Alex Merkulov

Ultrasound-Guided Diffuse Optical Tomography for Predicting and Monitoring Neoadjuvant Chemotherapy of Breast Cancers Recent Progress

In this manuscript, we review the current progress of utilizing ultrasound-guided diffuse optical tomography (US-guided DOT) for predicting and monitoring neoadjuvant chemotherapy (NAC) outcomes of breast cancer patients. We also report the recent advance on optical tomography systems toward portable and robust clinical use at multiple clinical sites. The first patient who has been closely monitored before NAC, at day 2, day 8, end of first three cycles of NAC, and before surgery is given as an example to demonstrate the potential of US-guided DOT technique.

Coregistered photoacoustic and ultrasound imaging and classification of ovarian cancer: ex vivo and in vivo studies

Abstract. Most ovarian cancers are diagnosed at advanced stages due to the lack of efficacious screening techniques. Photoacoustic tomography (PAT) has a potential to image tumor angiogenesis and detect early neovascular changes of the ovary. We have developed a coregistered PAT and ultrasound (US) prototype system for real-time assessment of ovarian masses. Features extracted from PAT and US angular beams, envelopes, and images were input to a logistic classifier and a support vector machine (SVM) classifier to diagnose ovaries as benign or malignant. A total of 25 excised ovaries of 15 patients were studied and the logistic and SVM classifiers achieved sensitivities of 70.4 and 87.7%, and specificities of 95.6 and 97.9%, respectively. Furthermore, the ovaries of two patients were noninvasively imaged using the PAT/US system before surgical excision. By using five significant features and the logistic classifier, 12 out of 14 images (86% sensitivity) from a malignant ovarian mass and all 17 images (100% specificity) from a benign mass were accurately classified; the SVM correctly classified 10 out of 14 malignant images (71% sensitivity) and all 17 benign images (100% specificity). These initial results demonstrate the clinical potential of the PAT/US technique for ovarian cancer diagnosis.

The radiology assistant: a contrarian’s view

Recent and rapid increases in the utilization of diagnostic imaging have not been matched by concomitant additions to the supply of radiologists and radiology technologists. One proposal to alleviate an expected worsening of this emerging workforce crisis is to create a new job category, the radiology assistant (RA), encompassing a roster of enhanced capabilities that would allow the radiologists to divest themselves of some of their non-interpretative duties with respect to the performance of imaging tests. Through the collaborative efforts of the American College of Radiology and the American Society of Radiology Technologists a nationally recognized, baccalaureate-level curriculum has been designed for the training of RAs. A centerpiece of the curriculum is instruction in fluoroscopy. However, examinations of the GI tract by fluoroscopy are rapidly declining in frequency, raising doubt about the enhanced value an RA would bring to a radiology practice in the near future and worries about encroachment on the range of radiologists’ responsibilities over the long term.

Penetration of Günther Tulip filter struts through an introducer sheath: case report and safety concerns.

The authors present a patient who had a Günther-Tulip inferior vena cava filter placed under fluoroscopic guidance. The filter struts were seen to penetrate through the introducer sheath at deployment. This was believed to be secondary to a kink in the sheath at the site of venous entry and was due to the patients nuchal obesity as well as his inability to turn his head to the opposite side. The introducer sheath was then placed through a long reinforced metal sheath through which the filter was then placed without complication.

Technical Challenges in TIPS Creation via the Right Subclavian Vein

This report describes a 64-year-old man with Laennec cirrhosis requiring a transjugular intrahepatic portosystemic shunt (TIPS) to alleviate ascites before surgical mesh repair of a large symptomatic umbilical hernia. During the procedure, both internal jugular veins and the right external jugular vein were found to be occluded. The right subclavian vein was accessed and a TIPS was successfully created. Some of the technical challenges encountered in performing the procedure from the right subclavian vein are described.