F V Gleeson

Oxford University Hospitals NHS Trust, Oxford, England, United Kingdom

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Publications (89)516.09 Total impact

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    ABSTRACT: Multidisciplinary team (MDT) meetings are becoming the model of care for cancer patients worldwide. While MDTs have improved the quality of cancer care, the meetings impose substantial time pressure on the members, who generally attend several such MDTs. We describe Lung Cancer Assistant (LCA), a clinical decision support (CDS) prototype designed to assist the experts in the treatment selection decisions in the lung cancer MDTs. A novel feature of LCA is its ability to provide rule-based and probabilistic decision support within a single platform. The guideline-based CDS is based on clinical guideline rules, while the probabilistic CDS is based on a Bayesian network trained on the English Lung Cancer Audit Database (LUCADA). We assess rule-based and probabilistic recommendations based on their concordances with the treatments recorded in LUCADA. Our results reveal that the guideline rule-based recommendations perform well in simulating the recorded treatments with exact and partial concordance rates of 0.57 and 0.79, respectively. On the other hand, the exact and partial concordance rates achieved with probabilistic results are relatively poorer with 0.27 and 0.76. However, probabilistic decision support fulfils a complementary role in providing accurate survival estimations. Compared to recorded treatments, both CDS approaches promote higher resection rates and multimodality treatments.
    Journal of The Royal Society Interface 09/2014; 11(98). DOI:10.1098/rsif.2014.0534 · 3.86 Impact Factor
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    ABSTRACT: The definitive diagnosis of pleural malignancy depends upon histological confirmation by pleural biopsy. CT is reported to have a high sensitivity and specificity for the diagnosis of malignant pleural disease, and is part of the routine diagnostic workup of these patients. The aim of this study was to assess the sensitivity and specificity of CT in detecting pleural malignancy prior to definitive histology obtained via thoracoscopy in a large cohort of patients with suspected malignant pleural disease. Retrospective review of thoracoscopies between January 2008 and January 2013 at two UK tertiary referral centres: Oxford and Preston. The histological results were compared with the CT reported diagnosis before the procedure. CT scan reports were assessed by independent respiratory physicians as to whether the radiologist concluded evidence of malignant pleural disease or benign features only. 211 (57%) of 370 patients included in the analysis had malignant disease: CT scans were reported as 'malignant' in 144, giving a sensitivity of 68% (95% CI 62% to 75%). Of the 159 patients with benign disease, 124 had CT scans reported as benign: specificity 78% (72% to 84%). The positive predictive value of a malignant CT report was 80% (75% to 86%), with a negative predictive value of 65% (58% to 72%). A significant proportion of patients being investigated for malignant disease will have malignancy despite a negative CT report. The use of CT alone in determining which patients should have invasive pleural biopsies should be re-evaluated, and further studies to define the diagnostic pathway are now required.
    Thorax 07/2014; 70(2). DOI:10.1136/thoraxjnl-2014-206054 · 8.56 Impact Factor
  • J. S. Z. Lee, K. M. Bradley, F. V. Gleeson
    Thorax 11/2013; 68(Suppl 3):A99-A99. DOI:10.1136/thoraxjnl-2013-204457.203 · 8.56 Impact Factor
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    ABSTRACT: A comprehensive framework for predicting response to therapy on the basis of heterogeneity in dceMRI parameter maps is presented. A motion-correction method for dceMRI sequences is extended to incorporate uncertainties in the pharmacokinetic parameter maps using a variational Bayes framework. Simple measures of heterogeneity (with and without uncertainty) in parameter maps for colorectal cancer tumours imaged before therapy are computed, and tested for their ability to distinguish between responders and non-responders to therapy. The statistical analysis demonstrates the importance of using the spatial distribution of parameters, and their uncertainties, when computing heterogeneity measures and using them to predict response on the basis of the pre-therapy scan. The results also demonstrate the benefits of using the ratio of K trans with the bolus arrival time as a biomarker.
  • Lung Cancer 01/2013; 79:S48. DOI:10.1016/S0169-5002(13)70143-0 · 3.74 Impact Factor
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    ABSTRACT: The aim of this study was to demonstrate the principle of supporting radiologists by using a computer algorithm to quantitatively analyse MRI morphological features used by radiologists to predict the presence or absence of metastatic disease in local lymph nodes in rectal cancer. A computer algorithm was developed to extract and quantify the following morphological features from MR images: chemical shift artefact; relative mean signal intensity; signal heterogeneity; and nodal size (volume or maximum diameter). Computed predictions on nodal involvement were generated using quantified features in isolation or in combinations. Accuracies of the predictions were assessed against a set of 43 lymph nodes, determined by radiologists as benign (20 nodes) or malignant (23 nodes). Predictions using combinations of quantified features were more accurate than predictions using individual features (0.67-0.86 vs 0.58-0.77, respectively). The algorithm was more accurate when three-dimensional images were used (0.58-0.86) than when only middle image slices (two-dimensional) were used (0.47-0.72). Maximum node diameter was more accurate than node volume in representing the nodal size feature; combinations including maximum node diameter gave accuracies up to 0.91. We have developed a computer algorithm that can support radiologists by quantitatively analysing morphological features of lymph nodes on MRI in the context of rectal cancer nodal staging. We have shown that this algorithm can combine these quantitative indices to generate computed predictions of nodal status which closely match radiological assessment. This study provides support for the feasibility of computer-assisted reading in nodal staging, but requires further refinement and validation with larger data sets.
    The British journal of radiology 09/2012; 85(1017):1272-8. DOI:10.1259/bjr/13374146 · 1.53 Impact Factor
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    ABSTRACT: PET-CT scans are routinely performed in patients with lung cancer after investigation by chest x-ray (CXR) and CT scan, when these have demonstrated potentially curable disease. If the majority of patients with lung cancer potentially suitable for curative treatment could be identified earlier in the diagnostic pathway on the basis of CXR findings they could be referred for PET-CT imaging without a prior CT scan. We investigated the clinical and financial implications of adopting such a strategy. The details of 1187 patients referred with suspected lung cancer between July 2006 and August 2009 were analysed. The initial CXR and subsequent imaging of patients fit for curative treatment (Performance Status 0/1, FEV1 > 1.0) were reviewed (n = 251). The clinical and financial implications of referring patients for first line PET-CT if deemed potentially curable based on CXR findings were assessed. 107 of 1187 patients had potentially curable lung cancer on PS, lung function, CT and PET-CT. 96 of these 107 patients (90%) were correctly identified on CXR. 149 patients overall were diagnosed as potentially curable on CXR. Referring suitable patients for an immediate PET-CT scan resulted in a reduction in the time to complete staging investigations. Early PET-CT scanning for patients with suspected lung cancer, potentially suitable for curative therapy could result in more efficient staging with little additional cost.
    Clinical Radiology 01/2012; 67(6):564-73. DOI:10.1016/j.crad.2011.10.032 · 1.66 Impact Factor
  • J M Franklin, E M Anderson, F V Gleeson
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    ABSTRACT: To describe the post-chemoradiotherapy magnetic resonance imaging (MRI) features of locally advanced rectal carcinoma (LARC) in which there has been a complete histopathological response to neoadjuvant chemoradiotherapy (CRT). This retrospective cohort study was performed between January 2005 and November 2009 at a regional cancer centre. Consecutive patients with LARC and a histopathological complete response to long-course CRT were identified. Pre- and post-treatment MRI images were reviewed using a proforma for predefined features and response criteria. ymrT0 was defined as the absence of residual abnormality on MRI. Twenty patients were included in the study. Seven (35%) ypT0 tumours were ymrT0. All 13 ypT0 tumours not achieving ymrT0 appearances had a good radiological response, with at least 65% tumour reduction. The appearances were heterogeneous: in 11/13 patients the tumour was replaced by a region of at least 50% low signal on MRI, with 8/13 having ≥80% low signal, and 3/13 with 100% low signal. MRI may be useful in identifying a complete histopathological response. However, the MRI appearances of ypT0 tumours are heterogeneous and conventional MRI complete response criteria will not detect the majority of patients with a complete histopathological response.
    Clinical Radiology 01/2012; 67(6):546-52. DOI:10.1016/j.crad.2011.11.004 · 1.66 Impact Factor
  • Thorax 12/2011; 66(Suppl 4):A30-A31. DOI:10.1136/thoraxjnl-2011-201054b.62 · 8.56 Impact Factor
  • Thorax 09/2011; 66(9):829-829. DOI:10.1136/thx.2010.156398 · 8.56 Impact Factor
  • American Thoracic Society 2011 International Conference, May 13-18, 2011 • Denver Colorado; 05/2011
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    ABSTRACT: Can the detection rate of flexible bronchoscopy for lung cancer be increased by a series of simple quality improvement measures? Bronchoscopy-associated clinical parameters were prospectively recorded between 2001 and 2007 in patients with suspected lung malignancy. The detection rate of bronchoscopy, diagnostic yield of each biopsy modality and the possible impact of different service-improvement measures were assessed. 746 bronchoscopies were performed in 704 patients. The detection rate of bronchoscopy for malignancy was 83.6%, and increased over time (67.3% detection rate in 2001 (95% CI 52.9-79.7), 89.7% detection rate in 2007 (95% CI 81.3-95.2); p<0.001). Detection rate increased for bronchoscopically visible (75.0% in 2001 to 94.5% in 2007) and non-visible tumours (41.7% in 2001 to 81.2% in 2007; p<0.001 for both analyses). Prior computed tomography availability was associated with a higher diagnostic yield that did not reach statistical significance. Logistic regression analysis identified tumour visibility, year of study, use of transbronchial needle aspiration and pathologist identity as independent predictors of a positive diagnosis. A significant increase in bronchoscopic detection rate for malignancy occurred in association with a number of simple improvement measures.
    European Respiratory Journal 04/2011; 37(4):895-901. DOI:10.1183/09031936.00097110 · 7.13 Impact Factor
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    H E Davies, C G Wathen, F V Gleeson
    BMJ (online) 02/2011; 342:d947. DOI:10.1136/bmj.d947 · 16.38 Impact Factor
  • 01/2011; 1(1):92-117. DOI:10.5152/pb.2011.07
  • John Ayres, Fergus Gleeson
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    ABSTRACT: Imaging is integral to the investigation and management of pleural disease. This article addresses some of the important contributions of imaging to pleural disease, concentrating on ultrasonography, multislice computed tomography, magnetic resonance imaging, and positron-emission tomography combined with computed tomography.
    Seminars in Respiratory and Critical Care Medicine 12/2010; 31(6):674-88. DOI:10.1055/s-0030-1269827 · 3.02 Impact Factor
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    ABSTRACT: The CXR is the most commonly performed radiographic examination worldwide. Its ease of performance, apparent ease of interpretation and low radiation dose, alongside its great spatial resolution would suggest that it should be the first investigation performed in all patients presenting with thoracic disease. But, the advent of ever-improving multislice CT and increasing scanner availability has resulted in some patients being referred directly for scanning, bypassing the CXR. This has resulted in an inexorable rise in the number of scans performed, with an increase in patient radiation exposure and concerns among legislators and physicians that the number of scans needs to be regulated. A key role in the reduction of unnecessary scanning in patients with thoracic disease is the understanding of the place of the CXR, its ability to help in disease detection and monitoring, and its limitations.
    Respirology 08/2010; 15(8):1152-6. DOI:10.1111/j.1440-1843.2010.01842.x · 3.50 Impact Factor
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    Thorax 08/2010; 65 Suppl 2:ii61-76. DOI:10.1136/thx.2010.137026 · 8.56 Impact Factor
  • Chirag Patel, Andrew Scarsbrook, Fergus Gleeson
    The Lancet 05/2010; 375(9728):1778; author reply 1778-9. DOI:10.1016/S0140-6736(10)60798-2 · 45.22 Impact Factor
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    ABSTRACT: Image analysis researchers would benefit considerably by sharing and reusing image processing algorithms. We consider some of the issues that researchers face in trying to provide algorithms in a shareable and reusable form illustrating our approach in the context of medical imaging needs and workflow for colorectal cancer. We consider the use of workflow as a model for developing and reusing components of medical imaging and specifically we consider a solution built using .Net and Windows Workflow Foundation.
    e-Science, 2009. e-Science '09. Fifth IEEE International Conference on; 01/2010
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    ABSTRACT: In multidisciplinary team (MDT) meetings for colorectal and liver cancer, each patient case is reviewed while evidence, including digital image scans such as MRI and PET/CT, is presented by clinicians. Currently these images are projected onto a wall, limiting clinician interaction. While multi-touch and interactive tabletops have been used to enhance collaboration in various scenarios, some aspects such as image quality and touch resolution need to be evaluated in this particular scenario. In this paper we present the results of work conducted to test the suitability of using a DiamondTouch tabletop, a multitouch and multi-user surface, in MDT meetings to enhance clinician interaction.
    IEEE 23rd International Symposium on Computer-Based Medical Systems (CBMS 2010), Perth, Australia, October 12-15, 2010; 01/2010

Publication Stats

2k Citations
516.09 Total Impact Points


  • 2002–2014
    • Oxford University Hospitals NHS Trust
      • Department of Cellular Pathology
      Oxford, England, United Kingdom
  • 1998–2012
    • Churchill College
      Cambridge, England, United Kingdom
  • 2011
    • University of Wales
      Cardiff, Wales, United Kingdom
  • 2010
    • University of Southampton
      Southampton, England, United Kingdom
  • 2003–2010
    • University of Oxford
      • • Oxford e-Research Centre
      • • Department of Engineering Science
      Oxford, England, United Kingdom
    • Royal Berkshire NHS Foundation Trust
      Reading, England, United Kingdom
  • 2004
    • Chelsea and Westminster Hospital NHS Foundation Trust
      Londinium, England, United Kingdom
    • Royal Brompton and Harefield NHS Foundation Trust
      Harefield, England, United Kingdom