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Vijayan R, Sheth N, Mekki L, Lu A, Uneri A, Sisniega A, Magaraggia J, Kleinszig G, Vogt S, Thiboutot J, Lee H, Yarmus L, Siewerdsen JH. 3D-2D image registration in the presence of soft-tissue deformation in image-guided transbronchial interventions. Phys Med Biol 2022; 68. [PMID: 36317269 DOI: 10.1088/1361-6560/ac9e3c] [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: 05/31/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
Purpose. Target localization in pulmonary interventions (e.g. transbronchial biopsy of a lung nodule) is challenged by deformable motion and may benefit from fluoroscopic overlay of the target to provide accurate guidance. We present and evaluate a 3D-2D image registration method for fluoroscopic overlay in the presence of tissue deformation using a multi-resolution/multi-scale (MRMS) framework with an objective function that drives registration primarily by soft-tissue image gradients.Methods. The MRMS method registers 3D cone-beam CT to 2D fluoroscopy without gating of respiratory phase by coarse-to-fine resampling and global-to-local rescaling about target regions-of-interest. A variation of the gradient orientation (GO) similarity metric (denotedGO') was developed to downweight bone gradients and drive registration via soft-tissue gradients. Performance was evaluated in terms of projection distance error at isocenter (PDEiso). Phantom studies determined nominal algorithm parameters and capture range. Preclinical studies used a freshly deceased, ventilated porcine specimen to evaluate performance in the presence of real tissue deformation and a broad range of 3D-2D image mismatch.Results. Nominal algorithm parameters were identified that provided robust performance over a broad range of motion (0-20 mm), including an adaptive parameter selection technique to accommodate unknown mismatch in respiratory phase. TheGO'metric yielded median PDEiso= 1.2 mm, compared to 6.2 mm for conventionalGO.Preclinical studies with real lung deformation demonstrated median PDEiso= 1.3 mm with MRMS +GO'registration, compared to 2.2 mm with a conventional transform. Runtime was 26 s and can be reduced to 2.5 s given a prior registration within ∼5 mm as initialization.Conclusions. MRMS registration via soft-tissue gradients achieved accurate fluoroscopic overlay in the presence of deformable lung motion. By driving registration via soft-tissue image gradients, the method avoided false local minima presented by bones and was robust to a wide range of motion magnitude.
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Affiliation(s)
- R Vijayan
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - N Sheth
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - L Mekki
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - A Lu
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - A Uneri
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - A Sisniega
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | | | | | - S Vogt
- Siemens Healthineers, Erlangen, Germany
| | - J Thiboutot
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins Medical Institution, Baltimore, MD, United States of America
| | - H Lee
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins Medical Institution, Baltimore, MD, United States of America
| | - L Yarmus
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins Medical Institution, Baltimore, MD, United States of America
| | - J H Siewerdsen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America.,Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
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Han R, Uneri A, Vijayan RC, Wu P, Vagdargi P, Sheth N, Vogt S, Kleinszig G, Osgood GM, Siewerdsen JH. Fracture reduction planning and guidance in orthopaedic trauma surgery via multi-body image registration. Med Image Anal 2020; 68:101917. [PMID: 33341493 DOI: 10.1016/j.media.2020.101917] [Citation(s) in RCA: 12] [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: 04/28/2020] [Revised: 11/16/2020] [Accepted: 11/23/2020] [Indexed: 02/06/2023]
Abstract
PURPOSES Surgical reduction of pelvic fracture is a challenging procedure, and accurate restoration of natural morphology is essential to obtaining positive functional outcome. The procedure often requires extensive preoperative planning, long fluoroscopic exposure time, and trial-and-error to achieve accurate reduction. We report a multi-body registration framework for reduction planning using preoperative CT and intraoperative guidance using routine 2D fluoroscopy that could help address such challenges. METHOD The framework starts with semi-automatic segmentation of fractured bone fragments in preoperative CT using continuous max-flow. For reduction planning, a multi-to-one registration is performed to register bone fragments to an adaptive template that adjusts to patient-specific bone shapes and poses. The framework further registers bone fragments to intraoperative fluoroscopy to provide 2D fluoroscopy guidance and/or 3D navigation relative to the reduction plan. The framework was investigated in three studies: (1) a simulation study of 40 CT images simulating three fracture categories (unilateral two-body, unilateral three-body, and bilateral two-body); (2) a proof-of-concept cadaver study to mimic clinical scenario; and (3) a retrospective clinical study investigating feasibility in three cases of increasing severity and accuracy requirement. RESULTS Segmentation of simulated pelvic fracture demonstrated Dice coefficient of 0.92±0.06. Reduction planning using the adaptive template achieved 2-3 mm and 2-3° error for the three fracture categories, significantly better than planning based on mirroring of contralateral anatomy. 3D-2D registration yielded ~2 mm and 0.5° accuracy, providing accurate guidance with respect to the preoperative reduction plan. The cadaver study and retrospective clinical study demonstrated comparable accuracy: ~0.90 Dice coefficient in segmentation, ~3 mm accuracy in reduction planning, and ~2 mm accuracy in 3D-2D registration. CONCLUSION The registration framework demonstrated planning and guidance accuracy within clinical requirements in both simulation and clinical feasibility studies for a broad range of fracture-dislocation patterns. Using routinely acquired preoperative CT and intraoperative fluoroscopy, the framework could improve the accuracy of pelvic fracture reduction, reduce radiation dose, and could integrate well with common clinical workflow without the need for additional navigation systems.
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Affiliation(s)
- R Han
- Department of Biomedical Engineering, The Johns Hopkins University, BaltimoreMD, United States
| | - A Uneri
- Department of Biomedical Engineering, The Johns Hopkins University, BaltimoreMD, United States
| | - R C Vijayan
- Department of Biomedical Engineering, The Johns Hopkins University, BaltimoreMD, United States
| | - P Wu
- Department of Biomedical Engineering, The Johns Hopkins University, BaltimoreMD, United States
| | - P Vagdargi
- Department of Computer Science, The Johns Hopkins University, BaltimoreMD, United States
| | - N Sheth
- Department of Biomedical Engineering, The Johns Hopkins University, BaltimoreMD, United States
| | - S Vogt
- Siemens Healthineers, ErlangenGermany
| | | | - G M Osgood
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, BaltimoreMD, United States
| | - J H Siewerdsen
- Department of Biomedical Engineering, The Johns Hopkins University, BaltimoreMD, United States.
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3
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Wu P, Sheth N, Sisniega A, Uneri A, Han R, Vijayan R, Vagdargi P, Kreher B, Kunze H, Kleinszig G, Vogt S, Lo SF, Theodore N, Siewerdsen JH. C-arm orbits for metal artifact avoidance (MAA) in cone-beam CT. Phys Med Biol 2020; 65:165012. [PMID: 32428891 PMCID: PMC8650760 DOI: 10.1088/1361-6560/ab9454] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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] [Indexed: 11/12/2022]
Abstract
Metal artifacts present a challenge to cone-beam CT (CBCT) image-guided surgery, obscuring visualization of metal instruments and adjacent anatomy-often in the very region of interest pertinent to the imaging/surgical tasks. We present a method to reduce the influence of metal artifacts by prospectively defining an image acquisition protocol-viz., the C-arm source-detector orbit-that mitigates metal-induced biases in the projection data. The metal artifact avoidance (MAA) method is compatible with simple mobile C-arms, does not require exact prior information on the patient or metal implants, and is consistent with 3D filtered backprojection (FBP), more advanced (e.g. polyenergetic) model-based image reconstruction (MBIR), and metal artifact reduction (MAR) post-processing methods. The MAA method consists of: (i) coarse localization of metal objects in the field-of-view (FOV) via two or more low-dose scout projection views and segmentation (e.g. a simple U-Net) in coarse backprojection; (ii) model-based prediction of metal-induced x-ray spectral shift for all source-detector vertices accessible by the imaging system (e.g. gantry rotation and tilt angles); and (iii) identification of a circular or non-circular orbit that reduces the variation in spectral shift. The method was developed, tested, and evaluated in a series of studies presenting increasing levels of complexity and realism, including digital simulations, phantom experiment, and cadaver experiment in the context of image-guided spine surgery (pedicle screw implants). The MAA method accurately predicted tilted circular and non-circular orbits that reduced the magnitude of metal artifacts in CBCT reconstructions. Realistic distributions of metal instrumentation were successfully localized (0.71 median Dice coefficient) from 2-6 low-dose scout views even in complex anatomical scenes. The MAA-predicted tilted circular orbits reduced root-mean-square error (RMSE) in 3D image reconstructions by 46%-70% and 'blooming' artifacts (apparent width of the screw shaft) by 20-45%. Non-circular orbits defined by MAA achieved a further ∼46% reduction in RMSE compared to the best (tilted) circular orbit. The MAA method presents a practical means to predict C-arm orbits that minimize spectral bias from metal instrumentation. Resulting orbits-either simple tilted circular orbits or more complex non-circular orbits that can be executed with a motorized multi-axis C-arm-exhibited substantial reduction of metal artifacts in raw CBCT reconstructions by virtue of higher fidelity projection data, which are in turn compatible with subsequent MAR post-processing and/or polyenergetic MBIR to further reduce artifacts.
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Affiliation(s)
- P Wu
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
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Han R, Uneri A, Ketcha M, Vijayan R, Sheth N, Wu P, Vagdargi P, Vogt S, Kleinszig G, Osgood GM, Siewerdsen JH. Multi-body 3D-2D registration for image-guided reduction of pelvic dislocation in orthopaedic trauma surgery. Phys Med Biol 2020; 65:135009. [PMID: 32217833 PMCID: PMC8647002 DOI: 10.1088/1361-6560/ab843c] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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] [Indexed: 11/12/2022]
Abstract
Surgical reduction of pelvic dislocation is a challenging procedure with poor long-term prognosis if reduction does not accurately restore natural morphology. The procedure often requires long fluoroscopic exposure times and trial-and-error to achieve accurate reduction. We report a method to automatically compute the target pose of dislocated bones in preoperative CT and provide 3D guidance of reduction using routine 2D fluoroscopy. A pelvic statistical shape model (SSM) and a statistical pose model (SPM) were formed from an atlas of 40 pelvic CT images. Multi-body bone segmentation was achieved by mapping the SSM to a preoperative CT via an active shape model. The target reduction pose for the dislocated bone is estimated by fitting the poses of undislocated bones to the SPM. Intraoperatively, multiple bones are registered to fluoroscopy images via 3D-2D registration to obtain 3D pose estimates from 2D images. The method was examined in three studies: (1) a simulation study of 40 CT images simulating a range of dislocation patterns; (2) a pelvic phantom study with controlled dislocation of the left innominate bone; (3) a clinical case study investigating feasibility in images acquired during pelvic reduction surgery. Experiments investigated the accuracy of registration as a function of initialization error (capture range), image quality (radiation dose and image noise), and field of view (FOV) size. The simulation study achieved target pose estimation with translational error of median 2.3 mm (1.4 mm interquartile range, IQR) and rotational error of 2.1° (1.3° IQR). 3D-2D registration yielded 0.3 mm (0.2 mm IQR) in-plane and 0.3 mm (0.2 mm IQR) out-of-plane translational error, with in-plane capture range of ±50 mm and out-of-plane capture range of ±120 mm. The phantom study demonstrated 3D-2D target registration error of 2.5 mm (1.5 mm IQR), and the method was robust over a large dose range, down to 5 [Formula: see text]Gy/frame (an order of magnitude lower than the nominal fluoroscopic dose). The clinical feasibility study demonstrated accurate registration with both preoperative and intraoperative radiographs, yielding 3.1 mm (1.0 mm IQR) projection distance error with robust performance for FOV ranging from 340 × 340 mm2 to 170 × 170 mm2 (at the image plane). The method demonstrated accurate estimation of the target reduction pose in simulation, phantom, and a clinical feasibility study for a broad range of dislocation patterns, initialization error, dose levels, and FOV size. The system provides a novel means of guidance and assessment of pelvic reduction from routinely acquired preoperative CT and intraoperative fluoroscopy. The method has the potential to reduce radiation dose by minimizing trial-and-error and to improve outcomes by guiding more accurate reduction of joint dislocations.
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Affiliation(s)
- R Han
- Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, MD, United States of America
| | - A Uneri
- Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, MD, United States of America
| | - M Ketcha
- Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, MD, United States of America
| | - R Vijayan
- Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, MD, United States of America
| | - N Sheth
- Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, MD, United States of America
| | - P Wu
- Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, MD, United States of America
| | - P Vagdargi
- Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, MD, United States of America
| | - S Vogt
- Siemens Healthineers, Erlangen, Germany
| | | | - G M Osgood
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, United States of America
| | - J H Siewerdsen
- Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, MD, United States of America
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Woelfle UC, Briggs T, Bhattacharyya S, Qu H, Sheth N, Knabe C, Ducheyne P. Dual local drug delivery of vancomycin and farnesol for mitigation of MRSA infection in vivo - a pilot study. Eur Cell Mater 2020; 40:38-57. [PMID: 32696976 DOI: 10.22203/ecm.v040a03] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Surgical site infections after orthopaedic surgery using fracture fixation devices or endosseous implants create major surgical challenges with severe adverse effects, such as osteomyelitis. These infections are frequently caused by Staphylococcus aureus, often with high resistance to antibiotics, such as methicillin-resistant Staphylococcus aureus (MRSA). Due to the formation of impenetrable biofilms on implant surfaces, systemic antibiotic treatment has become exceedingly difficult. New solutions are pursued by combining several drugs using a controlled delivery system from specifically engineered implant surfaces. A sol-gel coating on titanium implants was previously developed with 20 wt % vancomycin and 30 wt % farnesol, with suppression of MRSA in vitro. The present study investigated the efficacy of sol-gel film coatings for controlled dual local delivery over 4 weeks utilising a rat infection model. The findings confirmed the viability of this new concept in vivo based on the differences observed between coatings containing vancomycin alone (SGV) and the dual-drug-containing coating with vancomycin and farnesol (SGVF). While both the SGVF and SGV coatings facilitated excellent preservation of the osseous microarchitecture, SGVF coating displayed a slightly higher potency for suppressing MRSA infiltration than SGV, in combination with a lower reactive bone remodelling activity, most likely by disturbing biofilm formation. The next step for advancing the concept of dual-drug delivery from sol-gel coatings to the clinic and confirming the promising effect of the SGVF coatings on reactive bone remodelling and suppressing MRSA infiltration is a study in a larger animal species with longer time points.
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Affiliation(s)
| | | | | | | | | | - C Knabe
- Department of Experimental Orofacial Medicine, Philipps University, Marburg,
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Vagdargi P, Uneri A, Sheth N, Sisniega A, De Silva T, Osgood GM, Siewerdsen JH. Calibration and Registration of a Freehand Video-Guided Surgical Drill for Orthopaedic Trauma. Proc SPIE Int Soc Opt Eng 2020; 11315. [PMID: 32476703 DOI: 10.1117/12.2550001] [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] [Indexed: 11/14/2022]
Abstract
Pelvic trauma surgical procedures rely heavily on guidance with 2D fluoroscopy views for navigation in complex bone corridors. This "fluoro-hunting" paradigm results in extended radiation exposure and possible suboptimal guidewire placement from limited visualization of the fractures site with overlapped anatomy in 2D fluoroscopy. A novel computer vision-based navigation system for freehand guidewire insertion is proposed. The navigation framework is compatible with the rapid workflow in trauma surgery and bridges the gap between intraoperative fluoroscopy and preoperative CT images. The system uses a drill-mounted camera to detect and track poses of simple multimodality (optical/radiographic) markers for registration of the drill axis to fluoroscopy and, in turn, to CT. Surgical navigation is achieved with real-time display of the drill axis position on fluoroscopy views and, optionally, in 3D on the preoperative CT. The camera was corrected for lens distortion effects and calibrated for 3D pose estimation. Custom marker jigs were constructed to calibrate the drill axis and tooltip with respect to the camera frame. A testing platform for evaluation of the navigation system was developed, including a robotic arm for precise, repeatable, placement of the drill. Experiments were conducted for hand-eye calibration between the drill-mounted camera and the robot using the Park and Martin solver. Experiments using checkerboard calibration demonstrated subpixel accuracy [-0.01 ± 0.23 px] for camera distortion correction. The drill axis was calibrated using a cylindrical model and demonstrated sub-mm accuracy [0.14 ± 0.70 mm] and sub-degree angular deviation.
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Affiliation(s)
- P Vagdargi
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA 21218
| | - A Uneri
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA 21218
| | - N Sheth
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA 21218
| | - A Sisniega
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA 21218
| | - T De Silva
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA 21218
| | - G M Osgood
- Department of Orthopedic Surgery, Johns Hopkins Medicine, Baltimore, MD, USA 21218
| | - J H Siewerdsen
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA 21218.,Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA 21218
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Kavi A, Lee A, Lederman A, Sheth N, Safdieh J, Schreiber D. Patterns of Care and Comparison of Outcomes between Patients with Inflammatory Breast Cancer Who Were Treated with Standard versus Dose-Escalated Adjuvant Radiation Therapy. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sheth N, Osborn V, Lee A, Kavi A, Schreiber D, Safdieh J. Burnout in Radiation Oncology: A Pilot Residency Wellness Program. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bakker JP, Goldsack JC, Clarke M, Coravos A, Geoghegan C, Godfrey A, Heasley MG, Karlin DR, Manta C, Peterson B, Ramirez E, Sheth N, Bruno A, Bullis E, Wareham K, Zimmerman N, Forrest A, Wood WA. A systematic review of feasibility studies promoting the use of mobile technologies in clinical research. NPJ Digit Med 2019; 2:47. [PMID: 31304393 PMCID: PMC6554345 DOI: 10.1038/s41746-019-0125-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/15/2019] [Indexed: 11/09/2022] Open
Abstract
Mobile technologies, such as smart phone applications, wearables, ingestibles, and implantables, are increasingly used in clinical research to capture study endpoints. On behalf of the Clinical Trials Transformation Initiative, we aimed to conduct a systematic scoping review and compile a database summarizing pilot studies addressing mobile technology sensor performance, algorithm development, software performance, and/or operational feasibility, in order to provide a resource for guiding decisions about which technology is most suitable for a particular trial. Our systematic search identified 275 publications meeting inclusion criteria. From these papers, we extracted data including the medical condition, concept of interest captured by the mobile technology, outcomes captured by the digital measurement, and details regarding the sensors, algorithms, and study sample. Sixty-seven percent of the technologies identified were wearable sensors, with the remainder including tablets, smartphones, implanted sensors, and cameras. We noted substantial variability in terms of reporting completeness and terminology used. The data have been compiled into an online database maintained by the Clinical Trials Transformation Initiative that can be filtered and searched electronically, enabling a user to find information most relevant to their work. Our long-term goal is to maintain and update the online database, in order to promote standardization of methods and reporting, encourage collaboration, and avoid redundant studies, thereby contributing to the design and implementation of efficient, high-quality trials.
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Affiliation(s)
| | - Jennifer C. Goldsack
- Clinical Trials Transformation Initiative, Durham, NC USA
- Digital Medicine Society (DiMe), Boston, MA USA
- monARC Bionetworks, San Francisco, CA USA
| | | | - Andrea Coravos
- Digital Medicine Society (DiMe), Boston, MA USA
- Elektra Labs, Boston, MA USA
- Harvard-MIT Center for Regulatory Science, Boston, MA USA
| | | | | | | | - Daniel R. Karlin
- Digital Medicine Society (DiMe), Boston, MA USA
- HealthMode, New York, NY USA
| | | | | | | | | | - Antonia Bruno
- Ross University School of Medicine, Bridgetown, Barbados
| | | | | | - Noah Zimmerman
- Icahn School of Medicine at Mount Sinai, New York, NY USA
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Boroojerdi B, Ghaffari R, Mahadevan N, Markowitz M, Melton K, Morey B, Otoul C, Patel S, Phillips J, Sen-Gupta E, Stumpp O, Tatla D, Terricabras D, Claes K, Wright JA, Sheth N. Clinical feasibility of a wearable, conformable sensor patch to monitor motor symptoms in Parkinson's disease. Parkinsonism Relat Disord 2019; 61:70-76. [DOI: 10.1016/j.parkreldis.2018.11.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/11/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
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11
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Sheth N, Osborn V, Adedoyin P, Safdieh J, Schreiber D. Hepatocellular Carcinoma: Patterns of Care and Outcomes for Patients receiving Stereotactic Radiation Therapy. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Lee A, Tam M, Wu P, Gerber N, Lederman A, Garay E, Sheth N, Safdieh J, Choi K, Schreiber D. Patterns of Care of Adjuvant Radiation Therapy after Lumpectomy and Survival in T1N0M0 Estrogen Receptor Positive Breast Cancer. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1622] [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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13
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Kavi A, Lee A, Sheth N, Adedoyin P, Lederman A, Schreiber D. Patterns of Care and Comparison of Outcomes Between Primary Anal Squamous Cell Carcinoma and Anal Adenocarcinoma. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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14
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De Silva T, Uneri A, Zhang X, Ketcha M, Han R, Sheth N, Martin A, Vogt S, Kleinszig G, Belzberg A, Sciubba DM, Siewerdsen JH. Real-time, image-based slice-to-volume registration for ultrasound-guided spinal intervention. Phys Med Biol 2018; 63:215016. [PMID: 30372418 DOI: 10.1088/1361-6560/aae761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Real-time fusion of magnetic resonance (MR) and ultrasound (US) images could facilitate safe and accurate needle placement in spinal interventions. We develop an entirely image-based registration method (independent of or complementary to surgical trackers) that includes an efficient US probe pose initialization algorithm. The registration enables the simultaneous display of 2D ultrasound image slices relative to 3D pre-procedure MR images for navigation. A dictionary-based 3D-2D pose initialization algorithm was developed in which likely probe positions are predefined in a dictionary with feature encoding by Haar wavelet filters. Feature vectors representing the 2D US image are computed by scaling and translating multiple Haar basis filters to capture scale, location, and relative intensity patterns of distinct anatomical features. Following pose initialization, fast 3D-2D registration was performed by optimizing normalized cross-correlation between intra- and pre-procedure images using Powell's method. Experiments were performed using a lumbar puncture phantom and a fresh cadaver specimen presenting realistic image quality in spinal US imaging. Accuracy was quantified by comparing registration transforms to ground truth motion imparted by a computer-controlled motion system and calculating target registration error (TRE) in anatomical landmarks. Initialization using a 315-length feature vector yielded median translation accuracy of 2.7 mm (3.4 mm interquartile range, IQR) in the phantom and 2.1 mm (2.5 mm IQR) in the cadaver. By comparison, storing the entire image set in the dictionary and optimizing correlation yielded a comparable median accuracy of 2.1 mm (2.8 mm IQR) in the phantom and 2.9 mm (3.5 mm IQR) in the cadaver. However, the dictionary-based method reduced memory requirements by 47× compared to storing the entire image set. The overall 3D error after registration measured using 3D landmarks was 3.2 mm (1.8 mm IQR) mm in the phantom and 3.0 mm (2.3 mm IQR) mm in the cadaver. The system was implemented in a 3D Slicer interface to facilitate translation to clinical studies. Haar feature based initialization provided accuracy and robustness at a level that was sufficient for real-time registration using an entirely image-based method for ultrasound navigation. Such an approach could improve the accuracy and safety of spinal interventions in broad utilization, since it is entirely software-based and can operate free from the cost and workflow requirements of surgical trackers.
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Affiliation(s)
- T De Silva
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21205, United States of America
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Perry B, Herrington W, Goldsack JC, Grandinetti CA, Vasisht KP, Landray MJ, Bataille L, DiCicco RA, Bradley C, Narayan A, Papadopoulos EJ, Sheth N, Skodacek K, Stem K, Strong TV, Walton MK, Corneli A. Use of Mobile Devices to Measure Outcomes in Clinical Research, 2010-2016: A Systematic Literature Review. Digit Biomark 2018; 2:11-30. [PMID: 29938250 PMCID: PMC6008882 DOI: 10.1159/000486347] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [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: 08/18/2017] [Accepted: 12/13/2017] [Indexed: 01/08/2023] Open
Abstract
Background The use of mobile devices in clinical research has advanced substantially in recent years due to the rapid pace of technology development. With an overall aim of informing the future use of mobile devices in interventional clinical research to measure primary outcomes, we conducted a systematic review of the use of and clinical outcomes measured by mobile devices (mobile outcomes) in observational and interventional clinical research. Method We conducted a PubMed search using a range of search terms to retrieve peer-reviewed articles on clinical research published between January 2010 and May 2016 in which mobile devices were used to measure study outcomes. We screened each publication for specific inclusion and exclusion criteria. We then identified and qualitatively summarized the use of mobile outcome assessments in clinical research, including the type and design of the study, therapeutic focus, type of mobile device(s) used, and specific mobile outcomes reported. Results The search retrieved 2,530 potential articles of interest. After screening, 88 publications remained. Twenty-five percent of the publications (n = 22) described mobile outcomes used in interventional research, and the rest (n = 66) described observational clinical research. Thirteen therapeutic areas were represented. Five categories of mobile devices were identified: (1) inertial sensors, (2) biosensors, (3) pressure sensors and walkways, (4) medication adherence monitors, and (5) location monitors; inertial sensors/accelerometers were most common (reported in 86% of the publications). Among the variety of mobile outcomes, various assessments of physical activity were most common (reported in 74% of the publications). Other mobile outcomes included assessments of sleep, mobility, and pill adherence, as well as biomarkers assessed using a mobile device, including cardiac measures, glucose, gastric reflux, respiratory measures, and intensity of head-related injury. Conclusion Mobile devices are being widely used in clinical research to assess outcomes, although their use in interventional research to assess therapeutic effectiveness is limited. For mobile devices to be used more frequently in pivotal interventional research – such as trials informing regulatory decision-making – more focus should be placed on: (1) consolidating the evidence supporting the clinical meaningfulness of specific mobile outcomes, and (2) standardizing the use of mobile devices in clinical research to measure specific mobile outcomes (e.g., data capture frequencies, placement of device). To that aim, this manuscript offers a broad overview of the various mobile outcome assessments currently used in observational and interventional research, and categorizes and consolidates this information for researchers interested in using mobile devices to assess outcomes in interventional research.
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Affiliation(s)
- Brian Perry
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Clinical Trials Transformation Initiative, Durham, North Carolina, USA
| | - Will Herrington
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jennifer C Goldsack
- Clinical Trials Transformation Initiative, Durham, North Carolina, USA.,Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Cheryl A Grandinetti
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Kaveeta P Vasisht
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Martin J Landray
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Lauren Bataille
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York, USA
| | | | - Corey Bradley
- Duke University Hospital, Durham, North Carolina, USA
| | | | - Elektra J Papadopoulos
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Nirav Sheth
- MicroMedicine, Watertown, Massachusetts, USA
| | - Ken Skodacek
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland, USA
| | | | | | - Marc K Walton
- Janssen Research and Development, Titusville, New Jersey, USA
| | - Amy Corneli
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Clinical Trials Transformation Initiative, Durham, North Carolina, USA
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16
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Lee SP, Ha G, Wright DE, Ma Y, Sen-Gupta E, Haubrich NR, Branche PC, Li W, Huppert GL, Johnson M, Mutlu HB, Li K, Sheth N, Wright JA, Huang Y, Mansour M, Rogers JA, Ghaffari R. Highly flexible, wearable, and disposable cardiac biosensors for remote and ambulatory monitoring. NPJ Digit Med 2018; 1:2. [PMID: 31304288 PMCID: PMC6550217 DOI: 10.1038/s41746-017-0009-x] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [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: 04/19/2017] [Revised: 06/15/2017] [Accepted: 07/07/2017] [Indexed: 11/15/2022] Open
Abstract
Contemporary cardiac and heart rate monitoring devices capture physiological signals using optical and electrode-based sensors. However, these devices generally lack the form factor and mechanical flexibility necessary for use in ambulatory and home environments. Here, we report an ultrathin (~1 mm average thickness) and highly flexible wearable cardiac sensor (WiSP) designed to be minimal in cost (disposable), light weight (1.2 g), water resistant, and capable of wireless energy harvesting. Theoretical analyses of system-level bending mechanics show the advantages of WiSP’s flexible electronics, soft encapsulation layers and bioadhesives, enabling intimate skin coupling. A clinical feasibility study conducted in atrial fibrillation patients demonstrates that the WiSP device effectively measures cardiac signals matching the Holter monitor, and is more comfortable. WiSP’s physical attributes and performance results demonstrate its utility for monitoring cardiac signals during daily activity, exertion and sleep, with implications for home-based care. A highly flexible, low-power wearable sensor that harvests energy and monitors cardiac signals has been developed by Lee et al. The team was led by Dr. Roozbeh Ghaffari and co-workers at MC10 Inc. and Northwestern University’s Center for Bio-Integrated Electronics at the Simpson & Querrey Institute, in collaboration with the Massachusetts General Hospital and Tsinghua University. The novel wearable sensors measure cardiac signals comparable in signal fidelity to those achievable with expensive monitoring systems used in hospitals. Wearable health-care solutions are fundamentally changing the way we monitor our well-being at all times of the day, no matter whether we are asleep at home or busy at work. The sensors reported here are lightweight, inexpensive to manufacture, robust to everyday use, and capable of wireless data transmission and energy harvesting to and from a smartphone. The approach proved successful for measuring episodic electrocardiograms (ECG) and continuous heart rate signals with significantly higher patient comfort scores compared to standard Holter monitors in an initial pilot study conducted at the Massachusetts General Hospital (MGH).
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Affiliation(s)
| | - Grace Ha
- 2Massachusetts General Hospital, Boston, MA 02114 USA
| | | | - Yinji Ma
- 3AML, Department of Engineering Mechanics, Center for Mechanics and Materials, Tsinghua University, Beijing, 100084 China.,4Department of Civil and Environmental Engineering, Mechanical Engineering, and Materials Science and Engineering, Northwestern University, Evanston, IL 60208 USA
| | | | | | | | | | | | | | | | - Kan Li
- 4Department of Civil and Environmental Engineering, Mechanical Engineering, and Materials Science and Engineering, Northwestern University, Evanston, IL 60208 USA
| | | | | | - Yonggang Huang
- 4Department of Civil and Environmental Engineering, Mechanical Engineering, and Materials Science and Engineering, Northwestern University, Evanston, IL 60208 USA.,5Center for Bio-Integrated Electronics, Departments of Materials Science and Engineering, Biomedical Engineering, Chemistry, Mechanical Engineering, Electrical Engineering and Computer Science, and Neurological Surgery, Simpson Querrey Institute for Nano/Biotechnology, McCormick School of Engineering, Northwestern University, Evanston, IL 60208 USA
| | | | - John A Rogers
- 5Center for Bio-Integrated Electronics, Departments of Materials Science and Engineering, Biomedical Engineering, Chemistry, Mechanical Engineering, Electrical Engineering and Computer Science, and Neurological Surgery, Simpson Querrey Institute for Nano/Biotechnology, McCormick School of Engineering, Northwestern University, Evanston, IL 60208 USA
| | - Roozbeh Ghaffari
- 1MC10 Inc, Lexington, MA 02421 USA.,5Center for Bio-Integrated Electronics, Departments of Materials Science and Engineering, Biomedical Engineering, Chemistry, Mechanical Engineering, Electrical Engineering and Computer Science, and Neurological Surgery, Simpson Querrey Institute for Nano/Biotechnology, McCormick School of Engineering, Northwestern University, Evanston, IL 60208 USA
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17
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Sun R, Moon Y, McGinnis RS, Seagers K, Motl RW, Sheth N, Wright JA, Ghaffari R, Patel S, Sosnoff JJ. Assessment of Postural Sway in Individuals with Multiple Sclerosis Using a Novel Wearable Inertial Sensor. Digit Biomark 2018; 2:1-10. [PMID: 32095755 DOI: 10.1159/000485958] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [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: 11/18/2017] [Accepted: 11/29/2017] [Indexed: 11/19/2022] Open
Abstract
Balance impairment is common in individuals with multiple sclerosis (MS). However, objective assessment of balance usually requires clinical expertise and/or the use of expensive and obtrusive measuring equipment. These barriers to the objective assessment of balance may be overcome with the development of a lightweight inertial sensor system. In this study, we examined the concurrent validity of a novel wireless, skin-mounted inertial sensor system (BioStamp®, MC10 Inc.) to measure postural sway in individuals with MS by comparing measurement agreement between this novel sensor and gold standard measurement tools (force plate and externally validated inertial sensor). A total of 39 individuals with MS and 15 healthy controls participated in the study. Participants with MS were divided into groups based on the amount of impairment (MS<sub>Mild</sub>: EDSS 2-4, n = 19; MS<sub>Severe</sub>: EDSS ≥6, n = 20). The balance assessment consisted of two 30-s quiet standing trials in each of three conditions: eyes open/firm surface, eyes closed/firm surface, and eyes open/foam surface. For each trial, postural sway was recorded with a force plate (Bertec) and simultaneously using two accelerometers (BioStamp and Xsens) mounted on the participant's posterior trunk at L5. Sway metrics (sway area, sway path length, root mean square amplitude, mean velocity, JERK, and total power) were derived to compare the measurement agreement among the measurement devices. Excellent agreement (intraclass correlation coefficients >0.9) between sway metrics derived from the BioStamp and the MTx sensors were observed across all conditions and groups. Good to excellent correlations (r >0.7) between devices were observed in all sway metrics and conditions. Additionally, the acceleration sway metrics were nearly as effective as the force plate sway metrics in differentiating individuals with poor balance from healthy controls. Overall, the BioStamp sensor is a valid and objective measurement tool for postural sway assessment. This novel, lightweight and portable sensor may offer unique advantages in tracking patient's postural performance.
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Affiliation(s)
- Ruopeng Sun
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Yaejin Moon
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Ryan S McGinnis
- Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, Vermont, USA
| | | | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | | | | | | | - Jacob J Sosnoff
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
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18
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Sheth N, Osborn V, Lee A, Schwartz D, Schreiber D. Association of Nadir PSA >0.5ng/Ml after Dose Escalated External Beam Radiation With Prostate Cancer-Specific Endpoints. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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19
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Osborn V, Givi B, Roden D, Katsoulakis E, Sheth N, Lederman A, Schwartz D, Schreiber D. Patterns of Care and Outcomes of Adjuvant Therapy for High Risk Head and Neck Cancer After Surgery. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1470] [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: 11/16/2022]
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20
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Adams JL, Dinesh K, Xiong M, Tarolli CG, Sharma S, Sheth N, Aranyosi AJ, Zhu W, Goldenthal S, Biglan KM, Dorsey ER, Sharma G. Multiple Wearable Sensors in Parkinson and Huntington Disease Individuals: A Pilot Study in Clinic and at Home. Digit Biomark 2017; 1:52-63. [PMID: 32095745 DOI: 10.1159/000479018] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [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: 04/12/2017] [Accepted: 06/26/2017] [Indexed: 12/24/2022] Open
Abstract
Background Clinician rating scales and patient-reported outcomes are the principal means of assessing motor symptoms in Parkinson disease and Huntington disease. However, these assessments are subjective and generally limited to episodic in-person visits. Wearable sensors can objectively and continuously measure motor features and could be valuable in clinical research and care. Methods We recruited participants with Parkinson disease, Huntington disease, and prodromal Huntington disease (individuals who carry the genetic marker but do not yet exhibit symptoms of the disease), and controls to wear 5 accelerometer-based sensors on their chest and limbs for standardized in-clinic assessments and for 2 days at home. The study's aims were to assess the feasibility of use of wearable sensors, to determine the activity (lying, sitting, standing, walking) of participants, and to survey participants on their experience. Results Fifty-six individuals (16 with Parkinson disease, 15 with Huntington disease, 5 with prodromal Huntington disease, and 20 controls) were enrolled in the study. Data were successfully obtained from 99.3% (278/280) of sensors dispatched. On average, individuals with Huntington disease spent over 50% of the total time lying down, substantially more than individuals with prodromal Huntington disease (33%, p = 0.003), Parkinson disease (38%, p = 0.01), and controls (34%; p < 0.001). Most (86%) participants were "willing" or "very willing" to wear the sensors again. Conclusions Among individuals with movement disorders, the use of wearable sensors in clinic and at home was feasible and well-received. These sensors can identify statistically significant differences in activity profiles between individuals with movement disorders and those without. In addition, continuous, objective monitoring can reveal disease characteristics not observed in clinic.
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Affiliation(s)
- Jamie L Adams
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA.,Center for Health and Technology, University of Rochester Medical Center, Rochester, New York, USA
| | - Karthik Dinesh
- Department of Electrical and Computer Engineering, University of Rochester Medical Center, Rochester, New York, USA
| | - Mulin Xiong
- Center for Health and Technology, University of Rochester Medical Center, Rochester, New York, USA
| | - Christopher G Tarolli
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA.,Center for Health and Technology, University of Rochester Medical Center, Rochester, New York, USA
| | - Saloni Sharma
- Center for Health and Technology, University of Rochester Medical Center, Rochester, New York, USA
| | | | | | - William Zhu
- Center for Health and Technology, University of Rochester Medical Center, Rochester, New York, USA
| | - Steven Goldenthal
- Center for Health and Technology, University of Rochester Medical Center, Rochester, New York, USA
| | - Kevin M Biglan
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA.,Center for Health and Technology, University of Rochester Medical Center, Rochester, New York, USA
| | - E Ray Dorsey
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA.,Center for Health and Technology, University of Rochester Medical Center, Rochester, New York, USA
| | - Gaurav Sharma
- Department of Electrical and Computer Engineering, University of Rochester Medical Center, Rochester, New York, USA.,Department of Computer Science, University of Rochester, Rochester, New York, USA
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21
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Salvo G, Iniesta M, Lasala J, Meyer L, Munsell M, Sheth N, Ramirez P. Bowel procedures during gynecologic surgery on an enhanced recovery program (ERP): Are perioperative outcomes compromised? Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.142] [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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22
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McGinnis RS, Mahadevan N, Moon Y, Seagers K, Sheth N, Wright JA, DiCristofaro S, Silva I, Jortberg E, Ceruolo M, Pindado JA, Sosnoff J, Ghaffari R, Patel S. A machine learning approach for gait speed estimation using skin-mounted wearable sensors: From healthy controls to individuals with multiple sclerosis. PLoS One 2017; 12:e0178366. [PMID: 28570570 PMCID: PMC5453431 DOI: 10.1371/journal.pone.0178366] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [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: 07/05/2016] [Accepted: 05/11/2017] [Indexed: 11/19/2022] Open
Abstract
Gait speed is a powerful clinical marker for mobility impairment in patients suffering from neurological disorders. However, assessment of gait speed in coordination with delivery of comprehensive care is usually constrained to clinical environments and is often limited due to mounting demands on the availability of trained clinical staff. These limitations in assessment design could give rise to poor ecological validity and limited ability to tailor interventions to individual patients. Recent advances in wearable sensor technologies have fostered the development of new methods for monitoring parameters that characterize mobility impairment, such as gait speed, outside the clinic, and therefore address many of the limitations associated with clinical assessments. However, these methods are often validated using normal gait patterns; and extending their utility to subjects with gait impairments continues to be a challenge. In this paper, we present a machine learning method for estimating gait speed using a configurable array of skin-mounted, conformal accelerometers. We establish the accuracy of this technique on treadmill walking data from subjects with normal gait patterns and subjects with multiple sclerosis-induced gait impairments. For subjects with normal gait, the best performing model systematically overestimates speed by only 0.01 m/s, detects changes in speed to within less than 1%, and achieves a root-mean-square-error of 0.12 m/s. Extending these models trained on normal gait to subjects with gait impairments yields only minor changes in model performance. For example, for subjects with gait impairments, the best performing model systematically overestimates speed by 0.01 m/s, quantifies changes in speed to within 1%, and achieves a root-mean-square-error of 0.14 m/s. Additional analyses demonstrate that there is no correlation between gait speed estimation error and impairment severity, and that the estimated speeds maintain the clinical significance of ground truth speed in this population. These results support the use of wearable accelerometer arrays for estimating walking speed in normal subjects and their extension to MS patient cohorts with gait impairment.
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Affiliation(s)
- Ryan S. McGinnis
- MC10, Inc., Lexington, Massachusetts, United States of America
- Department of Biomedical Engineering, University of Vermont, Burlington, Vermont, United States of America
| | | | - Yaejin Moon
- Motor Control Research Laboratory, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States of America
| | - Kirsten Seagers
- MC10, Inc., Lexington, Massachusetts, United States of America
| | - Nirav Sheth
- MC10, Inc., Lexington, Massachusetts, United States of America
| | - John A. Wright
- MC10, Inc., Lexington, Massachusetts, United States of America
| | | | - Ikaro Silva
- MC10, Inc., Lexington, Massachusetts, United States of America
| | - Elise Jortberg
- MC10, Inc., Lexington, Massachusetts, United States of America
| | - Melissa Ceruolo
- MC10, Inc., Lexington, Massachusetts, United States of America
| | | | - Jacob Sosnoff
- Motor Control Research Laboratory, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States of America
| | | | - Shyamal Patel
- MC10, Inc., Lexington, Massachusetts, United States of America
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23
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Bulat E, Davey S, Massawe H, Pallangyo A, Premkumar A, Sheth N. The Prevalence of Proximal DVT in Orthopaedic Trauma Patients in Northern
Tanzania Without the Routine Use of Thromboprophylaxis. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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24
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Moon Y, McGinnis RS, Seagers K, Motl RW, Sheth N, Wright JA, Ghaffari R, Sosnoff JJ. Monitoring gait in multiple sclerosis with novel wearable motion sensors. PLoS One 2017; 12:e0171346. [PMID: 28178288 PMCID: PMC5298289 DOI: 10.1371/journal.pone.0171346] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [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: 10/27/2016] [Accepted: 01/19/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Mobility impairment is common in people with multiple sclerosis (PwMS) and there is a need to assess mobility in remote settings. Here, we apply a novel wireless, skin-mounted, and conformal inertial sensor (BioStampRC, MC10 Inc.) to examine gait characteristics of PwMS under controlled conditions. We determine the accuracy and precision of BioStampRC in measuring gait kinematics by comparing to contemporary research-grade measurement devices. METHODS A total of 45 PwMS, who presented with diverse walking impairment (Mild MS = 15, Moderate MS = 15, Severe MS = 15), and 15 healthy control subjects participated in the study. Participants completed a series of clinical walking tests. During the tests participants were instrumented with BioStampRC and MTx (Xsens, Inc.) sensors on their shanks, as well as an activity monitor GT3X (Actigraph, Inc.) on their non-dominant hip. Shank angular velocity was simultaneously measured with the inertial sensors. Step number and temporal gait parameters were calculated from the data recorded by each sensor. Visual inspection and the MTx served as the reference standards for computing the step number and temporal parameters, respectively. Accuracy (error) and precision (variance of error) was assessed based on absolute and relative metrics. Temporal parameters were compared across groups using ANOVA. RESULTS Mean accuracy±precision for the BioStampRC was 2±2 steps error for step number, 6±9ms error for stride time and 6±7ms error for step time (0.6-2.6% relative error). Swing time had the least accuracy±precision (25±19ms error, 5±4% relative error) among the parameters. GT3X had the least accuracy±precision (8±14% relative error) in step number estimate among the devices. Both MTx and BioStampRC detected significantly distinct gait characteristics between PwMS with different disability levels (p<0.01). CONCLUSION BioStampRC sensors accurately and precisely measure gait parameters in PwMS across diverse walking impairment levels and detected differences in gait characteristics by disability level in PwMS. This technology has the potential to provide granular monitoring of gait both inside and outside the clinic.
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Affiliation(s)
- Yaejin Moon
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Ryan S. McGinnis
- Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, Vermont, United States of America
| | - Kirsten Seagers
- MC10 Inc., Lexington, Massachusetts, United States of America
| | - Robert W. Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Nirav Sheth
- MC10 Inc., Lexington, Massachusetts, United States of America
| | - John A. Wright
- MC10 Inc., Lexington, Massachusetts, United States of America
| | | | - Jacob J. Sosnoff
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
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Sheth N, Tabibian A, Rose J, Alvelo M, Perel C, Laiken K, Kim A. SU-F-T-604: Dosimetric Evaluation of Intracranial Stereotactic Radiotherapy Plans On a LINAC. Med Phys 2016. [DOI: 10.1118/1.4956789] [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: 11/07/2022] Open
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26
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Tabibian A, Kim A, Rose J, Alvelo M, Perel C, Laiken K, Sheth N. SU-F-T-387: A Novel Optimization Technique for Field in Field (FIF) Chestwall Radiation Therapy Using a Single Plan to Improve Delivery Safety and Treatment Planning Efficiency. Med Phys 2016. [DOI: 10.1118/1.4956572] [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: 11/07/2022] Open
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27
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Mistry N, Kim A, Schaum J, Bermudez M, Driscoll K, Holowinski C, Yang C, Chen Y, Sheth N. SU-E-T-320: Dosimetric Evaluation of Intracranial Stereotactic Radiotherapy Plans Using Jaws-Only Collimation On a LINAC. Med Phys 2015. [DOI: 10.1118/1.4924681] [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: 11/07/2022] Open
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28
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Locatelli F, Choukroun G, Fliser D, Moecks J, Wiggenhauser A, Gupta A, Swinkels DW, Lin V, Guss C, Pratt R, Carrilho P, Martins AR, Alves M, Mateus A, Gusmao L, Parreira L, Assuncao J, Rodrigues I, Stamopoulos D, Mpakirtzi N, Afentakis N, Grapsa E, Zitt E, Sturm G, Kronenberg F, Neyer U, Knoll F, Lhotta K, Weiss G, Robinson BM, Larkina M, Bieber B, Kleophas W, Li Y, Locatelli F, McCullough K, Nolen JG, Port FK, Pisoni RL, Kalicki RM, Uehlinger DE, Ogawa C, Kanda F, Tomosugi N, Maeda T, Kuji T, Fujikawa T, Shino M, Shibata K, Kaneda T, Nishihara M, Satta H, Kawata SI, Koguchi N, Tamura K, Hirawa N, Toya Y, Umemura S, Chanliau J, Martin H, Stamatelou K, Gonzalez-Tabares L, Manamley N, Farouk M, Addison J, Donck J, Schneider A, Gutjahr-Lengsfeld L, Ritz E, Scharnagl H, Gelbrich G, Pilz S, Macdougall IC, Wanner C, Drechsler C, Kuntsevich V, Charen E, Kobena D, Sheth N, Siktel H, Levin NW, Winchester JF, Kotanko P, Kaysen G, Kuragano T, Kida A, Yahiro M, Nanami M, Nagasawa Y, Hasuike Y, Nakanishi T, Stamopoulos D, Mpakirtzi N, Dimitratou V, Griveas I, Lianos E, Grapsa E, Sasaki Y, Yamazaki S, Fujita K, Kurasawa M, Yorozu K, Shimonaka Y, Suzuki N, Yamamoto M, Zwiech R, Szczepa ska J, Bruzda-Zwiech A, Rao A, Gilg J, Caskey F, Kirkpantur A, Balci MM, Turkvatan A, Afsar B, Alkis M, Mandiroglu F, Kim YO, Yoon SA, Kim YS, Choi SJ, Min JW, Cheong MA, Hasuike Y, Kida A, Oue M, Yamamoto K, Kimura T, Fukao W, Yahiro M, Kaibe S, Nanami M, Nakanishi T, Djuric PS, Ikonomovski J, Tosic J, Jankovic A, Majster Z, Stankovic Popovic V, Dimkovic N, Aicardi Spalloni V, Del Vecchio L, Longhi S, Violo L, La Milia V, Pontoriero G, Locatelli F, Shino M, Kuji T, Fujikawa T, Toya Y, Umemura S, Macdougall I, Rumjon A, Mangahis E, Goldstein L, Ryzlewicz T, Becker F, Kilgallon W, Fukasawa M, Otake Y, Yamagishi T, Kamiyama M, Kobayashi H, Takeda M, Toida T, Sato Y, Fujimoto S. DIALYSIS ANAEMIA. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Coleman AJ, Penney GP, Richardson TJ, Guyot A, Choi MJ, Sheth N, Craythorne E, Robson A, Mallipeddi R. Automated registration of optical coherence tomography and dermoscopy in the assessment of sub-clinical spread in basal cell carcinoma. ACTA ACUST UNITED AC 2014; 19:1-12. [PMID: 24784842 PMCID: PMC4075257 DOI: 10.3109/10929088.2014.885085] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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] [Indexed: 11/13/2022]
Abstract
Optical coherence tomography (OCT) has been shown to be of clinical value in imaging basal cell carcinoma (BCC). A novel dual OCT-video imaging system, providing automated registration of OCT and dermoscopy, has been developed to assess the potential of OCT in measuring the degree of sub-clinical spread of BCC. Seventeen patients selected for Mohs micrographic surgery (MMS) for BCC were recruited to the study. The extent of BCC infiltration beyond a segment of the clinically assessed pre-surgical border was evaluated using OCT. Sufficiently accurate (<0.5 mm) registration of OCT and dermoscopy images was achieved in 9 patients. The location of the OCT-assessed BCC border was also compared with that of the final surgical defect. Infiltration of BCC across the clinical border ranged from 0 mm to >2.5 mm. In addition, the OCT border lay between 0.5 mm and 2.0 mm inside the final MMS defect in those cases where this could be assessed. In one case, where the final MMS defect was over 17 mm from the clinical border, OCT showed >2.5 mm infiltration across the clinical border at the FOV limit. These results provide evidence that OCT allows more accurate assessment of sub-clinical spread of BCC than clinical observation alone. Such a capability may have clinical value in reducing the number of surgical stages in MMS for BCC. There may also be a role for OCT in aiding the selection of patients most suitable for MMS.
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Affiliation(s)
- A J Coleman
- Medical Physics Department, Guy's and St. Thomas' Foundation Trust , London
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Anchlia S, Parmar B, Garg B, Sheth N, Agarwal M. Outcome assessment of six different surgical techniques in the management of temporomandibular joint ankylosis. A retrospective evaluation of 467 joints. Int J Oral Maxillofac Surg 2013. [DOI: 10.1016/j.ijom.2013.07.664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Barlow R, Mallipeddi R, Sheth N. Is Mohs micrographic surgery more effective than wide local excision for treatment of dermatofibrosarcoma protuberans in reducing risk of local recurrence? A critically appraised topic. Br J Dermatol 2012; 168:229-30. [DOI: 10.1111/bjd.12053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Sheth N, Mistry N, Sim S, Weiss M, Grebler A, Geltzeiler J, Litvin Y, Keselman I, Waldman I, Yang C. Validation of Inverse Planning-simulated Annealing Class Solution for Prostate High-dose-rate Brachytherapy. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sheth N, Chen Y, Yang J. SU-E-T-453: Optimization of Dose Gradient for Gamma Knife Radiosurgery. Med Phys 2012; 39:3809. [DOI: 10.1118/1.4735542] [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: 11/07/2022] Open
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Yang C, Sheth N, Chen Y. SU-E-T-378: Dosimetry Comparison of VMAT and Tomotherapy Plans with Dose Painting in Brain Metastases. Med Phys 2012. [DOI: 10.1118/1.4735465] [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: 11/07/2022] Open
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Sheth N, Mistry N, Chen Y, Yang C. SU-E-T-428: Class Solution for Prostate High Dose Rate Brachytherapy with Inverse Planning Simulated Annealing. Med Phys 2012; 39:3803. [DOI: 10.1118/1.4735517] [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: 11/07/2022] Open
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Sheth N, Kandala S, Chen Y, Yang C. SU-E-J-34: Influence of Prone versus Supine Patient Position on Localization with Image Guided Radiotherapy of Prostate Cancer. Med Phys 2012; 39:3660. [DOI: 10.1118/1.4734868] [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: 11/07/2022] Open
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Cunha D, Richardson T, Sheth N, Orchard G, Coleman A, Mallipeddi R. Comparison of ex vivo optical coherence tomography with conventional frozen-section histology for visualizing basal cell carcinoma during Mohs micrographic surgery. Br J Dermatol 2011; 165:576-80. [DOI: 10.1111/j.1365-2133.2011.10461.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Sheth N, Cheng J, Jani A, Sim S, Murphy S, Chen Y, Stapleton P, Winant S, Yang C. SU-E-T-877: Dosimetric Evaluation of Intracranial Stereotactic Radiotherapy with Helical Tomotherapy. Med Phys 2011. [DOI: 10.1118/1.3612841] [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: 11/07/2022] Open
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Yang C, Chen Y, Sheth N, Murphy S, Wu G. SU-E-T-617: Dosimetric Comparison of Prone Breast Treatment on Tomotherapy and Conventional LINAC. Med Phys 2011. [DOI: 10.1118/1.3612580] [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: 11/07/2022] Open
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Murphy S, Yang C, Sheth N, Chen Y. TU-A-BRA-01: Non-Coplanar Treatment of Hypofractionated Intracranial SRT with Tomotherapy. Med Phys 2010. [DOI: 10.1118/1.3469162] [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: 11/07/2022] Open
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Sheth N, Murphy S, Chen Y, Yang C. SU-GG-I-103: Comparison of Model-Based Segmentation Systems for Contouring of Male Pelvic Structures. Med Phys 2010. [DOI: 10.1118/1.4755940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Murphy S, Sim S, Sheth N, Weiss M, Yang J. Intracranial Hypofractionated Stereotactic Radiotherapy with Different Head Positions Utilizing a New Positioning Device. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.1546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sheth N, Sarker SJ, Harries M, Healy C, Russell-Jones R, Acland K. Predictors of patient satisfaction with initial diagnosis and management of malignant melanoma. Clin Exp Dermatol 2009; 35:599-602. [DOI: 10.1111/j.1365-2230.2009.03639.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sheth N, Yang C, Murphy S, Weiss M, Sim S. SU-FF-T-87: Dose Reconstruction of Intracranial Hypofractionated Helical Tomotherapy Treatments for Adaptive Planning. Med Phys 2009. [DOI: 10.1118/1.3181560] [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: 11/07/2022] Open
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Yang C, Sheth N, Murphy S, Sim S, Chen Y. SU-FF-T-664: Dose Grid Effects in Adaptive Planning of Helical TomoTherapy for Hypofractionated Treatments. Med Phys 2009. [DOI: 10.1118/1.3182162] [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: 11/07/2022] Open
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Vaghasiya J, Sheth N, Bhalodia Y, Jivani N. Diabetes type-II exaggerates renal ischemia reperfusion injury by elevation of oxidative stress and inflammatory response. J Young Pharm 2009. [DOI: 10.4103/0975-1483.55748] [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: 11/04/2022] Open
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Yang C, Weiss M, Sheth N, Murphy S. An Efficient Way to Determine the Needle Tip in Real Time Seed Implant Procedure. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.158] [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: 11/26/2022]
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Yang C, Sheth N, Murphy S, Chen Y. SU-GG-T-33: Accurate Localization of the Needle Position During the Real Time Seed Implant Procedure in OR. Med Phys 2008. [DOI: 10.1118/1.2961783] [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: 11/07/2022] Open
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