave, 11528 Athens, Greece (V.K., S.F., C.B., L.A.M.); Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (E.T., M.G., I.N.S., E.K., M.A.D.); Computational Clinical Imaging Group, Center for the Unknown, Champalimaud Foundation, Lisbon, Portugal (N.P., J.S., J.M.M.); and Department of Medical Physics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (I.S.)
| | - Maria Gavriatopoulou
- From the 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76 Vas. Sophias Ave, 11528 Athens, Greece (V.K., S.F., C.B., L.A.M.); Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (E.T., M.G., I.N.S., E.K., M.A.D.); Computational Clinical Imaging Group, Center for the Unknown, Champalimaud Foundation, Lisbon, Portugal (N.P., J.S., J.M.M.); and Department of Medical Physics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (I.S.)
| | - Ioannis Ntanasis-Stathopoulos
- From the 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76 Vas. Sophias Ave, 11528 Athens, Greece (V.K., S.F., C.B., L.A.M.); Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (E.T., M.G., I.N.S., E.K., M.A.D.); Computational Clinical Imaging Group, Center for the Unknown, Champalimaud Foundation, Lisbon, Portugal (N.P., J.S., J.M.M.); and Department of Medical Physics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (I.S.)
| | - Charis Bourgioti
- From the 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76 Vas. Sophias Ave, 11528 Athens, Greece (V.K., S.F., C.B., L.A.M.); Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (E.T., M.G., I.N.S., E.K., M.A.D.); Computational Clinical Imaging Group, Center for the Unknown, Champalimaud Foundation, Lisbon, Portugal (N.P., J.S., J.M.M.); and Department of Medical Physics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (I.S.)
| | - João Santinha
- From the 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76 Vas. Sophias Ave, 11528 Athens, Greece (V.K., S.F., C.B., L.A.M.); Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (E.T., M.G., I.N.S., E.K., M.A.D.); Computational Clinical Imaging Group, Center for the Unknown, Champalimaud Foundation, Lisbon, Portugal (N.P., J.S., J.M.M.); and Department of Medical Physics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (I.S.)
| | - José Maria Moreira
- From the 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76 Vas. Sophias Ave, 11528 Athens, Greece (V.K., S.F., C.B., L.A.M.); Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (E.T., M.G., I.N.S., E.K., M.A.D.); Computational Clinical Imaging Group, Center for the Unknown, Champalimaud Foundation, Lisbon, Portugal (N.P., J.S., J.M.M.); and Department of Medical Physics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (I.S.)
| | - Efstathios Kastritis
- From the 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76 Vas. Sophias Ave, 11528 Athens, Greece (V.K., S.F., C.B., L.A.M.); Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (E.T., M.G., I.N.S., E.K., M.A.D.); Computational Clinical Imaging Group, Center for the Unknown, Champalimaud Foundation, Lisbon, Portugal (N.P., J.S., J.M.M.); and Department of Medical Physics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (I.S.)
| | - Meletios A Dimopoulos
- From the 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76 Vas. Sophias Ave, 11528 Athens, Greece (V.K., S.F., C.B., L.A.M.); Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (E.T., M.G., I.N.S., E.K., M.A.D.); Computational Clinical Imaging Group, Center for the Unknown, Champalimaud Foundation, Lisbon, Portugal (N.P., J.S., J.M.M.); and Department of Medical Physics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (I.S.)
| | - Lia A Moulopoulos
- From the 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76 Vas. Sophias Ave, 11528 Athens, Greece (V.K., S.F., C.B., L.A.M.); Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (E.T., M.G., I.N.S., E.K., M.A.D.); Computational Clinical Imaging Group, Center for the Unknown, Champalimaud Foundation, Lisbon, Portugal (N.P., J.S., J.M.M.); and Department of Medical Physics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (I.S.)
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Pappas EP, Seimenis I, Kouris P, Theocharis S, Lampropoulos KI, Kollias G, Karaiskos P. Target localization accuracy in frame‐based stereotactic radiosurgery: Comparison between MR‐only and MR/CT co‐registration approaches. J Appl Clin Med Phys 2022; 23:e13580. [PMID: 35285583 PMCID: PMC9121047 DOI: 10.1002/acm2.13580] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose In frame‐based Gamma Knife (GK) stereotactic radiosurgery two treatment planning workflows are commonly employed; one based solely on magnetic resonance (MR) images and the other based on magnetic resonance/computed tomography (MR/CT) co‐registered images. In both workflows, target localization accuracy (TLA) can be deteriorated due to MR‐related geometric distortions and/or MR/CT co‐registration uncertainties. In this study, the overall TLA following both clinical workflows is evaluated for cases of multiple brain metastases. Methods A polymer gel‐filled head phantom, having the Leksell stereotactic headframe attached, was CT‐imaged and irradiated by a GK Perfexion unit. A total of 26 4‐mm shots were delivered at 26 locations directly defined in the Leksell stereotactic space (LSS), inducing adequate contrast in corresponding T2‐weighted (T2w) MR images. Prescribed shot coordinates served as reference locations. An additional MR scan was acquired to implement the “mean image” distortion correction technique. The TLA for each workflow was assessed by comparing the radiation‐induced target locations, identified in MR images, with corresponding reference locations. Using T1w MR and CT images of 15 patients (totaling 81 lesions), TLA in clinical cases was similarly assessed, considering MR‐corrected data as reference. For the MR/CT workflow, both global and region of interest (ROI)‐based MR/CT registration approaches were studied. Results In phantom measurements, the MR‐corrected workflow demonstrated unsurpassed TLA (median offset of 0.2 mm) which deteriorated for MR‐only and MR/CT workflows (median offsets of 0.8 and 0.6 mm, respectively). In real‐patient cases, the MR‐only workflow resulted in offsets that exhibit a significant positive correlation with the distance from the MR isocenter, reaching 1.1 mm (median 0.6 mm). Comparable results were obtained for the MR/CT‐global workflow, although a maximum offset of 1.4 mm was detected. TLA was improved with the MR/CT‐ROI workflow resulting in median/maximum offsets of 0.4 mm/1.1 mm. Conclusions Subpixel TLA is achievable in all workflows. For the MR/CT workflow, a ROI‐based MR/CT co‐registration approach could considerably increase TLA and should be preferred instead of a global registration.
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Affiliation(s)
- Eleftherios P. Pappas
- Medical Physics Laboratory Medical School National and Kapodistrian University of Athens Athens Greece
| | - Ioannis Seimenis
- Medical Physics Laboratory Medical School National and Kapodistrian University of Athens Athens Greece
| | - Panagiotis Kouris
- Medical Physics Laboratory Medical School National and Kapodistrian University of Athens Athens Greece
| | - Stefanos Theocharis
- Medical Physics Laboratory Medical School National and Kapodistrian University of Athens Athens Greece
| | | | - Georgios Kollias
- Medical Physics and Gamma Knife Department Hygeia Hospital Marousi Greece
| | - Pantelis Karaiskos
- Medical Physics Laboratory Medical School National and Kapodistrian University of Athens Athens Greece
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Velonis M, Papanastasiou E, Hatziioannou K, Siountas A, Kamperis E, Papavasileiou P, Seimenis I. Dose optimisation of 2D x-ray image acquisition protocols in image-guided radiotherapy. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00402-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Pappas E, Seimenis I, Kouris P, Lampropoulos K, Karaiskos P. Stereotactic radiosurgery for multiple brain metastases: does MR/CT co-registration improve target localization accuracy compared to the MR-only approach? Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00374-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Dellios D, Seimenis I, Pappas E, Karaiskos P, Kollias G. Evaluation of MR image correction schemes for accurate lesion localization in intracranial stereotactic radiosurgery. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00132-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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37
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Busoni S, Bock M, Chmelik M, Colgan N, De Bondt T, Hanson LG, Israel M, Kugel H, Maieron M, Mazzoni LN, Seimenis I, Vestergaard P. ADDENDUM to EFOMP Policy statement No.14 "The role of the Medical Physicist in the management of safety within the magnetic resonance imaging environment: EFOMP recommendations". Phys Med 2021; 89:303-305. [PMID: 34492497 DOI: 10.1016/j.ejmp.2021.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- S Busoni
- Medical Physics Department, Firenze University Hospital - AOU Careggi, Firenze, Italy.
| | - M Bock
- Radiology - Medical Physics Dpt., University Medical Center Freiburg, Freiburg, Germany
| | - M Chmelik
- Department of Technical Disciplines in Health Care, Faculty of Health Care, University of Prešov, Prešov, Slovakia
| | - N Colgan
- Galway University Hospital, National University of Ireland Galway, Galway, Ireland
| | - T De Bondt
- Vinçotte - Controlatom, Vilvoorde, Belgium; De Bondt Consulting BV, Antwerp, Belgium
| | - L G Hanson
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark; Section for Magnetic Resonance, DTU Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - M Israel
- Department of Hygiene, Medical Ecology and Professional Diseases, Medical University - Pleven, Bulgaria; Department of Physical Factors, National Centre of Public Health and Analyses, Sofia, Bulgaria
| | - H Kugel
- University Clinic for Radiology, University Hospital Muenster, Muenster, Germany
| | - M Maieron
- Health Physics Department, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - L N Mazzoni
- Health Physics Unit, AUSL Toscana Centro, Pistoia, Italy
| | - I Seimenis
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - P Vestergaard
- Indkøb & Medicoteknik, Region Midtjylland, Aarhus, Denmark
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Morales Mojica CM, Velazco-Garcia JD, Pappas EP, Birbilis TA, Becker A, Leiss EL, Webb A, Seimenis I, Tsekos NV. A Holographic Augmented Reality Interface for Visualizing of MRI Data and Planning of Neurosurgical Procedures. J Digit Imaging 2021; 34:1014-1025. [PMID: 34027587 DOI: 10.1007/s10278-020-00412-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 12/06/2020] [Accepted: 12/18/2020] [Indexed: 10/21/2022] Open
Abstract
The recent introduction of wireless head-mounted displays (HMD) promises to enhance 3D image visualization by immersing the user into 3D morphology. This work introduces a prototype holographic augmented reality (HAR) interface for the 3D visualization of magnetic resonance imaging (MRI) data for the purpose of planning neurosurgical procedures. The computational platform generates a HAR scene that fuses pre-operative MRI sets, segmented anatomical structures, and a tubular tool for planning an access path to the targeted pathology. The operator can manipulate the presented images and segmented structures and perform path-planning using voice and gestures. On-the-fly, the software uses defined forbidden-regions to prevent the operator from harming vital structures. In silico studies using the platform with a HoloLens HMD assessed its functionality and the computational load and memory for different tasks. A preliminary qualitative evaluation revealed that holographic visualization of high-resolution 3D MRI data offers an intuitive and interactive perspective of the complex brain vasculature and anatomical structures. This initial work suggests that immersive experiences may be an unparalleled tool for planning neurosurgical procedures.
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Affiliation(s)
- Cristina M Morales Mojica
- MRI Lab, Department of Computer Science, University of Houston, 4800 Calhoun Road PGH 501, Houston, TX, USA
| | - Jose D Velazco-Garcia
- MRI Lab, Department of Computer Science, University of Houston, 4800 Calhoun Road PGH 501, Houston, TX, USA
| | - Eleftherios P Pappas
- Medical Physics Laboratory, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Aaron Becker
- Department of Electrical and Computer Engineering, University of Houston, Houston, TX, USA
| | - Ernst L Leiss
- MRI Lab, Department of Computer Science, University of Houston, 4800 Calhoun Road PGH 501, Houston, TX, USA
| | - Andrew Webb
- C.J. Gorter Center for High Field MRI, Leiden University Medical Center, Leiden, Netherlands
| | - Ioannis Seimenis
- Medical Physics Laboratory, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos V Tsekos
- MRI Lab, Department of Computer Science, University of Houston, 4800 Calhoun Road PGH 501, Houston, TX, USA.
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Argyropoulos GD, Christidi F, Karavasilis E, Velonakis G, Antoniou A, Bede P, Seimenis I, Kelekis N, Douzenis A, Papakonstantinou O, Efstathopoulos E, Ferentinos P. Cerebro-cerebellar white matter connectivity in bipolar disorder and associated polarity subphenotypes. Prog Neuropsychopharmacol Biol Psychiatry 2021; 104:110034. [PMID: 32710925 DOI: 10.1016/j.pnpbp.2020.110034] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/08/2020] [Accepted: 07/12/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The cerebellum has a crucial role in mood regulation. While cerebellar grey matter (GM) alterations have been previously reported in bipolar disorder (BD), cerebro-cerebellar white matter (WM) connectivity alterations and cerebellar GM profiles have not been characterised in the context of predominant polarity (PP) and onset polarity (OP) subphenotypes of BD patients which is the aim of the present study. METHODS Forty-two euthymic BD patients stratified for PP and OP and 42 healthy controls (HC) were included in this quantitative neuroimaging study to evaluate cerebellar GM patterns and cerebro-cerebellar WM connections. Diffusion tensor tractography was used to characterise afferent and efferent cerebro-cerebellar tract integrity. False discovery rate corrections were applied in post-hoc comparisons. RESULTS BD patients exhibited higher fractional anisotropy (FA) in fronto-ponto-cerebellar tracts bilaterally compared to HC. Subphenotype-specific FA profiles were identified within the BD cohort. Regarding PP subgroups, we found FA changes in a) left contralateral fronto-ponto-cerebellar tract (depressive-PP > HC) and b) contralateral/ipsilateral fronto-ponto-cerebellar tracts bilaterally (manic-PP > HC). Regarding OP subgroups, we observed FA changes in a) left/right contralateral fronto-ponto-cerebellar tracts (depressive-OP > HC) and b) all fronto-ponto-cerebellar, most parieto-ponto-cerebellar and right contralateral occipito-ponto-cerebellar tracts (manic-OP>HC). In general, greater and more widespread cerebro-cerebellar changes were observed in manic-OP patients than in depressive-OP patients compared to HC. Manic-OP showed higher FA compared to depressive-OP patients in several afferent WM tracts. No GM differences were identified between BD and HC and across BD subgroups. CONCLUSIONS Our findings highlight fronto-ponto-cerebellar connectivity alterations in euthymic BD. Polarity-related subphenotypes have distinctive cerebro-cerebellar WM signatures with potential clinical and pathobiological implications.
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Affiliation(s)
- Georgios D Argyropoulos
- Research Unit of Radiology and Medical Imaging, 2nd Department of Radiology, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Foteini Christidi
- 2nd Department of Psychiatry, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Efstratios Karavasilis
- Research Unit of Radiology and Medical Imaging, 2nd Department of Radiology, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Velonakis
- Research Unit of Radiology and Medical Imaging, 2nd Department of Radiology, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Antoniou
- 2nd Department of Psychiatry, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Peter Bede
- Biomedical Imaging Laboratory, Sorbonne University, CNRS, INSERM, Paris, France; Computational Neuroimaging Group, Trinity College Dublin, Ireland
| | - Ioannis Seimenis
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kelekis
- Research Unit of Radiology and Medical Imaging, 2nd Department of Radiology, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Douzenis
- 2nd Department of Psychiatry, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Olympia Papakonstantinou
- Research Unit of Radiology and Medical Imaging, 2nd Department of Radiology, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstathios Efstathopoulos
- Research Unit of Radiology and Medical Imaging, 2nd Department of Radiology, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Ferentinos
- 2nd Department of Psychiatry, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Dellios D, Pappas EP, Seimenis I, Paraskevopoulou C, Lampropoulos KI, Lymperopoulou G, Karaiskos P. Evaluation of patient-specific MR distortion correction schemes for improved target localization accuracy in SRS. Med Phys 2020; 48:1661-1672. [PMID: 33230923 DOI: 10.1002/mp.14615] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/16/2020] [Accepted: 11/16/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE This work aims at promoting target localization accuracy in cranial stereotactic radiosurgery (SRS) applications by focusing on the correction of sequence-dependent (also patient induced) magnetic resonance (MR) distortions at the lesion locations. A phantom-based quality assurance (QA) methodology was developed and implemented for the evaluation of three distortion correction techniques. The same approach was also adapted to cranial MR images used for SRS treatment planning purposes in single or multiple brain metastases cases. METHODS A three-dimensional (3D)-printed head phantom was filled with a 3D polymer gel dosimeter. Following treatment planning and dose delivery, volumes of radiation-induced polymerization served as hypothetical lesions, offering adequate MR contrast with respect to the surrounding unirradiated areas. T1-weighted (T1w) MR imaging was performed at 1.5 T using the clinical scanning protocol for SRS. Additional images were acquired to implement three distortion correction methods; the field mapping (FM), mean image (MI) and signal integration (SI) techniques. Reference lesion locations were calculated as the averaged centroid positions of each target identified in the forward and reverse read gradient polarity MRI scans. The same techniques and workflows were implemented for the correction of contrast-enhanced T1w MR images of 10 patients with a total of 27 brain metastases. RESULTS All methods employed in the phantom study diminished spatial distortion. Median and maximum distortion magnitude decreased from 0.7 mm (2.10 ppm) and 0.8 mm (2.36 ppm), respectively, to <0.2 mm (0.61 ppm) at all target locations, using any of the three techniques. Image quality of the corrected images was acceptable, while contrast-to-noise ratio slightly increased. Results of the patient study were in accordance with the findings of the phantom study. Residual distortion in corrected patient images was found to be <0.3 mm in the vast majority of targets. Overall, the MI approach appears to be the most efficient correction method from the three investigated. CONCLUSIONS In cranial SRS applications, patient-specific distortion correction at the target location(s) is feasible and effective, despite the expense of longer imaging time since additional MRI scan(s) need to be performed. A phantom-based QA methodology was developed and presented to reassure efficient implementation of correction techniques for sequence-dependent spatial distortion.
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Affiliation(s)
- Dimitrios Dellios
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, 115 27, Greece
| | - Eleftherios P Pappas
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, 115 27, Greece
| | - Ioannis Seimenis
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, 115 27, Greece
| | | | - Kostas I Lampropoulos
- Medical Physics and Gamma Knife Department, Hygeia Hospital, Marousi, 151 23, Greece
| | - Georgia Lymperopoulou
- 1st Department of Radiology, Medical School, National and Kapodistrian University of Athens, Athens, 115 28, Greece
| | - Pantelis Karaiskos
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, 115 27, Greece.,Medical Physics and Gamma Knife Department, Hygeia Hospital, Marousi, 151 23, Greece
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Psarras M, Ploussi A, Carinou E, Brountzos E, Spiliopoulos SC, Palialexis K, Kelekis A, Filippiadis D, Seimenis I, Efstathopoulos EP. RADIATION DOSES TO THE EYE LENS AND FOREHEAD OF INTERVENTIONAL RADIOLOGISTS: HOW HIGH AND ON WHAT GROUNDS? Radiat Prot Dosimetry 2020; 190:150-157. [PMID: 32626896 DOI: 10.1093/rpd/ncaa097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/05/2020] [Accepted: 06/10/2020] [Indexed: 02/05/2023]
Abstract
The aim of the study was to measure and evaluate the radiation dose to the eye lens and forehead of interventional radiologists (IRs). The study included 96 procedures (lower-limb percutaneous transluminal angioplasties, embolisations/chemoembolisations and vertebroplasties) performed by 6 IRs. A set of seven thermoluminescence dosemeters was allocated to each physician. The highest dose per procedure was found for the left eye lens of the primary operator in vertebroplasties (1576 μSv). Left and right eye doses were linearly correlated to left and right forehead doses, respectively. A workload-based estimation of the annual dose to participating IRs revealed that the occupational dose limit for the eye lens can be easily exceeded. The left eye dose of ΙRs must be routinely monitored on a personalised basis. Τhe left eye dose measurement provides a reliable assessment of the ipsilateral forehead dose, along with valid estimations for the right eye and right forehead doses.
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Affiliation(s)
- M Psarras
- 2nd Department of Radiology, Medical Physics Unit, National and Kapodistrian University of Athens, Attikon University Hospital, 12462, Athens, Greece
| | - A Ploussi
- 2nd Department of Radiology, Medical Physics Unit, National and Kapodistrian University of Athens, Attikon University Hospital, 12462, Athens, Greece
| | - E Carinou
- Greek Atomic Energy Commission (GAEC), 15310, Agia Paraskevi, Attiki, Greece
| | - E Brountzos
- 2nd Department of Radiology, Interventional Radiology Unit, National and Kapodistrian University of Athens, Attikon University Hospital, 12462, Athens, Greece
| | - S C Spiliopoulos
- 2nd Department of Radiology, Interventional Radiology Unit, National and Kapodistrian University of Athens, Attikon University Hospital, 12462, Athens, Greece
| | - K Palialexis
- 2nd Department of Radiology, Interventional Radiology Unit, National and Kapodistrian University of Athens, Attikon University Hospital, 12462, Athens, Greece
| | - A Kelekis
- 2nd Department of Radiology, Interventional Radiology Unit, National and Kapodistrian University of Athens, Attikon University Hospital, 12462, Athens, Greece
| | - D Filippiadis
- 2nd Department of Radiology, Interventional Radiology Unit, National and Kapodistrian University of Athens, Attikon University Hospital, 12462, Athens, Greece
| | - I Seimenis
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, 115 27, Greece
| | - E P Efstathopoulos
- 2nd Department of Radiology, Medical Physics Unit, National and Kapodistrian University of Athens, Attikon University Hospital, 12462, Athens, Greece
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Gkotsis DE, Gotsis ED, Lymperopoulou G, Karaiskos P, Seimenis I. Determination of the R 2* relaxation rate constant for estimating hepatic iron concentration: A customized approach that considers liver fat infiltration. Phys Med 2020; 76:150-158. [PMID: 32679410 DOI: 10.1016/j.ejmp.2020.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/05/2020] [Accepted: 06/23/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Α customized approach to determine R2* relaxation rate for hepatic iron concentration (HIC) estimation is presented, and is evaluated in the context of concurrent liver fat infiltration. METHODS The proposed method employs a customized acquisition protocol, featuring a 16-echo, gradient-echo sequence, and a bi-exponential least squares fitting that considers baseline noise and uses a cosine function to correct for fat-induced signal oscillation. 193 patients with wide-ranging HIC and liver fat fraction (FF) were imaged at 1.5 T. In severely iron-overload patients, a four-echo train technique was applied to enforce all 16 echoes in the 1.2-4.0 ms range. Acquired data were compared to corresponding results obtained with the IDEAL IQ method. RESULTS Techniques employed to counter the rapid signal decay in iron-overloaded liver, such as the offset and the truncation methods, have to be combined with the appropriate calibration curve to provide reliable HIC estimation. When high grade steatosis and siderosis co-exist, fat-suppression may downgrade siderosis. A high correlation was observed between data obtained with the proposed technique and the IDEAL IQ method, except from the high R2* region. However, systematic differences were detected. In the concurrent presence of high FF and non-severe iron overload, it is postulated that the bi-exponential model may attribute patient siderosis grading more accurately than IDEAL IQ, while simultaneously providing reliable FF estimation. CONCLUSIONS The proposed approach is widely available and seems capable of providing reliable R2* measurements regardless of liver steatosis grading, whilst it succeeds in averting significant R2* underestimation in severely iron-overloaded liver.
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Affiliation(s)
- D E Gkotsis
- National and Kapodistrian University of Athens, Medical School, Department of Medical Physics, Greece
| | | | - G Lymperopoulou
- National and Kapodistrian University of Athens, Medical School, 1(st) Department of Radiology, Greece
| | - P Karaiskos
- National and Kapodistrian University of Athens, Medical School, Department of Medical Physics, Greece
| | - I Seimenis
- National and Kapodistrian University of Athens, Medical School, Department of Medical Physics, Greece.
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Intzes S, Symeonidou M, Zagoridis K, Bezirgiannidou Z, Pentidou A, Vrachiolias G, Seimenis I, Kotsianidis I, Spanoudakis E. Socioeconomic Status Is an Independent Prognostic Factor for Overall Survival in Patients With Multiple Myeloma: Real-World Data From a Cohort of 223 Patients. Clin Lymphoma Myeloma Leuk 2020; 20:704-711. [PMID: 32653455 DOI: 10.1016/j.clml.2020.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Socioeconomic status (SES) has been shown to be a prognostic factor for overall survival in a variety of hematologic malignancies, especially for patients who require continuous care such as those with multiple myeloma (MM). PATIENTS AND METHODS We retrospectively collected data from 223 patients with symptomatic MM diagnosed and treated in our department from January 2005 to December 2019. The modified Kuppuswamy scale, slightly modified, was used for the SES assessment. The Kaplan-Meier estimator of survival and Cox regression analysis were used. RESULTS In our cohort of 223 patients with MM, low SES was an independent poor prognostic factor for overall survival (OS), in addition to higher International Staging System stage and high-risk cytogenetics (hazard ratio for low SES on Cox regression analysis, 2.092; 95% confidence interval [CI], 1.36-3.2; log-rank P = .000). Patients with low SES had inferior survival compared with the whole patient cohort (median OS: low SES, 28 months; 95% CI, 18-37.9; high SES, 68 months; 95% CI, 55.6-80.4; log-rank P = .000). The low SES effect on OS was more evident for the elderly patients who were not transplant eligible and in those with a diagnosis of MM International Staging System stage I. The effect of low SES on OS was attenuated by time, and ethnic origin had no effect on OS. CONCLUSIONS The results of the present study have shown that low SES is an independent poor prognostic factor for survival of patients with MM.
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Affiliation(s)
- Stergios Intzes
- Department of Hematology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Marianthi Symeonidou
- Department of Hematology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Konstantinos Zagoridis
- Department of Hematology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Zoe Bezirgiannidou
- Department of Hematology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Aikaterini Pentidou
- Department of Hematology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Georgios Vrachiolias
- Department of Hematology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Ioannis Seimenis
- Department of Hematology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Ioannis Kotsianidis
- Department of Hematology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Emmanouil Spanoudakis
- Department of Hematology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.
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Parthimos TP, Karavasilis E, Rankin KP, Seimenis I, Leftherioti K, Papanicolaou AC, Miller B, Papageorgiou SG, Papatriantafyllou JD. The Neural Correlates of Impaired Self-Monitoring Among Individuals With Neurodegenerative Dementias. J Neuropsychiatry Clin Neurosci 2020; 31:201-209. [PMID: 30605361 DOI: 10.1176/appi.neuropsych.17120349] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Self-monitoring is a crucial component of human empathy and necessary for the formation and repair of social relations. Several studies have brought to light possible neuronal substrates associated with self-monitoring, but the information that they have provided is inconclusive. The authors, therefore, studied a large group of patients with dementia to assess what brain structures are necessary for the self-monitoring function.Methods: Seventy-seven patients with dementia of various types were screened using voxel-based morphometry to assess possible volume reduction in the brain structures of patients with self-monitoring problems, and the decrease of socioemotional expressiveness and modification of self-presentation was estimated using the Revised Self-Monitoring Scale. Regression analysis was employed to investigate the correlation between gray matter loss and deficient self-monitoring.Results: The socioemotional expressiveness scores were associated with decreased gray matter volume in the right olfactory cortex, inferior frontal gyrus, superior temporal pole, parahippocampal gyrus, insula, and medial temporal gyrus bilaterally. Self-presentation scores were associated with bilateral gray matter volume reduction in the olfactory cortex, insula, rectus gyrus and inferior frontal gyrus, right superior temporal pole, and parahippocampal gyrus, as well as the left medial temporal gyrus and anterior superior frontal gyrus.Conclusions: These results suggest that patients with dementia present decreased ability of self-monitoring, probably due to impaired insula and orbitofrontal cortex and their disconnection from structures of the salience network.
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Affiliation(s)
- Theodore P Parthimos
- The 3rd Age Day Care Center IASIS, Glyfada, Greece (Parthimos, Leftherioti, Papatriantafyllou); the Department of Medical Physics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece (Karavasilis, Seimenis); the Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Greece (Karavasilis); the Department of Neurology, Memory and Aging Center, University of California San Francisco (Rankin, Miller); the Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis (Papanicolaou); and the Second Department of Neurology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece (Papageorgiou)
| | - Efstratios Karavasilis
- The 3rd Age Day Care Center IASIS, Glyfada, Greece (Parthimos, Leftherioti, Papatriantafyllou); the Department of Medical Physics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece (Karavasilis, Seimenis); the Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Greece (Karavasilis); the Department of Neurology, Memory and Aging Center, University of California San Francisco (Rankin, Miller); the Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis (Papanicolaou); and the Second Department of Neurology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece (Papageorgiou)
| | - Katherine P Rankin
- The 3rd Age Day Care Center IASIS, Glyfada, Greece (Parthimos, Leftherioti, Papatriantafyllou); the Department of Medical Physics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece (Karavasilis, Seimenis); the Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Greece (Karavasilis); the Department of Neurology, Memory and Aging Center, University of California San Francisco (Rankin, Miller); the Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis (Papanicolaou); and the Second Department of Neurology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece (Papageorgiou)
| | - Ioannis Seimenis
- The 3rd Age Day Care Center IASIS, Glyfada, Greece (Parthimos, Leftherioti, Papatriantafyllou); the Department of Medical Physics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece (Karavasilis, Seimenis); the Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Greece (Karavasilis); the Department of Neurology, Memory and Aging Center, University of California San Francisco (Rankin, Miller); the Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis (Papanicolaou); and the Second Department of Neurology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece (Papageorgiou)
| | - Katerina Leftherioti
- The 3rd Age Day Care Center IASIS, Glyfada, Greece (Parthimos, Leftherioti, Papatriantafyllou); the Department of Medical Physics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece (Karavasilis, Seimenis); the Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Greece (Karavasilis); the Department of Neurology, Memory and Aging Center, University of California San Francisco (Rankin, Miller); the Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis (Papanicolaou); and the Second Department of Neurology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece (Papageorgiou)
| | - Andrew C Papanicolaou
- The 3rd Age Day Care Center IASIS, Glyfada, Greece (Parthimos, Leftherioti, Papatriantafyllou); the Department of Medical Physics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece (Karavasilis, Seimenis); the Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Greece (Karavasilis); the Department of Neurology, Memory and Aging Center, University of California San Francisco (Rankin, Miller); the Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis (Papanicolaou); and the Second Department of Neurology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece (Papageorgiou)
| | - Bruce Miller
- The 3rd Age Day Care Center IASIS, Glyfada, Greece (Parthimos, Leftherioti, Papatriantafyllou); the Department of Medical Physics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece (Karavasilis, Seimenis); the Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Greece (Karavasilis); the Department of Neurology, Memory and Aging Center, University of California San Francisco (Rankin, Miller); the Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis (Papanicolaou); and the Second Department of Neurology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece (Papageorgiou)
| | - Sokratis G Papageorgiou
- The 3rd Age Day Care Center IASIS, Glyfada, Greece (Parthimos, Leftherioti, Papatriantafyllou); the Department of Medical Physics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece (Karavasilis, Seimenis); the Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Greece (Karavasilis); the Department of Neurology, Memory and Aging Center, University of California San Francisco (Rankin, Miller); the Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis (Papanicolaou); and the Second Department of Neurology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece (Papageorgiou)
| | - John D Papatriantafyllou
- The 3rd Age Day Care Center IASIS, Glyfada, Greece (Parthimos, Leftherioti, Papatriantafyllou); the Department of Medical Physics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece (Karavasilis, Seimenis); the Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Greece (Karavasilis); the Department of Neurology, Memory and Aging Center, University of California San Francisco (Rankin, Miller); the Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis (Papanicolaou); and the Second Department of Neurology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece (Papageorgiou)
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Koutsojannis C, Andrikopoulos A, Seimenis I, Adamopoulos A. MAGNETO-THERAPY IN PHYSIOTHERAPY UNITS: INTRODUCTION OF QUALITY CONTROL PROCEDURE DUE TO LACK OF MAINTENANCE. Radiat Prot Dosimetry 2019; 185:532-541. [PMID: 31329986 DOI: 10.1093/rpd/ncz049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/12/2019] [Accepted: 03/18/2019] [Indexed: 06/10/2023]
Abstract
Rehabilitation practice for many patients consisting of a combined use of magneto therapy resulting emission of low frequency magnetic fields to the patient, elicit concerns about occupational exposure to electromagnetic radiation (EMR) for the operators. The time extended use of the device periodically leads to mechanical failures or troubleshooting of the machine which, in most cases, are not perceived by the operator of the device. All device's efficient functionality have a major impact on the completion of the treatment procedure in a large percentage of specific clinical conditions. If the device's operating condition is technically out of order or in a mode of over-activity, operators are mainly seeking solutions by reviewing the clinical case of the patient. This eliminates their contribution during the primary therapeutic plan or increases the treatment sessions. In this work, an extended survey is presented including 75 physiotherapy centres concerning usability and maintenance issues of magneto therapy devices throughout Greek territory combined with extended measurements of Electromagnetic Radiation in the unit room were performed. Physiotherapists' perceptions revealed lack of technical support, maintenance and safe use of magneto therapy devices that extract auxiliary observations upon their clinical practice routines. Additionally safety measurements have not revealed field strengths over International Reference Levels which could result health risks for users and coexisting patients. The pilot survey that conducted in Attica and Western Greece confirms that magnetic fields strength that are measured are in accordance with the statutory legislation but will, at the same time, revealed lack of maintenance of the devices. Deficiency in topics such as proper equipment function will necessitate the creation of quality safety protocols, concerning the use of magneto-therapy, with the main aim the improvement of treatment procedures for the higher performance of therapeutic rehabilitation services to patients. Finally in this work, the proposal of a QC protocol for magnetotherapy devices is proposed for evaluation.
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Affiliation(s)
- Constantinos Koutsojannis
- Laboratory of Health Physics, Department of Physiotherapy, Technological and Educational Institute of Western Greece, 251 00 Aigion, Greece
| | - Andreas Andrikopoulos
- Laboratory of Health Physics, Department of Physiotherapy, Technological and Educational Institute of Western Greece, 251 00 Aigion, Greece
| | - Ioannis Seimenis
- Laboratory of Medical Physics, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece
| | - Adam Adamopoulos
- Laboratory of Medical Physics, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece
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Christidi F, Karavasilis E, Rentzos M, Velonakis G, Zouvelou V, Xirou S, Argyropoulos G, Papatriantafyllou I, Pantolewn V, Ferentinos P, Kelekis N, Seimenis I, Evdokimidis I, Bede P. Neuroimaging data indicate divergent mesial temporal lobe profiles in amyotrophic lateral sclerosis, Alzheimer's disease and healthy aging. Data Brief 2019; 28:104991. [PMID: 31921944 PMCID: PMC6948121 DOI: 10.1016/j.dib.2019.104991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 12/05/2019] [Indexed: 12/12/2022] Open
Abstract
A prospective, standardised neuroimaging protocol was implemented to characterise mesial temporal lobe pathology in amyotrophic lateral sclerosis, Alzheimer's disease and healthy controls focusing on the evaluation of interconnected white and grey matter structures. “Hippocampal pathology in Amyotrophic Lateral Sclerosis: selective vulnerability of subfields and their associated projections” [1]. High-resolution diffusion tensor and structural imaging data were acquired on a 3 T MRI platform using standardised sequence parameters. The integrity of the fornix and the perforant pathway was assessed by tractography, to provide fractional anisotropy, axial diffusivity and radial diffusivity measures. Quantitative structural imaging was used to estimate the total intracranial volume, total hippocampal volumes and hippocampal subfield volumes for each participant. Raw white- and grey-matter measures, demographic and clinical data are available online at ‘Mendeley Data’. Amyotrophic lateral sclerosis and Alzheimer's disease exhibit divergent hippocampal profiles.
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Affiliation(s)
- Foteini Christidi
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Greece
| | - Efstratios Karavasilis
- Second Department of Radiology, General University Hospital "Attikon", National and Kapodistrian University of Athens, Greece
| | - Michail Rentzos
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Greece
| | - Georgios Velonakis
- Second Department of Radiology, General University Hospital "Attikon", National and Kapodistrian University of Athens, Greece
| | - Vasiliki Zouvelou
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Greece
| | - Sofia Xirou
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Greece
| | - Georgios Argyropoulos
- Second Department of Radiology, General University Hospital "Attikon", National and Kapodistrian University of Athens, Greece
| | | | - Varvara Pantolewn
- Second Department of Radiology, General University Hospital "Attikon", National and Kapodistrian University of Athens, Greece
| | - Panagiotis Ferentinos
- Second Department of Psychiatry, General University Hospital "Attikon", National and Kapodistrian University of Athens, Greece
| | - Nikolaos Kelekis
- Second Department of Radiology, General University Hospital "Attikon", National and Kapodistrian University of Athens, Greece
| | - Ioannis Seimenis
- Department of Medical Physics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Ioannis Evdokimidis
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Greece
| | - Peter Bede
- Department of Neurology, Pitié-Salpêtrière University Hospital, Paris, France.,Biomedical Imaging Laboratory, Sorbonne University, INSERM, Paris, France.,Computational Neuroimaging Group, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland
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Christidi F, Karavasilis E, Rentzos M, Velonakis G, Zouvelou V, Xirou S, Argyropoulos G, Papatriantafyllou I, Pantolewn V, Ferentinos P, Kelekis N, Seimenis I, Evdokimidis I, Bede P. Hippocampal pathology in amyotrophic lateral sclerosis: selective vulnerability of subfields and their associated projections. Neurobiol Aging 2019; 84:178-188. [DOI: 10.1016/j.neurobiolaging.2019.07.019] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/10/2019] [Accepted: 07/10/2019] [Indexed: 12/29/2022]
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48
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Pappas E, Kalaitzakis G, Boursianis T, Zoros E, Zourari K, Pappas EP, Makris D, Seimenis I, Efstathopoulos E, Maris TG. Dosimetric performance of the Elekta Unity MR-linac system: 2D and 3D dosimetry in anthropomorphic inhomogeneous geometry. ACTA ACUST UNITED AC 2019; 64:225009. [DOI: 10.1088/1361-6560/ab52ce] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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49
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Pappas E, Kalaitzakis G, Seimenis I, Pappas E, Maris T. Clinical IMRT Irradiation with an MR-Linac System: A Methodology and Preliminary Results for a Real-Time Verification of Spatial Accuracy of Dose Delivery. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.565] [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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50
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Lagoumintzis G, Andrikopoulos A, Adamopoulos A, Seimenis I, Koutsojannis C. Microwave diathermy induces mitogen-activated protein kinases and tumor necrosis factor-α in cultured human monocytes. Electromagn Biol Med 2019; 38:218-229. [PMID: 31079506 DOI: 10.1080/15368378.2019.1613426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Although rehabilitation practice for most patients consists of a combined use of thermotherapy that is produced from diathermy devices resulting faster and deeper heating to the patient, major concerns about occupational exposure to electromagnetic radiation for the operators must be considered. In most occasions, physiotherapists have involved multi-hour treatment sessions to different patients, resulting overuse of the diathermy device. Recently, our team along with other groups have raised serious concerns about the occupational safety aspects related to microwave diathermy (MWD) use. Driven by these recent reports, in this work, we tried to investigate the in vitro effects of a physiotherapist routine MWD device regarding its potential inflammatory biological effects that could be evoked in human cultured monocytes. Our results show that MWD does not alter the integrity of the cell membrane and, consequently, the viability of monocytes as assessed by Trypan blue and MTT measurements. Then again, members of the MAPK family (p38 and ERK1/2) were activated upon MWD exposure at 5-30 min, eventually leading to a time-dependent considerable increase in TNF-α production, a key pro-inflammatory mediator. Our results are indicative of a stress-activated phenomenon of monocytes upon MWD radiation, which could trigger potential hazardous cellular outcomes due to thermal and/or non-thermal bystander effects. Our results deserve further investigation, planned by our team in due course, to delineate the clinical correlations of these findings.
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Affiliation(s)
- George Lagoumintzis
- a Laboratory of Health Physics, Department of Optics & Optometry and Department of Physiotherapy, Western Greece University of Applied Sciences (TEI of Western Greece) , Aigion , Greece
| | - Andreas Andrikopoulos
- a Laboratory of Health Physics, Department of Optics & Optometry and Department of Physiotherapy, Western Greece University of Applied Sciences (TEI of Western Greece) , Aigion , Greece.,b Laboratory of Medical Physics, School of Medicine , Democritus University of Thrace , Alexandroupolis , Greece
| | - Adam Adamopoulos
- b Laboratory of Medical Physics, School of Medicine , Democritus University of Thrace , Alexandroupolis , Greece
| | - Ioannis Seimenis
- b Laboratory of Medical Physics, School of Medicine , Democritus University of Thrace , Alexandroupolis , Greece
| | - Constantinos Koutsojannis
- a Laboratory of Health Physics, Department of Optics & Optometry and Department of Physiotherapy, Western Greece University of Applied Sciences (TEI of Western Greece) , Aigion , Greece
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