Publications by authors named "Param Bhatter"

7 Publications

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The Evolving Importance of Artificial Intelligence and Radiology in Medical Trainee Education.

Acad Radiol 2021 May 18. Epub 2021 May 18.

Centaur Labs Diagnostics, Inc., Boston, Massachusetts.

Radiology education is understood to be an important component of medical school and resident training, yet lacks a standardization of instruction. The lack of uniformity in both how radiology is taught and learned has afforded opportunities for new technologies to intervene. Now with the integration of artificial intelligence within medicine, it is likely that the current medical trainee curricula will experience the impact it has to offer both for education and medical practice. In this paper, we seek to investigate the landscape of radiologic education within the current medical trainee curricula, and also to understand how artificial intelligence may potentially impact the current and future radiologic education model.
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http://dx.doi.org/10.1016/j.acra.2021.03.023DOI Listing
May 2021

Prostate minimally invasive procedures: complications and normal vs. abnormal findings on multiparametric magnetic resonance imaging (mpMRI).

Abdom Radiol (NY) 2021 May 11. Epub 2021 May 11.

Department of Radiological Sciences, University of California, Irvine, Orange, CA, 92868-3201, USA.

Minimally invasive alternatives to traditional prostate surgery are increasingly utilized to treat benign prostatic hyperplasia and localized prostate cancer in select patients. Advantages of these treatments over prostatectomy include lower risk of complication, shorter length of hospital stay, and a more favorable safety profile. Multiparametric magnetic resonance imaging (mpMRI) has become a widely accepted imaging modality for evaluation of the prostate gland and provides both anatomical and functional information. As prostate mpMRI and minimally invasive prostate procedure volumes increase, it is important for radiologists to be familiar with normal post-procedure imaging findings and potential complications. This paper reviews the indications, procedural concepts, common post-procedure imaging findings, and potential complications of prostatic artery embolization, prostatic urethral lift, irreversible electroporation, photodynamic therapy, high-intensity focused ultrasound, focal cryotherapy, and focal laser ablation.
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http://dx.doi.org/10.1007/s00261-021-03097-6DOI Listing
May 2021

Outcomes of Artificial Intelligence Volumetric Assessment of Kidneys and Renal Tumors for Preoperative Assessment of Nephron Sparing Interventions.

J Endourol 2021 Apr 13. Epub 2021 Apr 13.

University of California Irvine School of Medicine, 12219, Radiological Sciences, Orange, California, United States.

Background Renal cell carcinoma is the most common kidney cancer and the 13th most common cause of cancer death worldwide. Partial nephrectomy and percutaneous ablation, increasingly utilized to treat small renal masses and preserve renal parenchyma, require precise preoperative imaging interpretation. We sought to develop and evaluate a convolutional neural network (CNN), a type of deep learning artificial intelligence, to act as a surgical planning aid by determining renal tumor and kidney volumes via segmentation on single-phase computed tomography (CT). Materials and Methods After institutional review board approval, the CT images of 319 patients were retrospectively analyzed. Two distinct CNNs were developed for (1) bounding cube localization of the right and left hemi-abdomen and (2) segmentation of the renal parenchyma and tumor within each bounding cube. Training was performed on a randomly selected cohort of 269 patients. CNN performance was evaluated on a separate cohort of 50 patients using Sorensen-Dice coefficients (which measures the spatial overlap between the manually segmented and neural network derived segmentations) and Pearson correlation coefficients. Experiments were run on a GPU-optimized workstation with a single NVIDIA GeForce GTX Titan X (12GB, Maxwell architecture). Results Median Dice coefficients for kidney and tumor segmentation were 0.970 and 0.816, respectively; Pearson correlation coefficients between CNN-generated and human-annotated estimates for kidney and tumor volume were 0.998 and 0.993 (p < 0.001), respectively. End-to-end trained CNNs were able to perform renal parenchyma and tumor segmentation on a new test case in an average of 5.6 seconds. Conclusions Initial experience with automated deep learning artificial intelligence demonstrates that it is capable of rapidly and accurately segmenting kidneys and renal tumors on single-phase contrast-enhanced CT scans and calculating tumor and renal volumes.
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http://dx.doi.org/10.1089/end.2020.1125DOI Listing
April 2021

Pharmaceutical and Supply Waste in Oculofacial Plastic Surgery at a Hospital-Based Outpatient Surgery Center.

Ophthalmic Plast Reconstr Surg 2020 Nov 19. Epub 2020 Nov 19.

Division of Oculofacial Plastic and Orbital Surgery, Gavin Herbert Eye Institute, University of California, Irvine, Irvine, California, U.S.A.

Purpose: To investigate the financial and environmental waste burden of unused disposable surgical supplies and pharmaceutical products in oculofacial plastic surgery at a hospital-based outpatient surgery center.

Methods: This descriptive study was performed at a single academic hospital-based outpatient surgery center. Unused pharmaceuticals and disposable surgical materials were recorded for each of 34 consecutive oculofacial plastic surgeries performed by the same surgical team. Pharmaceutical products were grouped as local anesthetic (tetracaine, bupivacaine, lidocaine, and sodium bicarbonate), intraoperative (basic saline solution, methylene blue, and oxymetazoline hydrochloride), or antiseptic/antimicrobial (erythromycin ointment and hydrogen peroxide). Percentage of unused pharmaceutical product and disposable surgical material were calculated and extrapolated to direct costs to the institution and greenhouse gas emissions.

Results: The mean percentage of disposable surgical supply waste per case was 11.6% ($29.32). The mean percentage of pharmaceutical waste was 96.1% ($271.84) for local anesthetic, 71.0% ($163.47) for intraoperative medications, and 26.7% ($2.19) for antiseptic medication. The mean emissions per surgical case for unused disposable surgical equipment and unused pharmaceutical product were 10 and 103 kg of carbon equivalent gases (kg CO2-e), respectively.

Conclusions: Surgical supply waste was nominal, but pharmaceutical waste was considerable in this single hospital-based outpatient surgery center study. There may exist opportunities for quality improvement in waste, especially pharmacologic burden, in oculofacial plastic surgery.
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http://dx.doi.org/10.1097/IOP.0000000000001891DOI Listing
November 2020

Orbital Microscopic Polyangiitis With Secondary Angle Closure Due to Uveal Effusion.

Ophthalmic Plast Reconstr Surg 2021 Jan-Feb 01;37(1):e33-e35

Division of Oculofacial Plastic & Orbital Surgery, Gavin Herbert Eye Institute, University of California Irvine, Irvine, California, U.S.A.

A 63 year-old man presented with 3 weeks of worsening, painless left-sided proptosis, ptosis, and diplopia. Examination of the affected eye revealed normal visual acuity, normal intraocular pressure in the presence of a shallow anterior chamber, grade 1 relative afferent pupillary defect, restricted motility in all directions of gaze, and 6 mm of proptosis. Ultrasound biomicroscopy revealed uveal effusions with anterior rotation of the ciliary body causing appositional angle closure. B-scan ultrasonography and MRI demonstrated enhancement of the posterior globe and an infiltrative mass involving the lacrimal gland and multiple extraocular muscles. Laboratory studies revealed positive perinuclear antineutrophil cytoplasmic antibody with elevated myeloperoxidase antibodies, consistent with a diagnosis of microscopic polyangiitis. Biopsy showed nonspecific dacryoadenitis. Intravenous and oral corticosteroids were associated with rapid improvement of all examination findings. The patient was later switched to rituximab steroid-sparing therapy and has shown no recurrence of disease at 3-months follow-up.
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http://dx.doi.org/10.1097/IOP.0000000000001725DOI Listing
April 2021

Using a Macro Lens for Anterior Segment Imaging in Rural Panama.

Telemed J E Health 2020 11 7;26(11):1414-1418. Epub 2020 Feb 7.

Insitute of Clinical and Translational Science, University of California, Irvine, Irvine, California, USA.

Visual impairment, specifically anterior segment pathology, presents a significant burden of disease in the world. Inexpensive tools are necessary to improve eye health of residents in developing countries where care is difficult to access. Our study aimed at determining whether a $5 macro lens attached to a smartphone camera is an effective anterior segment imaging method for screening diseases. Fifty four (n = 54) patients had anterior segment imaging performed by using an Easy Macro lens and an iPhone. Imaging was performed at the Floating Doctors' mobile clinic sites in Panama. Images were sent back and graded by two board-certified ophthalmologists using a modified version of the FOTO-ED scale. Statistical analysis was performed by using a Wilcoxon signed-rank test to compare grades between the two imaging modalities. There was no significant difference in overall clinical utility of images obtained by the iPhone versus Easy Macro lens. The iPhone was significantly superior in imaging of the lens and conjunctiva, whereas the Easy Macro lens was superior in regards to the anterior chamber, iris, and lens. The imaging modality that best captures pathology is dependent on what part of the anterior segment is being examined. An imaging protocol with a pair of images, one from a smartphone and one from a macro lens, would have significant clinical utility. Our study demonstrates how minimally trained users can deliver effective eye screening via a telemedicine-based approach in a resource-deprived setting. Future directions would be to develop a telemedicine protocol and determine whether it improves clinically measurable outcomes in patients.
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http://dx.doi.org/10.1089/tmj.2019.0152DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7698642PMC
November 2020