Karius

BACKGROUND: CBCT imaging with field of views (FOVs) exceeding the size of scans acquired in the conventional imaging geometry, i.e. with opposing source and detector, is of high clinical importance for many medical fields. A novel approach for enlarged FOV scanning with one full-scan (EnFOV360) or two short-scans (EnFOV180) using an O-arm system arises from non-isocentric imaging based on independent source and detector rotations. PURPOSE: The presentation, description, and experimental validation of this novel approach and the novel scanning techniques EnFOV360 and EnFOV180 for an O-arm system forms the scope of this work...

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Thoracoabdominal normothermic regional perfusion (TA-NRP) has recently begun being utilized in the United States for recovery of cardiothoracic allografts from some donors after circulatory death (DCD), but data on lungs recovered in this method is limited to case reports. We conducted a national retrospective review of lung transplants from DCD donors recovered using TA-NRP. Of the 434 total DCD lung transplants performed between January 2020 and March 2022, 17 were recovered using TA-NRP. Compared to direct recovery DCD transplants, recipients of TA-NRP DCD transplants had lower likelihood of ventilation >48 hours (23...

BACKGROUND AND PURPOSE: To assess implant stability and identify causes of implant variations during high-dose-rate multi-catheter breast brachytherapy. MATERIALS AND METHODS: Planning-CTs were compared to control-CTs acquired halfway through the treatment for 100 patients. For assessing geometric stability, Fréchet-distance and button-to-button distance changes of all catheters as well as variations of Euclidean distances and convex hulls of all dwell positions were determined...

PURPOSE: To investigate differences in seed-displacements between the immediate post-implant phase (day 0-1) and the time to post-plan computed tomography (CT) (day 1-30) in seed prostate brachytherapy. MATERIALS AND METHODS: Seed positions were identified on the intra-operatively created ultrasound-based treatment plan (day 0) and CT scans of day 1 and 30 for 33 patients. The day 1 (30) seed arrangement was registered onto the day 0 (1) arrangement using a seed-only approach...

Timely diagnosis remains an unmet need in non-neutropenic patients at risk for aspergillosis, including those with COVID-19-associated pulmonary aspergillosis (CAPA), which in its early stages is characterized by tissue-invasive growth of the lungs with limited angioinvasion. Currently available mycological tests show limited sensitivity when testing blood specimens. Metagenomic next-generation sequencing (mNGS) to detect microbial cell-free DNA (mcfDNA) in plasma might overcome some of the limitations of conventional diagnostics...

BACKGROUND:  Age is a poor predictor of postoperative outcomes in breast reconstruction necessitating new methods for risk-stratifying patients preoperatively. The 5-item modified frailty index (mFI-5) is a validated measure of frailty which assesses patients' global health. The purpose of this study was to compare the effectiveness of mFI-5 and age as independent predictors of 30-day postoperative complications following autologous breast reconstruction. METHODS:  Patients who underwent autologous breast reconstruction between 2005 and 2019 were identified from the American College of Surgeons National Surgical Quality Improvement Program...

BACKGROUND: Cell-free next-generation sequencing (cfNGS) may have a unique role in the diagnosis of infectious complications in immunocompromised hosts. The rapid turnaround time and non-invasive nature make it a promising supplement to standard of care. METHODS: This retrospective, observational single-center study at a tertiary care medical center in Virginia investigated the use of cfNGS in clinical practice. Patients over age 18 years with cfNGS performed for any indication were included...

The diagnosis of Q fever can be challenging and a high index of suspicion is necessary. Within this case series, we highlight the utility of the microbial cell-free DNA next-generation sequencing or Karius Test in the timely diagnosis and management of acute Q fever.

We present 23 cases of Pneumocystis jirovecii pneumonia (PCP) diagnosed with commercially available noninvasive plasma microbial cell-free deoxyribonucleic acid (mcfDNA) assay. Our findings suggest that plasma mcfDNA testing resulted in positive clinical impact for the diagnosis and treatment of PCP and coinfections in 82.6% of cases.

BACKGROUND: Successful intraoperative microvascular anastomoses are essential for deep inferior epigastric perforator (DIEP) flap survival. This study identifies factors associated with anastomotic failure during DIEP flap reconstruction and analyzes the impact of these anastomotic failures on post-operative patient outcomes and surgical costs. METHODS: A retrospective cohort study was conducted of patients undergoing DIEP flap reconstruction at two high-volume tertiary care centers from January 2017 to December 2020...

Plasma cell-free metagenomic next-generation sequencing (cf-mNGS) is a non-invasive method that may be able to identify thousands of pathogens through a hypothesis-free approach. There is a lack of consensus on how this test compares to conventional microbiologic testing. We conducted a systematic review and meta-analysis of published studies evaluating the accuracy of plasma cf-mNGS in hospitalized patients and present pooled estimates of the positive (PPA) and negative percent agreement (NPA) compared to a composite reference standard that included all conventional microbiological testing and clinical history as assessed by an adjudication panel or clinical treatment team...

Plasma microbial cell-free DNA (cf-DNA) from next-generation sequencing (NGS) provides improved sensitivity and specificity compared to standard microbial blood cultures. cf-DNA sequencing also has an improved turnaround time (TAT) and allows quicker commencement of antibiotics in life-threatening infections such as a brain abscess. Brain abscesses carry significant morbidity and mortality. Empiric treatment and management are critical in improving functional neurological outcomes. Reported here is the case of a severe central nervous system (CNS) infection with multiple ring-enhancing lesions seen throughout the cerebrum on magnetic resonance imaging (MRI)...

BACKGROUND: Cladophialophora bantiana is a dematiaceous, saprophytic fungus and a rare but reported cause of intracranial abscesses due to its strong neurotropism. Although it predominantly affects immunocompetent individuals with environmental exposure, more recently, its significance as a highly lethal opportunistic infection in transplant recipients has been recognized. Successful treatment requires timely but often challenging diagnosis, followed by complete surgical excision. Next-generation sequencing of microbial cell-free DNA (cfDNA) from plasma is a novel diagnostic method with the potential to identify invasive fungal infections more rapidly and less invasively than conventional microbiological testing, including brain biopsy...

BACKGROUND: Virtual Reality (VR) has been used as a distraction tool in various medical settings to reduce pain and anxiety associated with procedures. This study evaluates the effectiveness of VR as a distraction tool for decreasing fear, anxiety, and pain in pediatric patients undergoing common outpatient orthopaedic procedures. METHODS: A total of 210 patients were recruited from a single orthopaedic clinic between October 2017 and July 2019. Patients were randomized to the VR group or to the control group (standard of care)...

PURPOSE: A novel, mobile 3-in-1 X-ray system featuring radiography, fluoroscopy, and cone-beam computed tomography (CBCT) has been launched for brachytherapy recently. Currently, there is no quality assurance (QA) procedure explicitly applicable to this system equipped with innovative technologies such as dynamic jaws and motorized lasers. We developed a dedicated QA procedure and, based on its performance for a duration of 6 months, provide an assessment of the device's stability over time...

Background & purpose: Four-dimensional computed tomography (4DCT) scans are standardly used for radiotherapy planning of tumors subject to respiratory motion. Based on online analysis and automatic adaption of scan parameters to the patient's individual breathing pattern, a new breathing-controlled 4DCT (i4DCT) algorithm attempts to counteract irregular breathing and thus prevent artifacts. The aim of this study was to perform an initial quality assurance for i4DCT. Material & methods: To validate the i4DCT algorithm, phantom measurements were performed to evaluate geometric accuracy (diameter, volume, eccentricity), image quality (dose-normalized contrast-noise-ratio, CT number accuracy), and correct representation of motion amplitude of simulated tumor lesions...

BACKGROUND:  Prevention of nosocomial coronavirus disease 2019 (COVID-19) infection for patients undergoing flap-based reconstructive surgery is crucial to providing care and maintaining operative volume and income to support plastic surgery programs. We conducted this study to (1) determine the postoperative incidence of COVID-19 among patients undergoing flap reconstruction from December 1, 2019 to November 1, 2020 and (2) compare 30-day outcomes between patients who underwent surgery before and during the early pandemic...

PURPOSE: To enable a fast and automatic deep learning-based QSM reconstruction of tissues with diverse chemical shifts, relevant to most regions outside the brain. METHODS: A UNET was trained to reconstruct susceptibility maps using synthetically generated, unwrapped, multi-echo phase data as input. The RMS error with respect to synthetic validation data was computed. The method was tested on two in vivo knee and two pelvis data sets. Comparisons were made to a conventional fat-water separation pipeline by applying a commonly used graph-cut algorithm, both without and with an extended mask for background field removal (FWS-CONV-QSM and FWS-MASK-CONV-QSM, respectively)...

PURPOSE: Seed brachytherapy is a well-established treatment modality for prostate cancer. However, there is still a lack of profound characterizations of seed motions within the prostate. We assessed these dynamics between day 0 and day 30 of brachytherapy. METHODS: We considered 45 patients with 2408 implanted seeds, and performed a 1:1 assignment between their positions on post-plan CT (nominal day 30) and intraoperative ultrasound (day 0). Geometric seed arrangement changes were measured for each patient and the entire collective...