Enhancing the Contouring Efficiency for Head and Neck Cancer Radiotherapy Using Atlas-based Auto-segmentation and Scripting.

BACKGROUND/AIM: Intensity-modulated radiation therapy can deliver a highly conformal dose to a target while minimizing the dose to the organs at risk (OARs). Delineating the contours of OARs is time-consuming, and various automatic contouring software programs have been employed to reduce the delineation time. However, some software operations are manual, and further reduction in time is possible. This study aimed to automate running atlas-based auto-segmentation (ABAS) and software operations using a scripting function, thereby reducing work time. MATERIALS AND METHODS: Dice coefficient and Hausdorff distance were used to determine geometric accuracy. The manual delineation, automatic delineation, and modification times were measured. While modifying the contours, the degree of subjective correction was rated on a four-point scale. RESULTS: The model exhibited generally good geometric accuracy. However, some OARs, such as the chiasm, optic nerve, retina, lens, and brain require improvement. The average contour delineation time was reduced from 57 to 29 min (p<0.05). The subjective revision degree results indicated that all OARs required minor modifications; only the submandibular gland, thyroid, and esophagus were rated as modified from scratch. CONCLUSION: The ABAS model and scripted automation in head and neck cancer reduced the work time and software operations. The time can be further reduced by improving contour accuracy.

A Case of Intestinal Adhesive Ileus, Successfully Treated with Daikenchuto during Pregnancy and Post Cesarean Section / 日本東洋医学雑誌

We report a clinical case of adhesive ileus that was treated with daikenchuto during pregnancy, and post cesarean section. A 29-year woman, who had undergone a laparotomy for small intestinal volvulus at the age of 15, was referred to our hospital for abdominal distention at11weeks gestation. Her severe abdominal distention led to the intestinal adhesive ileus finding. After treatment with daikenchuto, she had mass diarrhea while the abdominal symptoms disappeared. Afterwards, the prenatal course was uneventful. Spontaneous labor began at 36 weeks gestation. Under the indication of fetal distress, an emergent cesarean section was performed. There was widespread adhesion between the small intestine and abdominal wall. On post operative day 4, nausea and vomiting increased. Daikenchuto was orally administered with the diagnosis of recurrent adhesive ileus. On day 6, flatus and soft stool were passed. On day 9, oral food ingestion was begun. Her post operative course was uneventful beyond this, and she was discharged on day 25. Recently, clinical reports of adhesive ileus during pregnancy have been increasing as average maternal ages rise. Adhesive ileus during pregnancy tends to be critical for mothers and babies, so a surgical procedure is necessary in many cases. This report suggests the usefulness of daikenchuto for adhesive ileus during the perinatal period.