Beaumont Health

About: Beaumont Health is a nonprofit organization based out in Royal Oak, Michigan, United States. It is known for research contribution in the topics: Medicine & Population. The organization has 1483 authors who have published 1448 publications receiving 15407 citations. The organization is also known as: William Beaumont Health System & Beaumont Hospitals.

The Effects of Pulsed Radiation Therapy on Tumor Oxygenation in 2 Murine Models of Head and Neck Squamous Cell Carcinoma.

Abstract: Purpose To evaluate the efficacy of low-dose pulsed radiation therapy (PRT) in 2 head and neck squamous cell carcinoma (HNSCC) xenografts and to investigate the mechanism of action of PRT compared with standard radiation therapy (SRT). Methods and Materials Subcutaneous radiosensitive UT-SCC-14 and radioresistant UT-SCC-15 xenografts were established in athymic NIH III HO female mice. Tumors were irradiated with 2 Gy/day by continuous standard delivery (SRT: 2 Gy) or discontinuous low-dose pulsed delivery (PRT: 0.2 Gy × 10 with 3-min pulse interval) to total doses of 20 Gy (UT14) or 40 Gy (UT15) using a clinical 5-day on/2-day off schedule. Treatment response was assessed by changes in tumor volume, 18 F-fluorodeoxyglucose (FDG) (tumor metabolism), and 18 F-fluoromisonidazole (FMISO) (hypoxia) positron emission tomography (PET) imaging before, at midpoint, and after treatment. Tumor hypoxia using pimonidazole staining and vascular density (CD34 staining) were assessed by quantitative histopathology. Results UT15 and UT14 tumors responded similarly in terms of growth delay to either SRT or PRT. When compared with UT14 tumors, UT15 tumors demonstrated significantly lower uptake of FDG at all time points after irradiation. UT14 tumors demonstrated higher levels of tumor hypoxia after SRT when compared with PRT as measured by 18 F-FMISO PET. By contrast, no differences were seen in 18 F-FMISO PET imaging between SRT and PRT for UT15 tumors. Histologic analysis of pimonidazole staining mimicked the 18 F-FMISO PET imaging data, showing an increase in hypoxia in SRT-treated UT14 tumors but not PRT-treated tumors. Conclusions Differences in 18 F-FMISO uptake for UT14 tumors after radiation therapy between PRT and SRT were measurable despite the similar tumor growth delay responses. In UT15 tumors, both SRT and PRT were equally effective at reducing tumor hypoxia to a significant level as measured by 18 F-FMISO and pimonidazole.

Comparison of Self-Reported Data on Student Doctor Network to Objective Data of the National Resident Matching Program.

Abstract: Purpose To compare matching outcomes between self-reporting on Student Doctor Network (SDN) and objective data from the National Resident Matching Program (NRMP). Materials and Methods Data were collected from SDN starting in the 2010 to 2011 academic year and extending to the 2015 to 2016 academic year. A total of 193 radiation oncology applicants had reported data during the period. A total of four applicants (2.1%) did not match and were excluded from the analysis. Applicants were compared with the NRMP charting outcomes of 2011, 2014, and 2016. Results US allopathic seniors comprised a majority of those reporting on SDN (95.2%). The majority of applicants (58.2%) self-reported in the later years between 2014 and 2016. Those reporting on SDN were more likely to be members of Alpha Omega Alpha (39.7% on SDN versus 27.5% in 2016 NRMP, 23.6% in 2014 NRMP, and 31.2% in 2011 NRMP) and had higher mean United States Medical Licensing Examination (USMLE) step 1 and step 2 scores. Of the applicants, 81% matched within their top three ranked residencies on their match list. Common themes associated with reasons for their successful match included research experience, letters of recommendation, and away rotations. Common themes associated with advice given to future applicants were the importance of research, personality, and away rotations. Conclusion Self-reporting on SDN does have a bias toward more successful radiation oncology applicants compared with the objective NRMP data. However, if self-reporting increases, SDN may serve as a reasonably accurate source of information for future applicants.

Assessing the use of 4DCT-ventilation in pre-operative surgical lung cancer evaluation

Abstract: Purpose A primary treatment option for lung cancer patients is surgical resection. Patients who have poor lung function prior to surgery are at increased risk of developing serious and life-threatening complications after surgical resection. Surgeons use nuclear medicine ventilation-perfusion (VQ) scans along with pulmonary function test (PFT) information to assess a patient's pre-surgical lung function. The nuclear medicine images and pre-surgery PFTs are used to calculate percent predicted postoperative (%PPO) PFT values by estimating the amount of functioning lung tissue that would be lost with surgical resection. Nuclear medicine imaging is currently considered the standard of care when evaluating the amount of ventilation that would be lost due to surgery. A novel lung function imaging modality has been developed in radiation oncology that uses 4-Dimensional computed tomography data to calculate ventilation maps (4DCT-ventilation). Compared to nuclear medicine, 4DCT-ventilation is cheaper, does not require a radioactive contrast agent, provides a faster imaging procedure, and has improved spatial resolution. In this work we perform a retrospective study to assess the use of 4DCT-ventilation as a pre-operative surgical lung function evaluation tool. Specifically, the purpose of our study was to compare %PPO PFT values calculated with 4DCT-ventilation and %PPO PFT values calculated with nuclear medicine ventilation-perfusion imaging. Methods The study included 16 lung cancer patients that had undergone 4DCT imaging, nuclear medicine imaging, and had Forced Expiratory Volume in 1 second (FEV1) acquired as part of a standard PFT. The 4DCT datasets, spatial registration, and a density-change-based model were used to compute 4DCT-ventilation maps. Both 4DCT-ventilation and nuclear medicine images were used to calculate %PPO FEV1. The %PPO FEV1 was calculated by scaling the pre-surgical FEV1 by (1-fraction of total resected ventilation); where the resected ventilation was determined using either the 4DCT-ventilation or nuclear medicine imaging. Calculations were done assuming both lobectomy and pneumonectomy resections. The %PPO FEV1 values were compared between the 4DCT-ventilation-based calculations and the nuclear medicine-based calculations using correlation coefficients, average differences, and Receiver Operating Characteristic (ROC) analysis. Results Overall the 4DCT-ventilation derived %PPO FEV1 values agreed well with nuclear medicine-derived %PPO FEV1 data with correlations of 0.99 and 0.81 for lobectomy and pneumonectomy, respectively. The average differences between the 4DCT-ventilation and nuclear medicine-based calculation for %PPO FEV1 were less than 5%. ROC analysis revealed predictive accuracy that ranged from 87.5% to 100% when assessing the ability of 4DCT-ventilation to predict for nuclear medicine-based %PPO FEV1 values. Conclusions 4DCT-ventilation is an innovative technology developed in radiation oncology that has great potential to translate to the surgical domain. The high correlation results when comparing 4DCT-ventilation to the current standard of care provide a strong rationale for a prospective clinical trial assessing 4DCT-ventilation in the clinical setting. 4DCT-ventilation can reduce the cost and imaging time for patients while providing improved spatial accuracy and quantitative results for surgeons.

The Association of Preoperative Opioid Usage with Patient-Reported Outcomes, Adverse Events, and Return to Work after Lumbar Fusion: Analysis from the Michigan Spine Surgery Improvement Collaborative (MSSIC)

Abstract: BACKGROUND It is important to delineate the relationship between opioid use and spine surgery outcomes. OBJECTIVE To determine the association between preoperative opioid usage and postoperative adverse events, patient satisfaction, return to work, and improvement in Oswestry Disability Index (ODI) in patients undergoing lumbar fusion procedures by using 2-yr data from a prospective spine registry. METHODS Preoperative opioid chronicity from 8693 lumbar fusion patients was defined as opioid-naive (no usage), new users ( 6 mo). Multivariate generalized estimating equation models were constructed. RESULTS All comparisons were to opioid-naive patients. Chronic opioid users showed less satisfaction with their procedure at 90 d (Relative Risk (RR) 0.95, P = .001), 1 yr (RR 0.89, P = .001), and 2 yr (RR 0.89, P = .005). New opioid users were more likely to show improvement in ODI at 90 d (RR 1.25, P < .001), 1 yr (RR 1.17, P < .001), and 2 yr (RR 1.19, P = .002). Short-term opioid users were more likely to show ODI improvement at 90 d (RR 1.25, P < .001). Chronic opioid users were less likely to show ODI improvement at 90 d (RR 0.90, P = .004), 1 yr (RR 0.85, P < .001), and 2 yr (RR 0.80, P = .003). Chronic opioid users were less likely to return to work at 90 d (RR 0.80, P < .001). CONCLUSION In lumbar fusion patients and when compared to opioid-naive patients, new opioid users were more likely and chronic opioid users less likely to have improved ODI scores 2 yr after surgery. Chronic opioid users are less likely to be satisfied with their procedure 2 yr after surgery and less likely to return to work at 90 d. Preoperative opioid counseling is advised.

Missed peritalar injuries: an analysis of factors in cases of known delayed diagnosis and methods for improving identification.

Abstract: Because of the complex anatomy of the foot, rarity of fractures of the foot, and subtle radiographic cues, foot injuries are commonly overlooked and mis/undiagnosed. This study seeks to investigate a patient population whose peritalar injuries, including fractures and dislocations, were missed on initial examination, in order to analyze factors of known, missed injuries and provide insight into methods for reducing the incidence of missed diagnoses. Surgical cases between January 1999 and May 2011 were queried and retrospectively reviewed to identify missed peritalar injuries. Of 1682 surgical cases reviewed, 27 patients with missed peritalar injury(ies), which were subsequently confirmed by imaging studies, were identified. Using the Orthopaedic Trauma Association classification, fracture and dislocation subtypes were classified. A medical record review was performed to assess demographic and surgical data elements. In this study population, 7 types of peritalar injuries (talus, calcaneal, navicular, and...