{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,9,4]],"date-time":"2024-09-04T05:54:53Z","timestamp":1725429293517},"reference-count":49,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2022,4,18]],"date-time":"2022-04-18T00:00:00Z","timestamp":1650240000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Physics"],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Pancreatic cancer is the fourth leading cause of cancer\u2010related death with a 10% 5\u2010year overall survival rate (OS). Radiation therapy (RT) in addition to dose escalation improves the outcome by significantly increasing the OS at 2 and 3 years but is hindered by the toxicity of the duodenum. Our group showed that the insertion of hydrogel spacer reduces duodenal toxicity, but the complex anatomy and the demanding procedure make the benefits highly uncertain. Here, we investigated the feasibility of augmenting the workflow with intraoperative feedback to reduce the adverse effects of the uncertainties.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>We simulated three scenarios of the virtual spacer for four cadavers with two types of gross tumor volume (GTV) (small and large); first, the ideal injection; second, the nonideal injection that incorporates common spacer placement uncertainties; and third, the corrective injection that uses the simulation result from nonideal injection and is designed to compensate for the effect of uncertainties. We considered two common uncertainties: (1) \u201cNarrowing\u201d is defined as the injection of smaller spacer volume than planned. (2) \u201cMissing part\u201d is defined as failure to inject spacer in the ascending section of the duodenum. A total of 32 stereotactic body radiation therapy (SBRT) plans (33\u00a0Gy in 5 fractions) were designed, for four cadavers, two GTV sizes, and two types of uncertainties. The preinjection scenario for each case was compared with three scenarios of virtual spacer placement from the dosimetric and geometric points of view.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We found that the overlapping PTV space with the duodenum is an informative quantity for determining the effective location of the spacer. The ideal spacer distribution reduced the duodenal V33Gy for small and large GTV to less than 0.3 and 0.1cc, from an average of 3.3cc, and 1.2cc for the preinjection scenario. However, spacer placement uncertainties reduced the efficacy of the spacer in sparing the duodenum (duodenal V33Gy: 1.3 and 0.4cc). The separation between duodenum and GTV decreased by an average of 5.3 and 4.6\u00a0mm. The corrective feedback can effectively bring back the expected benefits from the ideal location of the spacer (averaged V33Gy of 0.4 and 0.1cc).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>An informative feedback metric was introduced and used to mitigate the effect of spacer placement uncertainties and maximize the benefits of the EUS\u2010guided procedure.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mp.15665","type":"journal-article","created":{"date-parts":[[2022,4,18]],"date-time":"2022-04-18T16:12:16Z","timestamp":1650298336000},"page":"4794-4803","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Demonstrating the benefits of corrective intraoperative feedback in improving the quality of duodenal hydrogel spacer placement"],"prefix":"10.1002","volume":"49","author":[{"given":"Hamed","family":"Hooshangnejad","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering Johns Hopkins School of Medicine  Baltimore Maryland USA"},{"name":"Department of Radiation Oncology and Molecular Radiation Sciences Johns Hopkins School of Medicine  Baltimore Maryland USA"},{"name":"Carnegie Center for Surgical Innovation Johns Hopkins School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Han\u2010Oh","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology and Molecular Radiation Sciences Johns Hopkins School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eun Ji","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Johns Hopkins School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amol","family":"Narang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology and Molecular Radiation Sciences Johns Hopkins School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Avani Dholakia","family":"Rao","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology and Molecular Radiation Sciences Johns Hopkins School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junghoon","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology and Molecular Radiation Sciences Johns Hopkins School of Medicine  Baltimore Maryland USA"},{"name":"Carnegie Center for Surgical Innovation Johns Hopkins School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Todd","family":"McNutt","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology and Molecular Radiation Sciences Johns Hopkins School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chen","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology and Molecular Radiation Sciences Johns Hopkins School of Medicine  Baltimore Maryland USA"},{"name":"Division of Biostatistics and Bioinformatics Sidney Kimmel Comprehensive Cancer Center Johns Hopkins School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology and Molecular Radiation Sciences Johns Hopkins School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kai","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology and Molecular Radiation Sciences Johns Hopkins School of Medicine  Baltimore Maryland USA"},{"name":"Carnegie Center for Surgical Innovation Johns Hopkins School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,4,18]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21654"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2015.12.003"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2019.07.012"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014-020-01731-z"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.21873\/anticanres.14801"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2017.08.006"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.adro.2021.100757"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prro.2020.01.013"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.15197"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.13266"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2018.02.024"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.12100"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1109\/TBME.2016.2612229"},{"key":"e_1_2_10_15_1","doi-asserted-by":"crossref","unstructured":"\u015eenHT BellMAL ZhangY et\u00a0al.System integration and preliminary in\u2010vivo experiments of a robot for ultrasound guidance and monitoring during radiotherapy. In:2015 International Conference on Advanced Robotics (ICAR);2015:53\u201059","DOI":"10.1109\/ICAR.2015.7251433"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.3389\/frobt.2016.00049"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1109\/TMI.2021.3087450"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361-6560\/ab33db"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1515\/raon-2016-0036"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1089\/end.2019.0431"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2014-206931"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.disamonth.2019.02.004"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prro.2016.10.004"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.14990"},{"key":"e_1_2_10_25_1","volume-title":"Medical Physics","author":"Hooshangnejad H","year":"2021"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.3109\/00365528809093914"},{"key":"e_1_2_10_27_1","unstructured":"MuhletalerA.Sonog ra ph ic Assessment the Bowel Wall of."},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2009.04.066"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40323-015-0049-1"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1109\/TMI.2016.2597313"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.7150\/thno.37965"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1115\/1.4033846"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmbbm.2011.05.030"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9780511663406"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361-6560\/aa9a30"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2018.07.184"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.4769424"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2014.07.009"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2010.05.026"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2012.06.047"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.833231"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2017.09.017"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.1038\/natrevmats.2016.71"},{"key":"e_1_2_10_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.coche.2016.11.003"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.asj.2007.12.005"},{"key":"e_1_2_10_46_1","doi-asserted-by":"publisher","DOI":"10.1080\/0284186X.2016.1275781"},{"key":"e_1_2_10_47_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2021.759811"},{"key":"e_1_2_10_48_1","doi-asserted-by":"publisher","DOI":"10.12913\/22998624\/62771"},{"key":"e_1_2_10_49_1","doi-asserted-by":"crossref","unstructured":"HooshangnejadH DingK.Feasibility of planning\u2010CT\u2010free rapid workflow for stereotactic body radiotherapy: removing the need for planning CT by AI\u2010driven intelligent prediction of body deformation.Proceedings of SPIE;2022.","DOI":"10.1117\/12.2611484"},{"key":"e_1_2_10_50_1","doi-asserted-by":"crossref","unstructured":"FongJ MarcalP RainsbergerR MaL HeckertN FillibenJ Finite element method solution uncertainty asymptotic solution and a new approach to accuracy assessment. In:Proceedings of ASME Verification and Validation Symposium May 16\u201318 2018 Minneapolis MN USA;2018.","DOI":"10.1115\/VVS2018-9320"}],"container-title":["Medical Physics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mp.15665","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/mp.15665","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mp.15665","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,20]],"date-time":"2023-08-20T00:26:06Z","timestamp":1692491166000},"score":1,"resource":{"primary":{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/10.1002\/mp.15665"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,18]]},"references-count":49,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2022,7]]}},"alternative-id":["10.1002\/mp.15665"],"URL":"https:\/\/doi.org\/10.1002\/mp.15665","archive":["Portico"],"relation":{},"ISSN":["0094-2405","2473-4209"],"issn-type":[{"value":"0094-2405","type":"print"},{"value":"2473-4209","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,18]]},"assertion":[{"value":"2021-10-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-04-03","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-04-18","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}