Therapy Treatment Research Articles

Adenomas hipofisarios no funcionantes. Incidentaloma hipofisario

Non-functioning pituitary adenomas (NFPAs) are tumors of the pituitary gland that are usually benign and show no clinical or biochemical signs of excessive hormone production. These tumors manifest clinically when they are large enough to exert pressure on surrounding structures. Among pituitary incidentaloma, NFPAs are the most common, as they are often diagnosed accidentally during imaging tests performed for other reasons. To properly evaluate these tumors and their relationship to other structures, the use of contrast-enhanced MRI is preferred. In addition, it is necessary to perform a hormonal analysis to rule out hormonal alterations and a neuro-ophthalmological examination in those cases in which the adenomas are close to the optic chiasm or cavernous sinuses, or in patients who present vision problems. In cases where the tumors are symptomless, observation is an option. However, transsphenoidal surgery is the first-line treatment for patients with symptoms or large tumors. Other options include radiation therapy and medical treatment with dopaminergic agonists and other drugs that are being explored more recently.

327.5: 10GE pig-to-baboon lung xenotransplantation, combined with immunosuppressive therapy and pharmacologic treatment.

327.5: 10GE pig-to-baboon lung xenotransplantation, combined with immunosuppressive therapy and pharmacologic treatment.

Properties analysis on interlayer within lithium target and its beam uniformity for accelerator-based Boron Neutron Capture Therapy

In order to enhance the performance and lifetime of the lithium target used in accelerator-based neutron sources for Boron Neutron Capture Therapy (BNCT) treatment, an exploration of target design was conducted based on the 2.8 MeV, 20 mA proton beam. A comparison between scanning magnets and octupole magnets was performed for beam uniform, with octupole magnets selected to effectively avoid localized high thermal densities over short durations. Exploration was conducted on the performance of tantalum and vanadium as interlayers within the lithium target, considering aspects such as cooling, hydrogen diffusion, and neutron performances. This study revealed that, as the majority of energy deposition occurs within the interlayer, the presence of an appropriately thick tantalum or vanadium interlayer has minimal impact on cooling effectiveness, ensuring temperatures remain below 144 °C. The addition of an interlayer effectively reduces the maximum hydrogen concentration in copper, thus preventing copper blistering. Within the investigated thickness range, the interlayer does not affect neutron spectrum in the forward direction of the target, mitigating concerns regarding its impact on beam shaping.

Intracranial Hypertension Revealing Neuro-Behçet Disease With Favourable Outcome After Ventriculoperitoneal Shunt

A 39-year-old man had been diagnosed after rolling out all the other possible causes as having intracranial hypertension with bilateral papilledema secondary to Behçet’s disease with normal MRI scan. Despite treatment with steroids, methylprednisolone and repetitive LPs, he had little to no improvement. The patient later underwent a ventriculoperitoneal shunt operation with corticosteroid therapy and adjuvant treatment with topiramate and acetazolamide, which resulted in symptoms improvement. Thus, it is important to consider NBD in the differential diagnosis of patients with intracranial hypertension and bilateral papilledema and also ventriculoperitoneal shunting as an effective therapeutic alternative when medical treatment fail to normalize the intracranial hypertension building up

470. INTENSIVE EARLY SURVEILLANCE FOLLOWING ESOPHAGECTOMY IDENTIFIES DISTINCT PATTERNS OF RECURRENCE

Abstract Background There remains a lack of consensus about the protocol for follow-up following esophagectomy. Some centers will utilize a purely radiological approach to follow-up, while others will include routine endoscopy and blood markers. Furthermore, the frequency of follow-up is debated, though many centers will follow-up every 3 months due to the high recurrence rate in the first year. We follow patients every 3 months for the first year, every 6 months for the next year, then yearly to 5 years, solely with CT scans unless symptoms indicate endoscopy. We sought to examine our recurrence rate and survival using this follow-up protocol. Methods We reviewed our prospectively collected database for recurrence following esophagectomy in patients operated from March 2018 to May 2022. Consenting patients >18 years of age who underwent esophagectomy were included. Demographics including age, sex, and BMI, tumor factors including pathologic stage, tumor regression grade, and neoadjuvant therapy and post-recurrence treatment data were collected. Results We identified 190 patients who underwent esophagectomy and 69 patients had a recurrence. Patients with recurrence were younger (61.3 +/- 10.2 vs 66.4 +/- 10.1, p=0.001), were more likely pT3 (59.4% vs 36.4%, p=0.013) and have a tumor regression grade of 3 (27.5% vs 7.4%, p=0.002). There was no difference between patients with R1 resections vs R0 (5.8% vs 6.6%, p=0.824). Most recurrences were identified on CT scan (95.8%). For patients who recurred within 3 months, the mean time from operation to death was 9.11 months. Patients who recurred between 3-6mo, 6-9mo, and 9-12mo died at 17.1mo, 15.7mo, and 17.5mo following surgery, respectively. Patients who recurred in the next year died around 40 months from surgery. Conclusion As with other reports in the literature, recurrence is highest in the first year after esophagectomy. Patients recurring in the first 3 months had a short survival following esophagectomy and may represent missed micrometastatic disease at staging. Interestingly, patients who recurred between 3-12 months all had a similar time to death from the date of operation, suggesting lead-time bias for those detected at 3-6months. Early and later recurrence appear to have distinct biological behaviours. With improved and tailored adjuvant therapies, earlier detection may yet be beneficial and will require further study.

Neutron and photon calculations of beam shaping assembly for BNCT based on Monte Carlo-discrete ordinates coupled method

The radiation field parameters at the beam shaping assembly (BSA) exit port are the key to boron neutron capture therapy (BNCT) treatment. However, obtaining calculation results with high efficiency and accuracy using only Monte Carlo (MC) method or discrete ordinates (SN) method is difficult. Based on NECP-MCX code and Marvin code, this paper implemented the Monte Carlo-discrete ordinates coupled method and applied this method to the calculation of the radiation field at the BSA exit port. The effect of mesh grid division, the order of quadrature set, and the bias of quadrature set on the results of the coupled calculation was studied. It was concluded that the order and bias of the quadrature set have not improved the coupled calculation results. It was found that the data library used in the SN calculation is the main cause. Therefore, the Monte Carlo-discrete ordinates coupled method can be quickly and accurately applied to the calculation of the radiation field at the BSA exit port by dividing the energy and coordinate intervals rationally and using a more suitable cross section library.

Association of Rate of Functional Recovery With Therapy Time and Content Among Adults With Acquired Brain Injuries in Inpatient Rehabilitation

ObjectiveTo examine associations among the time and content of rehabilitation treatment with self-care and mobility functional gain rate for adults with acquired brain injury. DesignRetrospective cohort study using electronic health record and administrative billing data. SettingInpatient rehabilitation unit at a large, academic medical center. ParticipantsAdults with primary diagnosis of stroke, traumatic brain injury, or nontraumatic brain injury admitted to the inpatient rehabilitation unit between 2012 and 2017 (N=799). InterventionsNot applicable. Main Outcome MeasuresGain rate in self-care and mobility function, using the Functional Independence Measure. Hierarchical regression models were used to identify the contributions of baseline characteristics, units, and content of occupational therapy, physical therapy, and speech-language pathology treatment to functional gain rates. ResultsMedian length of rehabilitation stay was 10 days (interquartile range, 8-13d). Patients received an mean of 10.62 units of therapy (SD, 2.05) daily. For self-care care gain rate, the best-fitting model accounted for 32% of the variance. Occupational therapy activities of daily living units were positively associated with gain rate. For mobility gain rate, the best-fitting model accounted for 37% of the variance. Higher amounts of physical therapy bed mobility training were inversely associated with mobility gain rate. ConclusionsMore activities of daily living in occupational therapy is associated with faster improvement on self-care function for adults with acquired brain injury, whereas more bed mobility in physical therapy was associated with slower improvement. A potential challenge with value-based payments is the alignment between clinically appropriate therapy activities and the metrics by which patient improvement are evaluated. There is a risk that therapists and facilities will prioritize activities that drive improvement on metrics and deemphasize other patient-centered goals.

Invasive Treatment Strategy for Older Patients with Myocardial Infarction

BackgroundWhether a conservative strategy of medical therapy alone or a strategy of medical therapy plus invasive treatment is more beneficial in older adults with non–ST-segment elevation myocardial infarction (NSTEMI) remains unclear.MethodsWe conducted a prospective, multicenter, randomized trial involving patients 75 years of age or older with NSTEMI at 48 sites in the United Kingdom. The patients were assigned in a 1:1 ratio to a conservative strategy of the best available medical therapy or an invasive strategy of coronary angiography and revascularization plus the best available medical therapy. Patients who were frail or had a high burden of coexisting conditions were eligible. The primary outcome was a composite of death from cardiovascular causes (cardiovascular death) or nonfatal myocardial infarction assessed in a time-to-event analysis.ResultsA total of 1518 patients underwent randomization; 753 patients were assigned to the invasive-strategy group and 765 to the conservative-strategy group. The mean age of the patients was 82 years, 45% were women, and 32% were frail. A primary-outcome event occurred in 193 patients (25.6%) in the invasive-strategy group and 201 patients (26.3%) in the conservative-strategy group (hazard ratio, 0.94; 95% confidence interval [CI], 0.77 to 1.14; P=0.53) over a median follow-up of 4.1 years. Cardiovascular death occurred in 15.8% of the patients in the invasive-strategy group and 14.2% of the patients in the conservative-strategy group (hazard ratio, 1.11; 95% CI, 0.86 to 1.44). Nonfatal myocardial infarction occurred in 11.7% in the invasive-strategy group and 15.0% in the conservative-strategy group (hazard ratio, 0.75; 95% CI, 0.57 to 0.99). Procedural complications occurred in less than 1% of the patients.ConclusionsIn older adults with NSTEMI, an invasive strategy did not result in a significantly lower risk of cardiovascular death or nonfatal myocardial infarction (the composite primary outcome) than a conservative strategy over a median follow-up of 4.1 years. (Funded by the British Heart Foundation; BHF SENIOR-RITA ISRCTN Registry number, ISRCTN11343602.)

Can silver diamine fluoride reduce invasive treatments with general anesthesia?

This study aims to retrospectively evaluate the differences in dental treatments rendered in general anesthesia (GA) for patients who did or did not receive application of silver diamine fluoride (SDF) prior to GA. 1559 patients (≤6 years) who completed treatment with GA for caries at University of California San Francisco (UCSF) between 2015 and 2019 were included in the study. At baseline patients' electronic health record was reviewed to collect planned treatment, complete dental treatment and demographics. Patients were identified as SDF group (N = 335, 21.49%) or comparison (N = 1224, 78.51%). Dental treatments rendered were compared between the SDF and comparison group with multi-variable regression, including variables for demographics and clinical findings at baseline. The initial analysis identified variations in gender, age, dental pain, pulp involvement, and initial treatment plans between the SDF and comparison groups at baseline. In an unadjusted analysis, the SDF group displayed a statistically significant increase in the number of crown procedures but a notable decrease in the number of pulp therapy and extraction treatments completed (p < 0.05). An adjusted multivariable model affirmed the inverse relationship between SDF application and completion of pulp therapy and extractions at the time of GA (p < 0.05). No significant association was identified with the total number of crowns needed and SDF. The model further indicated a positive correlation between the total count of pulp therapy and extractions completed with patient age and the wait-time for GA. In conclusion, pre-GA application of SDF to carious primary teeth is negatively correlated with completed pulp therapy and extraction. SDF application prior to dental treatment with GA may be a valuable tool to reduce invasive dental procedures in GA.

970P Comparing clinical outcomes between PD-1 and PD-L1 inhibitors plus bevacizumab combined with hepatic arterial interventional therapies in unresectable hepatocellular carcinoma: A single-center, real-world study

970P Comparing clinical outcomes between PD-1 and PD-L1 inhibitors plus bevacizumab combined with hepatic arterial interventional therapies in unresectable hepatocellular carcinoma: A single-center, real-world study

Medium-to Long-term Outcomes of Rex Shunt in 105 Children With Extrahepatic Portal Vein Obstruction in China

PurposeThe aim of our study was to analyze the medium-to long-term outcomes of Rex shunts in a large series of children with extrahepatic portal vein obstruction (EHPVO). MethodsThe clinical data of 105 children aged between 6 months and 16 years with EHPVO who underwent Rex shunt between October 2014 and June 2021 at our center were retrospectively reviewed after more than 2 years of follow-up. ResultsThe overall patency rate of the Rex shunt was 91.43% (96/105) during a median follow-up of 41 months (range, 24–98 months). Eighty-seven (82.86%) of the 105 patients underwent classical Rex shunt with internal jugular vein (IJV) bypass, and the remaining 18 patients (17.14%) underwent modified Rex shunt with intra-abdominal vein bypass. Patients with a patent shunt experienced portal hypertension resolution, which was characterized by a reduction in portal pressure, disappearance of variceal bleeding, relief of gastroesophageal varices, and relief of splenomegaly or hypersplenism. The rate of Rex shunt thrombosis in our center was 8.57% (9/105), and a repeat Rex shunt was effective for the treatment of graft thrombosis. Anastomotic stenosis occurred in 14.26% (15/105) of the children, 38.46% (5/13) of whom received successful endovascular intervention therapy and experienced remission of portal hypertension symptoms. The patency rate of the classical Rex shunt was higher than that of the modified Rex shunt (97.70% vs. 61.11%), whereas the rate of vascular complications, including anastomotic stenosis and graft thrombosis, of the classical Rex shunt was lower than that of the modified Rex shunt (11.49% vs. 77.78%). Further comparison revealed that the risk of vascular complications was substantially greater in the modified Rex shunt group than in the classical Rex shunt group in the nonadjusted model, minimally adjusted model, and fully adjusted model (RR ranged from 6.77 to 7.07, all p < 0.001). ConclusionsThe Rex shunt provides medium-to long-term benefits for children with EHPVO. The classical Rex shunt with IJV bypass provides the best patency rate and the fewest vascular complications. Levels of EvidenceⅢ Type of StudyRetrospective comparative study.

A deep learning model for personalized intra-arterial therapy planning in unresectable hepatocellular carcinoma: a multicenter retrospective study

Unresectable Hepatocellular Carcinoma (uHCC) poses a substantial global health challenge, demanding innovative prognostic and therapeutic planning tools for improved patient management. The predominant treatment strategies include Transarterial chemoembolization (TACE) and hepatic arterial infusion chemotherapy (HAIC). Between January 2014 and November 2021, a total of 1725 uHCC patients [mean age, 52.8±11.5 years; 1529 males] received preoperative CECT scans and were eligible for TACE or HAIC. Patients were assigned to one of the four cohorts according to their treatment, four transformer models (SELECTION) were trained and validated on each cohort; AUC was used to determine the prognostic performance of the trained models. Patients were stratified into high and low-risk groups based on the survival scores computed by SELECTION. The proposed AI-based treatment decision model (ATOM) utilizes survival scores to further inform final therapeutic recommendation. In this study, the training and validation sets included 1448 patients, with an additional 277 patients allocated to the external validation sets. The SELECTION model outperformed both clinical models and the ResNet approach in terms of AUC. Specifically, SELECTION-TACE and SELECTION-HAIC achieved AUCs of 0.761 (95% CI, 0.693-0.820) and 0.805 (95% CI, 0.707-0.881) respectively, in predicting ORR in their external validation cohorts. In predicting OS, SELECTION-TC and SELECTION-HC demonstrated AUCs of 0.736 (95% CI, 0.608-0.841) and 0.748 (95% CI, 0.599-0.865) respectively, in their external validation sets. SELECTION-derived survival scores effectively stratified patients into high and low-risk groups, showing significant differences in survival probabilities (P<0.05 across all four cohorts). Additionally, the concordance between ATOM and clinician recommendations was associated with significantly higher response/survival rates in cases of agreement, particularly within the TACE, HAIC, and TC cohorts in the external validation sets (P<0.05). ATOM was proposed based on SELECTION-derived survival scores, emerges as a promising tool to inform the selection among different intra-arterial interventional therapy techniques. This study received funding from the Beijing Municipal Natural Science Foundation, China (Z190024); the Key Program of the National Natural Science Foundation of China, China (81930119); The Science and Technology Planning Program of Beijing Municipal Science & Technology Commission and Administrative Commission of Zhongguancun Science Park, China (Z231100004823012); Tsinghua University Initiative Scientific Research Program of Precision Medicine, China (10001020108); and Institute for Intelligent Healthcare, Tsinghua University, China (041531001).

Application of ultrasound in the diagnosis, evaluation, and interventional therapy monitoring of patent foramen ovale

Abstract To explore the impact of pre-intervention ultrasound diagnosis results of PFO and evaluation criteria on the success rate of surgery, intraoperative ultrasound monitoring methods, and postoperative ultrasound follow-up results, and to analyse the results of ultrasound-related examinations and the evaluation value of the success rate of surgery and interventional efficacy. A total of 1617 patients with related symptoms who were diagnosed and treated in our hospital from January 2022 to March 2023 were selected for screening, and transthoracic echocardiography (TTE), contrast transthoracic echocardiography (cTTE), and contrast-enhanced Transcranial Doppler (cTCD) were performed. Positive patients were selected for transesophageal Echocardiography (TEE). And interventional surgery for patent foramen ovale in 70 of these patients. cTTE was performed 3 months and 6 months respectively after surgery to evaluate the therapeutic efficacy. Among the 1617 cases of cTTE, 938 cases were positive, including 538 cases of grade 1, 198 cases of grade 2, and 202 cases of grade 3. TEE was performed in 317 patients with positive cTTE, and 228 patients were diagnosed as PFO with definite shunt. Then selected 76 patients of grade 2-3 in cTTE with positive TEE to perform the closure surgery of the PFO, and 70 cases were successfully operated, with a success rate of 92.11%. cTTE、cTCD and TEE results are correlated with the success rate of interventional surgery. Evaluation using multiple ultrasound techniques can provide guidance for rational selection of treatment in clinical application.

Beyond body mass index: Body composition profiling for perioperative risk stratification in intrahepatic cholangiocarcinoma patients.

Intrahepatic cholangiocarcinoma (iCC) is an aggressive tumor, usually detected at an advanced stage. Our aim was to investigate the potential of body composition analysis (BCA) derived from presurgical staging computed tomography (CT) in predicting perisurgical complications. In this retrospective cohort study, we enrolled 86 patients who underwent CT imaging prior to liver surgery. Cox and logistic regression were performed to assess risk factors for prolonged hospital and intensive care unit (ICU) stays, as well as the occurrence of various complications. BCA parameters served as covariates besides conventional risk factors. Postoperative complications after resection of iCC significantly prolonged the overall length of hospitalization (p < .001). Presence of sarcopenia was associated with longer ICU stays. Complications were common, with 62.5% classified as Clavien-Dindo grade IIIa or lower and 37.5% as more severe. Subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) were identified as risk factors for complications, including bile leakage (in 24 cases, p = .025), pleural effusions (in 26 cases, p = .025), and intra-abdominal abscess formation (in 24 cases, p = .043). SAT was associated with severe complications requiring interventional therapy, whereas VAT was correlated with abscess formation. Despite normal prevalence of obesity (22%), body mass index (BMI) did not have an impact on the development of perioperative complications. BCA is a useful tool for preoperative risk stratification in patients with iCC and is superior to BMI assessment. Increased SAT and VAT were associated with the risk of perisurgical complications, prolonging hospitalization. Therefore, BCA derived from routine staging CT should be considered in the preoperative assessment of patients with iCC.

Recommendations for Implementation of Dog Therapy Intervention in the Athletic Training Facility

Dog therapy is implemented in various healthcare fields because of its unique ability to reduce perceived anxiety and hormonal stress, increase positive patient relationships with practitioners, and assist with demonstrating procedures. However, implementation of dog therapy in a clinical athletic training setting is not frequently discussed in relevant literature. This article outlines recommendations for the use and efficacy of therapy dogs in an athletic training facility, based on data from several studies across various healthcare fields. We provide information regarding best practice recommendations to incorporate therapy dogs into athletic training services, as well as the necessary administrative aspects and safeguards. Athletic trainers can use these recommendations and framework to explore the implementation of dog therapy into clinical practice.

Physical therapy registries worldwide: A systematic review.

Nowadays, the demand for physical therapy services has grown significantly over the last few decades due to an aging population, a rise in chronic conditions, and increased awareness of the benefits of physical therapy for injury recovery and managing various health issues. Collecting and managing data from physical therapy services is highly significant and beneficial. One of the information management systems that facilitates data collection related to physical therapy services is a physical therapy registry. In this systematic review, we aimed to identify physical therapy registries worldwide and examine the characteristics and data elements of each registry. PubMed, Scopus, Web of Science, and IEEE databases were searched from inception until March 19, 2023 by using keywords and Medical Subject Headings (MeSH) terms regarding "registries" and "physical therapy." The criteria for inclusion in the study were: (1) studies with the English language; (2) original studies, and online access to the physical therapy registry is available; (3) full-text available; (4) studies related to the aims of the study, and (5) studies that have sufficient available information regarding the minimum datasets and other characteristics physical therapy registry. The methodological quality of the included studies was independently assessed by two reviewers using the Effective Public Health Practice Project's (EPHPP) quality assessment tool. Sixteen studies were eligible to be included. The findings of this review indicated that the oldest physical therapy registry was established in 1992, while the newest one was established in 2017. The USA has the highest number of physical therapy registries (n = 7). Ten registries were funded by the government, and the data source for most registries was collected in clinics (n = 11). The geographical coverage of 10 registries was national. All registries collected administrative data (such as sociodemographic data, healthcare provider's data, and others) and clinical data (such as diagnosis, type of physical therapy intervention, pain location, comorbidities, and others) through web-based systems. The data collection method in half of the registries was retrospective (n = 8 out of 16). According to the EPHPP quality assessment tool, 11 studies (73%) were rated as moderate, 3 (20%) as weak, and 1 (7%) as strong. This systematic review found that most developed countries have implemented web-based physical therapy registries to collect administrative and clinical data at the national level. It is recommended that developing countries design and implement similar registries based on these characteristics and extracted data elements. Additionally, these registries should be designed to enable data sharing and interoperability with other international health information systems.

Preventing Surgeon Work-Related Musculoskeletal Disorders: A Pilot Study of the Comprehensive Operating Room Ergonomics (CORE) Program.

Work-related musculoskeletal disorders (WMSDs) among surgeons are markedly increasing. Several proposed interventions to reduce WMSDs among surgeons have been studied, but few follow an occupational therapy-oriented approach addressing biomechanical, psychophysical, and psychosocial risk factors. To design, implement, and assess the potential of the Comprehensive Operating Room Ergonomics (CORE) program for surgeons, a holistic evidence-based ergonomics and wellness intervention grounded in occupational therapy principles. Mixed-methods pilot study with the quantitative strand embedded in the qualitative strand. University-affiliated hospital. Six laparoscopic surgeons. CORE program outcomes were assessed using qualitative and quantitative data to indicate changes in posture, physical discomfort, sense of wellness, and operating room (OR) ergonomic performance. The Rapid Upper Limb Assessment (RULA) was used to quantify surgeons' WMSD risk level before and after intervention. There were 12 baseline observations (two for each participant), and two or three post-CORE implementation observations. A statistically significant difference, F(1, 6) = 8.57, p = .03, was found between pre- and post-occupational therapy intervention RULA scores. Thematic analysis of surgeon feedback, which was overwhelmingly positive, identified five themes: postural alignment, areas of commonly reported physical pain or discomfort, setup of the OR environment, surgical ergonomics training, and ergonomics in everyday life. The CORE program effectively decreased ergonomic risk factors to optimize surgeons' occupational performance in the OR. This study demonstrates a potential solution to how occupational therapists can holistically support surgeons and health care providers who are at risk for WMSDs. Plain-Language Summary: By 2025, a surgeon shortage is expected, partly because of the increase in surgeons' work-related musculoskeletal disorders, which affect their health and job continuity. This pilot study shows that the Comprehensive Operating Room Ergonomics program effectively addresses these problems. The study also serves as a framework for occupational therapy professionals to work with health care providers on ergonomics, benefiting population health. Results suggest that this approach could enhance surgeons' work conditions, supporting the American Occupational Therapy Association's Vision 2025 to improve health and quality of life.

The crane project: Mixed-methods analysis of an expressive art therapy intervention to promote collective healing during the COVID-19 pandemic.

The crane project: Mixed-methods analysis of an expressive art therapy intervention to promote collective healing during the COVID-19 pandemic.

Factors associated with electroconvulsive therapy treatment for adults with serious psychiatric conditions in Australia.

To identify factors associated with receiving electroconvulsive therapy (ECT) for serious psychiatric conditions. Retrospective observational study using hospital administrative data linked with death registrations and outpatient mental health data in New South Wales (NSW), Australia. The cohort included patients admitted with a primary psychiatric diagnosis between 2013 and 2022. The outcome measure was receipt of ECT. Of 94,950 patients, 3465 (3.6%) received ECT. The likelihood of receiving ECT was higher in older (hazard ratio [HR] = 1.03), female (HR = 1.24) patients. Compared to depression, patients with schizophrenia/schizoaffective disorder (HR = 0.79), schizophrenia-related disorders (HR = 0.37), mania (HR = 0.64) and other mood disorders (HR = 0.45) had lower odds of receiving ECT. Patients with depression and one other serious psychiatric condition had higher odds of receiving ECT than depression alone. Bipolar disorder likelihood of ECT did not differ from depression. A higher number of mental health outpatient visits in the prior year and an involuntary index admission with depression were also associated with receiving ECT. Likelihood of receiving ECT increased with year of admission (HR = 1.32), private patient status (HR = 2.06), higher socioeconomic status (HR = 1.09) and being married (HR = 1.25). ECT use for depression and bipolar disorder in NSW aligns with clinical national guidelines. Patients with schizophrenia/schizoaffective, schizophrenia-related disorders, mania and other mood disorders had lower likelihood of ECT than depression, despite ECT being recommended by clinical guidelines for these diagnoses. Variations in ECT were strongly associated with healthcare access, with private patients twice as likely to receive ECT than their public counterparts, suggesting a need to explore ECT accessibility.

Visual Dose Monitoring for Whole Breast Radiation Therapy Treatments via Combined Cherenkov Imaging and Scintillation Dosimetry

PurposeThis study investigates scintillation dosimetry coupled with Cherenkov imaging for in vivo dose monitoring during whole breast radiotherapy (WBRT). Given recent observations of excess dose to the contralateral breast (CB), in vivo dosimetry (IVD) could help ensure accurate dose delivery and decrease risks of secondary cancer. This work presents a rapid, streamlined alternative to traditional IVD, providing direct visualization of measurement location relative to the treatment field on the patient. Methods and Materials10 WBRT patients consented under an IRB-approved protocol were monitored with scintillation dosimetry and always-on Cherenkov imaging, on both their treated and CB for one to three fractions. Scintillator dosimeters, small plastic discs 1mm thick and 15mm in diameter, were calibrated against optically-stimulated luminescent dosimeters (OSLDs) to generate an integral output-to-dose conversion, where integral output is measured in post-processing through a custom fitting algorithm. The discs have been extensively characterized in a previous study for various treatment conditions including beam energy and treatment geometry. ResultsN=44 dosimetry measurements were evaluated, including 22 treated breast and 22 CB measurements. Following integral output-to-dose calibration, in vivo scintillator dosimeters exhibited high linearity (R2=0.99) with paired OSLD readings across all patients. The difference between scintillation and OSLD dose measurements averaged 2.8% of the prescribed dose, or an absolute dose difference of approximately 7 cGy. ConclusionsIntegration of scintillation dosimetry with Cherenkov imaging offers an accurate, rapid alternative for in vivo dose verification in WBRT, circumventing the limitations of conventional point dosimeters. The additional benefit of visualizing measurement locations relative to the treatment field provides users an enhanced understanding of results and allows for detection of high dose gradients. Future work will explore the applicability of this technique across a broader range of radiotherapy treatments, aiming to streamline IVD practices.