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Ultrasound (US) imaging is used for the diagnosis and also evaluation of thyroid nodules. A Thyroid Imaging Reporting and Data System (TIRADS) is used for the risk stratification of thyroid nodules through US images. The composition of thyroid nodules plays an important role in the risk-stratification process. The percentages of cystic and solid components in a thyroid nodule are one of the features that are can be indicative of the risk of malignancy. In this work, we attempt to classify and estimate solid and cystic regions within nodules. 20x20 texture patches were extracted from solid and cystic regions and converted into signals. These signals are decomposed into low, mid, and high-frequency bands using Continuous Wavelet Transform (CWT). A total of 36 features were extracted from the decomposed signals using Auto- Regressive Modeling. The features were fed into three different Machine Learning (ML) algorithms (Artificial Neural Networks, K-Nearest Neighbors, and Random Forest Classifier) to provide us with a classification of solid versus cystic regions in thyroid nodule US images. The Random Forest Classifier obtained an Accuracy, Sensitivity, and Specificity of 90.41%, 99% and 91% respectively which was the highest among the three chosen ML algorithms. Additionally, the output from the classification phase was also be used to determine the percentage of cystic and solid regions with a given thyroid nodule US image.

This paper presents the proof-of-concept study of an adaptor allowing the combination of a gamma probe with ultrasound (US) imaging, intending to improve the detectability of sentinel lymph nodes (SLNs). The performance of the adaptor in US imaging, in terms of depth of penetration and distance accuracy, and gamma scanning, in terms of sensitivity and spatial resolution, was investigated. We observed that the quality of the US imaging through the adaptor was promising and close to that of normal US imaging. However, the performance of the gamma probe through the adaptor was fairly poor, necessitating the improvement in the design of the adaptor for better gamma scanning. This study shall provide a basis for the development of a handheld gamma-US scanner for interventional procedures and small field-of-view (FOV) imaging in the future.

Ultrasound (US) imaging is used as a preliminary diagnostic tool for the detection, risk-stratification and classification of thyroid nodules. In order to perform the risk stratification of nodules in US images physicians first need to effectively detect the nodules. This process is affected due to the presence of inter-observer and intra-observer variability and subjectivity. Computer Aided Diagnostic tools prove to be a step in the right direction towards reducing the issue of subjectivity and observer variability. Several segmentation techniques have been proposed, from these Deep Learning techniques have yielded promising results. This work presents a comparison between four state of the art (SOTA) Deep Learning segmentation algorithms (UNet, SUMNet, ResUNet and Attention UNet). Each network was trained on the same dataset and the results are compared using performance metrics such as accuracy, dice coefficient and Intersection over Union (IoU) to determine the most effective in terms of thyroid nodule segmentation in US images. It was found that ResUNet performed the best with an accuracy, dice coefficient and IoU of 89.2%, 0.857, 0.767. The aim is to use the trained algorithm in the development of a Computer Aided Diagnostic system for the detection, riskstratification and classification of thyroid nodules using US images to reduce subjectivity and observer variability

Dose optimization in computed tomography (CT) is crucial, especially in CT fluoroscopy (fluoro-CT) used for real-time navigation, affecting both patient and operator safety. This study evaluated the impact of spectral X-ray filtering using a tin filter (Sn filter), and a method called partial-angle computed tomography (PACT), which involves segmentally switching off the X-ray tube current at the ambient dose rate H ˙ * (10) at the interventional radiologist's (IR) position. Measurements were taken at two body regions (upper body: head/neck; lower body: lower legs/feet) using a 120 kV X-ray tube voltage, 3 × 5.0 mm CT collimation, 0.5 s rotation speed, and X-ray tube currents of 43 Eff.mAs (without Sn filter) and 165 Eff.mAs (with Sn filter). The study found significant dose reductions in both body regions when using the Sn filter and PACT together. For instance, in the upper body region, the combination protocol reduced H ˙ * (10) from 11.8 µSv/s to 6.1 µSv/s (p < 0.0001) compared to the protocol without using these features. Around 8% of the reduction (about 0.5 µSv/s) is attributed to the Sn filter (p = 0.0005). This approach demonstrates that using the Sn filter along with PACT effectively minimizes radiation exposure for the IR, particularly protecting areas like the head/neck, which can only be insufficiently covered by (standard) radiation protection material. [ABSTRACT FROM AUTHOR]

Simple Summary: Patients with metastasized, castration-resistant prostate cancer can be treated locally with radioactive radium-223, which usually comprises six cycles. We wanted to know whether this treatment affects immune function. We performed cell culture experiments with white blood cells from the patients and added components of microorganisms. We tested the ability of the cells to proliferate and produce two cytokines (interferon-gamma and interleukin-10) that are important for the balance of the immune system. Our data in 21 patients indicate that the immune cells show impairment in their defense against microorganisms after treatment. As determined by bone scintigraphy, a reduction in tumor burden was observed in 67% of patients. Interestingly, even before treatment, the number of cells producing interleukin-10, an anti-inflammatory cytokine, was an indicator of tumor burden at the end of treatment. Thus, a blood test can help assess whether the treatment is likely to be successful. Previous data indicate that one cycle of treatment with radium-223 (223Ra) did not significantly impair lymphocyte function in patients with metastasized, castration-resistant prostate cancer. The aim of the current study was to assess in 21 patients whether six cycles of this therapy had an effect on lymphocyte proliferation and interferon-γ and interleukin (IL)-10 ELISpot results. Lymphocyte proliferation after stimulation with microbial antigens and the production of interferon-γ continuously decreased after six cycles of radionuclide therapy, reaching statistical significance (p < 0.05) at months 1, 2, 4, and/or 6 after therapy. One month after the last cycle of therapy, 67% of patients showed a decrease in tumor burden. The tumor burden correlated negatively with IL-10 secretion at baseline, e.g., after stimulation with tetanus antigen (p < 0.0001, r = −0.82). As determined by receiver operating characteristic (ROC) curve analysis, tetanus-specific IL-10 spots at baseline had the highest predictive value (p = 0.005) for tumor burden at month 6, with an area under the curve (AUC) of 0.90 (sensitivity 100%, specificity 78%). In conclusion, we observed an additive effect of treatment with 223Ra on immune function and found that IL-10 secretion at baseline predicted tumor burden at month 6 after treatment. [ABSTRACT FROM AUTHOR]

PurposeCabozantinib, a tyrosine kinase inhibitor (TKI) of hepatocyte growth factor receptor (MET), vascular endothelial growth factor receptor 2, and rearranged during transfection (RET), demonstrated clinical activity in patients with medullary thyroid cancer (MTC) in phase I.Patients and methodsWe conducted a double-blind, phase III trial comparing cabozantinib with placebo in 330 patients with documented radiographic progression of metastatic MTC. Patients were randomly assigned (2:1) to cabozantinib (140 mg per day) or placebo. The primary end point was progression-free survival (PFS). Additional outcome measures included tumor response rate, overall survival, and safety.ResultsThe estimated median PFS was 11.2 months for cabozantinib versus 4.0 months for placebo (hazard ratio, 0.28; 95% CI, 0.19 to 0.40; P < .001). Prolonged PFS with cabozantinib was observed across all subgroups including by age, prior TKI treatment, and RET mutation status (hereditary or sporadic). Response rate was 28% for cabozantinib and 0% for placebo; responses were seen regardless of RET mutation status. Kaplan-Meier estimates of patients alive and progression-free at 1 year are 47.3% for cabozantinib and 7.2% for placebo. Common cabozantinib-associated adverse events included diarrhea, palmar-plantar erythrodysesthesia, decreased weight and appetite, nausea, and fatigue and resulted in dose reductions in 79% and holds in 65% of patients. Adverse events led to treatment discontinuation in 16% of cabozantinib-treated patients and in 8% of placebo-treated patients.ConclusionCabozantinib (140 mg per day) achieved a statistically significant improvement of PFS in patients with progressive metastatic MTC and represents an important new treatment option for patients with this rare disease. This dose of cabozantinib was associated with significant but manageable toxicity.