Faculty Bibliography

PURPOSE/UNASSIGNED:Radiation therapy has an increasing role in the management of metastatic cancers. Integrating radiation with surgical and systemic approaches is complex, and inappropriate management can lead to prolonged hospitalizations inconsistent with palliative goals. An inpatient radiation oncology consult (IROC) service was created in January 2020 to provide rapid access to specialized care for hospitalized patients. Here, we report outcomes of the IROC service, focusing on quality-of-care metrics including hospital length of stay (LOS), use of hypofractionated approaches, and treatments for patients discharged to hospice. METHODS AND MATERIALS/UNASSIGNED:= 1509) IROC, from 2019 to 2021. Continuous variables were analyzed using the Mann-Whitney test and categorical variables using Fisher's exact test. RESULTS/UNASSIGNED:= .036). CONCLUSIONS/UNASSIGNED:The IROC service was associated with reduced hospital LOS, increased use of hypofractionated approaches, and decreased treatments for patients discharged to hospice. Our findings demonstrate the value of a dedicated program addressing radiation delivery to hospitalized patients to improve goal-concordant treatments. The financial impact of reducing low-value care is an important subject for future investigations.

BACKGROUND:Nonadherence to antihypertensive medications is common. Mobile health (mHealth)-based behavioral economic interventions may improve adherence, but remain largely untested, especially in vulnerable populations. OBJECTIVE:The study sought to test whether an mHealth incentive lottery would lower systolic blood pressure (SBP) and improve adherence. METHODS:BETTER-BP (Behavioral Economics Trial To Enhance Regulation of Blood Pressure) was a randomized trial conducted in 3 safety-net clinics in New York City. Eligible participants were adults with hypertension prescribed at least 1 antihypertensive medication, with SBP >140 mm Hg, and poor self-reported adherence. In the intervention arm, an incentive lottery was administered via SMS messaging. All participants received passive adherence monitoring. The intervention lasted 6 months, with continued monitoring until 12 months. The primary clinical endpoint was change in SBP at 6 months. The primary process endpoint was adequate antihypertensive medication adherence (≥80% days adherent) from baseline to 6 months. RESULTS:Four-hundred participants (265 intervention:135 control) were enrolled with median age 57 years, 60.5% women, 61.5% Hispanic, and 20.3% non-Hispanic Black. Over 70% had Medicaid or no insurance. At 6 months, intervention arm participants were twice as likely to achieve adequate adherence (71% vs 34%; adjusted risk ratio: 2.04; 95% CI: 1.58-2.63), but there was no significant change in mean SBP (-6.7 mm Hg intervention vs -5.8 mm Hg control; P = 0.62). From 6 to 12 months, adherence was similar (31% intervention vs 26% control; adjusted risk ratio: 1.17; 95% CI: 0.83-1.65). CONCLUSIONS:In a diverse safety-net population, the BETTER-BP intervention doubled the rate of adequate antihypertensive medication adherence but did not reduce SBP at 6 months.

Conflicting practice recommendations regarding the grading of intraductal carcinoma of the prostate (IDCP) from two leading uropathology societies, the Genitourinary Pathology Society (GUPS) and the International Society of Urological Pathology (ISUP), are confusing for both pathologists and treating clinicians. The objectives of this consultation were to clarify unresolved issues regarding IDCP and atypical intraductal proliferation (AIP) terminology, diagnostic criteria, grading, and management implications, as well as to develop uniform reporting guidelines for IDCP and AIP, endorsed by both societies. A 32-member expert panel, composed of five core members, 25 expert urological pathologists, and two expert urologists, employed a modified Delphi process consisting of multiple rounds of consultation and voting. These were supplemented by discussions at the 2025 United States and Canadian Academy of Pathologists Annual Meeting to achieve expert consensus (defined as at least 67% agreement). Consensus was reached on several key issues. IDCP was regarded most commonly as reflecting the retrograde spread of invasive prostate cancer (PCa). IDCP diagnosis should be based on the Guo and Epstein criteria, supported by basal cell immunohistochemistry in cases that are difficult to distinguish from invasive PCa. The term AIP should be used only in equivocal proliferations where IDCP is favoured but the criteria are not fully met, and these should be reported as 'AIP, suspicious for IDCP'. In the presence of invasive PCa, IDCP should generally be incorporated into Gleason grading irrespective of Grade Group (GG). However, a significant minority (30%) favoured excluding IDCP from the Gleason score if the invasive component was solely Gleason pattern (GP) 3. Pure IDCP (not associated with invasive PCa) and AIP, suspicious for IDCP, should not be graded. IDCP should not be incorporated in the grading of invasive PCa when it is spatially distinct from invasive PCa. A second opinion from a senior or dedicated GU pathologist and discussion within a multidisciplinary management setting should be considered, in the rare settings of pure IDCP or GP3 + IDCP (formerly GG1 + IDCP scenario). This joint GUPS-ISUP consultation provides unified recommendations for the diagnosis, terminology, grading, and reporting of IDCP and AIP, and will pave the way for the development of future IDCP/AIP WHO guidelines. Their adoption should reduce interobserver variation, facilitate consistent communication with clinicians, and improve patient management.

PURPOSE/OBJECTIVE:To improve 0.55T T2-weighted PROPELLER lung MRI by developing a self-supervised framework for joint reconstruction and denoising. METHODS:T2-weighted 0.55T lung MRI datasets from 44 patients with prior COVID-19 infection were used. Each PROPELLER blade was split along the readout direction into two disjoint subsets: one subset for training an unrolled network, and the other for loss calculation. Following the Noise2Noise paradigm, this framework split k-space into two subsets with independent, matched noise but identical underlying signal, enabling joint reconstruction and denoising without external training references. For comparison, coil-wise Marchenko-Pastur Principal Component Analysis (MPPCA) denoising followed by parallel imaging reconstruction was performed. The reconstructed images were evaluated by two experienced chest radiologists. RESULTS:The self-supervised model generated lung images with improved clarity, better delineation of parenchymal and airway structures, and maintained high fidelity in cases with available CT references. In addition, the proposed framework also enabled further reduction of scan time by reconstructing images with adequate diagnostic quality from only half the number of blades. The reader study confirmed that the proposed method outperformed MPPCA across all categories (Wilcoxon signed-rank test, p < 0.001), with moderate inter-reader agreement (weighted Cohen's kappa = 0.55; percentage of exact and within ±1 point agreement = 91%). CONCLUSION/CONCLUSIONS:By leveraging the intrinsic data redundancy in PROPELLER sampling and extending the Noise2Noise concept, the proposed self-supervised framework enabled simultaneous reconstruction and denoising of lung images at 0.55T to address the low-SNR challenge at low-field. It holds great potential for broad use in other low-field MRI applications.

BACKGROUND:Few studies have evaluated the ototoxic effects of in utero antiretroviral (ARV) exposure on hearing in children HIV-exposed uninfected (CHEU). Concerns have been identified for some ARVs: tenofovir disoproxil fumarate (TDF), emtricitabine (FTC), lamivudine (3TC), zidovudine (ZDV) and atazanavir (ATV). The aims are to describe hearing outcomes in 5-year-old CHEU in the Surveillance Monitoring for Antiretroviral Therapy Toxicities study and evaluate their association with in utero ARV exposures. METHODS:Hearing evaluations including pure-tone thresholds and distortion product otoacoustic emissions (DPOAEs) were completed in CHEU at 5 years. Log-binomial regression models were fit to assess associations of maternal ARV exposures with risk of sensorineural hearing loss (SNHL) and incomplete DPOAE responses. RESULTS:Among 1078 CHEU, 13% had SNHL. Among those exposed to <13 weeks gestation, there was 28% higher risk (95% confidence interval: -37% to 158%) of SNHL with TDF/FTC with ATV and 38% lower risk (95% confidence interval: -68% to 19%) with ZDV/3TC without ATV than for regimens containing TDF/FTC without ATV. There was a higher risk of incomplete DPOAE responses for ZDV/3TC without ATV and a lower risk for TDF/FTC with ATV. For CHEU with first ARV exposure at 13-26 weeks gestation, those exposed to TDF/FTC with ATV or ZDV/3TC without ATV had a lower risk for SNHL compared with TDF/FTC without ATV. Despite nontrivial relative risks, all confidence intervals were wide. CONCLUSIONS:While SNHL was relatively common, there were no consistent associations between in utero ARV exposure and SNHL or incomplete DPOAEs. Further research is needed on ARV exposures and other hearing measures in CHEU.