Search

BACKGROUND & AIMS Transarterial radioembolization (TARE) with Yttrium-90 resin microspheres is an established treatment option for patients with hepatocellular carcinoma (HCC). However, optimising treatment application and patient selection remains challenging. We report here on the effectiveness, safety and prognostic factors, including dosing methods, associated with TARE for HCC in the prospective observational CIRT study. METHODS We analysed 422 patients with HCC enrolled between Jan 2015 and Dec 2017, with follow-up visits every 3 months for up to 24 months after first TARE. Patient characteristics and treatment-related data were collected at baseline; adverse events and time-to-event data (overall survival [OS], progression-free survival [PFS] and hepatic PFS) were collected at every 3-month follow-up visit. We used the multivariable Cox proportional hazard model and propensity score matching to identify independent prognostic factors for effectiveness outcomes. RESULTS The median OS was 16.5 months, the median PFS was 6.1 months, and the median hepatic PFS was 6.7 months. Partition model dosimetry resulted in improved OS compared to body surface area calculations on multivariable analysis (hazard ratio 0.65; 95% CI 0.46-0.92; p = 0.0144), which was confirmed in the exact matching propensity score analysis (hazard ratio 0.56; 95% CI 0.35-0.89; p = 0.0136). Other independent prognostic factors for OS were ECOG-performance status >0 (p = 0.0018), presence of ascites (p = 0.0152), right-sided tumours (p = 0.0002), the presence of portal vein thrombosis (p = 0.0378) and main portal vein thrombosis (p = 0.0028), ALBI grade 2 (p = 0.0043) and 3 (p = 0.0014). Adverse events were recorded in 36.7% of patients, with 9.7% of patients experiencing grade 3 or higher adverse events. CONCLUSIONS This large prospective observational dataset shows that TARE is an effective and safe treatment in patients with HCC. Using partition model dosimetry was associated with a significa

BACKGROUND Transarterial radioembolisation (TARE) with Yttrium-90 resin microspheres is a treatment option for patients with metastatic colorectal cancer in the liver (mCRC). A better understanding of the prognostic factors and treatment application can improve survival outcomes. METHODS We analysed the safety and effectiveness of 237 mCRC patients included in the prospective observational study CIRSE Registry for SIR-Spheres Therapy (CIRT) for independent prognostic factors for overall survival (OS), progression-free survival (PFS) and hepatic progression-free survival (hPFS) using the Cox proportional-hazard model. RESULTS The median OS was 9.8 months, median PFS was 3.4 months and median hPFS was 4.2 months. Independent prognostic factors for an improved overall survival were the absence of extra-hepatic disease (P= .0391), prior locoregional procedures (P= .0037), an Aspartate transaminase to Platelet Ratio Index (APRI) value of ≤0.40 (P< .0001) and International Normalized Ratio (INR) ≤1 (P= .0078). Partition model dosimetry resulted in improved OS outcomes compared to the body surface area model (P = .0120). Independent predictors for PFS were APRI >0.40 (P = .0416) and prior ablation (P = .0323), and for hPFS these were 2 to 5 tumor nodules (P = .0148), Albumin-bilirubin (ALBI) grade 3 (P = .0075) and APRI >0.40 (P = .0207). During the study, 95 of 237 (40.1%) patients experienced 197 adverse events, with 28 of 237 (11.8%) patients having a grade 3 or higher adverse events. CONCLUSION Including easy-to-acquire laboratory markers INR, APRI, ALBI and using partition model dosimetry can identify mCRC patients that may benefit from TARE.

PURPOSE To address the lack of prospective data on the real-life clinical application of trans-arterial radioembolization (TARE) in Europe, the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) initiated the prospective observational study CIRSE Registry for SIR-Spheres® Therapy (CIRT). MATERIALS AND METHODS Patients were enrolled from 1 January 2015 till 31 December 2017. Eligible patients were adult patients treated with TARE with Y90 resin microspheres for primary or metastatic liver tumours. Patients were followed up for 24 months after treatment, whereas data on the clinical context of TARE, overall survival (OS) and safety were collected. RESULTS Totally, 1027 patients were analysed. 68.2% of the intention of treatment was palliative. Up to half of the patients received systemic therapy and/or locoregional treatments prior to TARE (53.1%; 38.3%). Median overall survival (OS) was reported per cohort and was 16.5 months (95% confidence interval (CI) 14.2-19.3) for hepatocellular carcinoma, 14.6 months (95% CI 10.9-17.9) for intrahepatic cholangiocarcinoma. For liver metastases, median OS for colorectal cancer was 9.8 months (95% CI 8.3-12.9), 5.6 months for pancreatic cancer (95% CI 4.1-6.6), 10.6 months (95% CI 7.3-14.4) for breast cancer, 14.6 months (95% CI 7.3-21.4) for melanoma and 33.1 months (95% CI 22.1-nr) for neuroendocrine tumours. Statistically significant prognostic factors in terms of OS include the presence of ascites, cirrhosis, extra-hepatic disease, patient performance status (Eastern Cooperative Oncology Group), number of chemotherapy lines prior to TARE and tumour burden. Thirty-day mortality rate was 1.0%. 2.5% experienced adverse events grade 3 or 4 within 30 days after TARE. CONCLUSION In the real-life clinical setting, TARE is largely considered to be a part of a palliative treatment strategy across indications and provides an excellent safety profile. LEVEL OF EVIDENCE Level 3. TRIAL REGISTRATION ClinicalTrials.gov

ISAR imaging is a well known technique which uses range and Doppler information from a radar to generate an image of a moving target. Research performed on the combination of a large receive array with airborne ISAR is scarce. This thesis is aimed to reach the highest possible image quality for AMBER, a radar with a 24 element receive array which was developed by TNO. Optimizing the image quality was split up in two parts, motion compensation and clutter suppression. A literature study is performed to research the existing methods. A performance evaluation is performed on different motion compensation techniques based on a simulation which is set up to resemble the radar parameters of AMBER. Based on the results of this evaluation, keystone formatting combined with image contrast maximization is concluded to be the best fitting approach. For clutter suppression a similar approach is followed with real measured data. Apart from the existing techniques, MVDR, DPCA and ODPCA, a new technique is proposed which filtered a target from clutter based on motion. It is referenced to as the IDPCA. The techniques show better image quality than regular beam forming. To enhance the image quality more, a method is searched to combine different clutter suppression techniques. This leads to a unique method which is proposed in this thesis. The new technique exploits the circular phase variance of pixels in the range Doppler image between different sub arrays. With this approach, strong clutter can be filtered in the range Doppler domain based on its angle of arrival. The newly proposed technique is applied as a mask, as it does not contain amplitude information of the target. Combined with the ODPCA method, the final image is generated. The combination of techniques shows clear improvements from the other discussed approaches.

ISAR imaging is a well known technique which uses range and Doppler information from a radar to generate an image of a moving target. Research performed on the combination of a large receive array with airborne ISAR is scarce. This thesis is aimed to reach the highest possible image quality for AMBER, a radar with a 24 element receive array which was developed by TNO. Optimizing the image quality was split up in two parts, motion compensation and clutter suppression. A literature study is performed to research the existing methods. A performance evaluation is performed on different motion compensation techniques based on a simulation which is set up to resemble the radar parameters of AMBER. Based on the results of this evaluation, keystone formatting combined with image contrast maximization is concluded to be the best fitting approach. For clutter suppression a similar approach is followed with real measured data. Apart from the existing techniques, MVDR, DPCA and ODPCA, a new technique is proposed which filtered a target from clutter based on motion. It is referenced to as the IDPCA. The techniques show better image quality than regular beam forming. To enhance the image quality more, a method is searched to combine different clutter suppression techniques. This leads to a unique method which is proposed in this thesis. The new technique exploits the circular phase variance of pixels in the range Doppler image between different sub arrays. With this approach, strong clutter can be filtered in the range Doppler domain based on its angle of arrival. The newly proposed technique is applied as a mask, as it does not contain amplitude information of the target. Combined with the ODPCA method, the final image is generated. The combination of techniques shows clear improvements from the other discussed approaches.

The ZEBRO is a fully autonomous six-legged robot designed for swarm behaviour and is the size of an A4 sheet of paper. However, there does not exist an charging station for the ZEBRO yet. At this time, the battery still has to be replaced manually, which defeats the purpose of an autonomous system. An autonomous charging station has to be designed to complete the system. The charging station can be split into 3 parts: the autonomous charging station, the wireless power transfer, and the battery management system (located in the ZEBRO). In this particular thesis, the autonomous charging station will be discussed. Since all components in the ZEBRO are built to be modular, the design of the autonomous charging station is chosen to fit this principle. The charging station will consist of one central unit, and several connectable (modular) pads. Each pad will be able to hold and charge a single ZEBRO in 30 minutes. The charging station contains a communication module to communicate its location to ZEBRO's in need of charging. To calculate the locations of the connected pads, a grid will be created by serial communication between the charging station and the connected pads through Raspberry Pi's. (The pads do not have a communication module and do not have their location defined) To power the wireless power transfer unit, a power supply of 48V and 500W will be implemented in the charging station. Each pad will consume about 100W, so a maximum of 4 pads can be connected. (Due to power loss). If more pads need to be connected, an additional power supply can be put in parallel. All separate components have been simulated or tested and do work as predicted. The integration of all components of the charging station was successful as well. At this time, the complete system with the wireless power transfer and battery management system has not yet been put together and so it is unknown if it works as a whole., Zebro Project

The ZEBRO is a fully autonomous six-legged robot designed for swarm behaviour and is the size of an A4 sheet of paper. However, there does not exist an charging station for the ZEBRO yet. At this time, the battery still has to be replaced manually, which defeats the purpose of an autonomous system. An autonomous charging station has to be designed to complete the system. The charging station can be split into 3 parts: the autonomous charging station, the wireless power transfer, and the battery management system (located in the ZEBRO). In this particular thesis, the autonomous charging station will be discussed. Since all components in the ZEBRO are built to be modular, the design of the autonomous charging station is chosen to fit this principle. The charging station will consist of one central unit, and several connectable (modular) pads. Each pad will be able to hold and charge a single ZEBRO in 30 minutes. The charging station contains a communication module to communicate its location to ZEBRO's in need of charging. To calculate the locations of the connected pads, a grid will be created by serial communication between the charging station and the connected pads through Raspberry Pi's. (The pads do not have a communication module and do not have their location defined) To power the wireless power transfer unit, a power supply of 48V and 500W will be implemented in the charging station. Each pad will consume about 100W, so a maximum of 4 pads can be connected. (Due to power loss). If more pads need to be connected, an additional power supply can be put in parallel. All separate components have been simulated or tested and do work as predicted. The integration of all components of the charging station was successful as well. At this time, the complete system with the wireless power transfer and battery management system has not yet been put together and so it is unknown if it works as a whole., Zebro Project