Background To evaluate and establish a digital workflow for the custom designing and 3D printing of mouth opening tongue-depressing (MOTD) stents for patients receiving radiotherapy for head and neck cancer. Methods We retrospectively identified 3 patients who received radiation therapy (RT) for primary head and neck cancers with MOTD stents. We compared two methods for obtaining the digital impressions of patients’ teeth. The first method involved segmentation from computed tomography (CT) scans, as previously established by our group, and the second method used 3D scanning of the patients’ articulated stone models that were made during the conventional stent fabrication process. Three independent observers repeated the process to obtain digital impressions which provided data to design customized MOTD stents. For each method, we evaluated the time efficiency, dice similarity coefficient (DSC) for reproducibility, and the 3D printed stents’ accuracy. For the 3D scanning method, we evaluated the registration process using manual and automatic approaches. Results For all patients, the 3D scanning method demonstrated a significant advantage over the CT scanning method in terms of time efficiency with over 60% reduction in time consumed ( p < 0.0001) and reproducibility with significantly higher DSC ( p < 0.001). The printed stents were tested over the articulated dental stone models, and the trueness of fit and accuracy of dental anatomy was found to be significantly better for MOTD stents made using the 3D scanning method. The automated registration showed higher accuracy with errors < 0.001 mm compared to manual registration. Conclusions We developed an efficient workflow for custom designing and 3D-printing MOTD radiation stents. This workflow represents a considerable improvement over the CT-derived segmentation method. The application of this rapid and efficient digital workflow into radiation oncology practices can expand the use of these toxicity sparing devices to practices that do not currently have the support to make them. Electronic supplementary material The online version of this article (10.1186/s13014-019-1357-2) contains supplementary material, which is available to authorized users.

Background: Penile prosthesis surgery (PPS) is a commonly used treatment for erectile dysfunction (ED), either as first-line therapy or in cases refractory to other treatment options. In patients with a urologic malignancy such as prostate cancer, surgical interventions like radical prostatectomy (RP) as well as nonsurgical treatments such as radiation therapy can all induce ED. PPS as a treatment for ED has high satisfaction rates in the general population. Our aim was to compare sexual satisfaction in patients with prosthesis implantation for ED following RP versus ED following radiation therapy for prostate cancer.Methods: A retrospective chart review from our institutional database was conducted to identify patients who underwent PPS at our institution from 2011 to 2021. Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire data at least 6 months from implant operative date available was required for inclusion. Eligible patients were placed in one of two groups depending on etiology of ED-following RP or prostate cancer radiation therapy. To prevent crossover confounding; patients with history of pelvic radiation were excluded from the RP group and patients with history of RP were excluded from the radiation group. Data was obtained from 51 patients in the RP group and 32 patients in the radiation therapy group.Mean EDITS scores and additional survey questions were compared between the radiation and RP groups.Results: There was a significant difference in mean survey responses for 8 of the 11 questions in the EDITS questionnaire between the RP group and the radiation group. Additional survey questions administered also found RP patients reported significantly higher rate of satisfaction with size of penis postoperatively versus the radiation group.Conclusions: These preliminary findings, while requiring large-scale follow-up, suggest that there is greater sexual satisfaction and penile prosthesis device satisfaction in patients undergoing IPP placement following RP versus radiation therapy for prostate cancer. Use of validated questionnaires should continue to be utilized in quantifying device and sexual satisfaction following PPS.

The objective was to identify clinical and epidemiological factors associated with utilization of a complex oral treatment device (COTD), which may decrease toxicity in patients undergoing radiation therapy for head and neck cancer (HNC). Materials and Methods: We retrospectively reviewed data from 1992 to 2013 in the Surveillance, Epidemiology, and End Results (SEER)-Medicare databases to analyze COTD usage during intensity-modulated radiation therapy (IMRT) for patients diagnosed with cancer of the tongue, floor of mouth, nasopharynx, tonsil, or oropharynx. Patients with a radiation simulation and complex treatment device code within 4 weeks before the first IMRT claim were identified as meeting COTD usage criteria. Demographic, regional, tumor, and treatment data were analyzed. Results: Out of 4511 patients who met eligibility criteria, 1932 patients (42.8%) did not utilize a COTD while 2579 (57.2%) met usage criteria. COTD utilization increased over time (36.36% usage in 1992 vs. 67.44% usage in 2013, p < .0001). Patients less likely to receive a COTD included those aged 86 years or older compared to those aged 66-70 (OR = 0.713, 95% CI: 0.528-0.962), male patients (OR = 0.817, 95% CI: 0.710-0.941), non-Hispanic Black patients compared to non-Hispanic White patients (OR = 0.750, 95% CI: 0.582-0.966), and Louisiana residents (OR = 0.367, 95% CI: 0.279-0.483). Cancer site, grade, stage, or function of IMRT had no significant association with COTD usage. Conclusions: This study serves as the first known SEER-Medicare review of COTD utilization. Despite an increase in COTD usage over time, our results indicate age, gender, and geographic disparities are associated with utilization. Further research and development into methods that increase availability of COTDs may help increase utilization in specific patient populations.

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Introduction: We characterize patient perceptions of telemedicine (video-enabled) and telephonic (audio-only) visits conducted during the COVID-19 pandemic.Methods: A single-center cohort of 76 patients who underwent remote ambulatory visits from March 2020 to July 2020 was evaluated. Patients responded to a questionnaire assessing perception of timeliness, efficiency, overall satisfaction and willingness to have a remote appointment after the pandemic. Responses were compared for telephonic (audio-only) vs telemedicine (video) visits.Results: High satisfaction scores were reported for both telephonic and telemedicine appointments, with a mean score of 6.61 out of 7 (SD 1.0) for overall satisfaction. Telephonic visits demonstrated higher scores regarding timeliness and efficiency of the visit (6.58 vs 5.92, p¼0.017) and willingness to have a remote encounter with a urology resident (6.58 vs 5.61, p¼0.001) or advanced practice provider (6.21 vs 5.51, p¼0.015). No difference in perception of confidentiality or overall satisfaction was observed between both groups. In all, 91% of participants desired the option of a virtual visit with their provider after the pandemic.Conclusions: Patients undergoing remote urology appointments during the COVID-19 pandemic report high satisfaction rates, though telephonic encounters were more favorable for patients in regard to timeliness and efficiency. Importantly, most patients desired the option of telephonic and telemedicine calls after the pandemic. Further analysis on safety, efficacy, provider perceptions, outcomes and economic impact is needed to assess the feasibility of continuing regular telephonic and telemedicine visits after the COVID-19 pandemic is over.