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  1. Fulltext Analysis of codon usage patterns and influencing factors in Nipah virus
    Chakraborty S, Deb B, Barbhuiya PA, Uddin A
    Virus Res, 2019 04 02;263:129-138.
    PMID: 30664908 DOI: 10.1016/j.virusres.2019.01.011
    Codon usage bias (CUB) is the unequal usage of synonymous codons of an amino acid in which some codons are used more often than others and is widely used in understanding molecular biology, genetics, and functional regulation of gene expression. Nipah virus (NiV) is an emerging zoonotic paramyxovirus that causes fatal disease in both humans and animals. NiV was first identified during an outbreak of a disease in Malaysia in 1998 and then occurred periodically since 2001 in India, Bangladesh, and the Philippines. We used bioinformatics tools to analyze the codon usage patterns in a genome-wide manner among 11 genomes of NiV as no work was reported yet. The compositional properties revealed that the overall GC and AT contents were 41.96 and 58.04%, respectively i.e. Nipah virus genes were AT-rich. Correlation analysis between overall nucleotide composition and its 3rd codon position suggested that both mutation pressure and natural selection might influence the CUB across Nipah genomes. Neutrality plot revealed natural selection might have played a major role while mutation pressure had a minor role in shaping the codon usage bias in NiV genomes.
  2. Review on diagnosis and molecular characterization of Toxoplasma gondii in humans and animals
    Uddin AHMM, Hossain D, Ahsan MI, Atikuzzaman M, Karim MR
    Trop Biomed, 2021 Dec 01;38(4):511-539.
    PMID: 35001919 DOI: 10.47665/tb.38.4.091
    Toxoplasma gondii is an obligate intracellular protozoon which causes toxoplasmosis, an important zoonotic disease that is endemic worldwide. Common sources of T. gondii infection in humans are food or water contaminated with oocysts and raw or undercooked meat with cysts. In animals, common sources of infection include feed, water, or litter contaminated with oocysts. The diagnosis and molecular characterization of T. gondii infection in humans and animals is crucial due to public and veterinary health importance. Various traditional and serological methods have been used in clinical practice for toxoplasmosis diagnosis, but interpreting the results remains a challenge. Several molecular techniques have also been used for the detection and genetic characterization of T. gondii , but primarily in research settings. In this paper, we review the techniques that are currently used for the diagnosis and genetic characterization of T. gondii in humans and animals, along with their advantages and disadvantages. The techniques reviewed have laid the groundwork for the future development of more effective and precise detection and characterization of T. gondii . These advances will contribute to a better understanding of epidemiology, prevention and control of toxoplasmosis. Thus, this review would be of particular interest to clinical physicians, veterinarians and researchers.
  3. Fulltext Study on the Perception of Staff and Students of a University on Community Pharmacy Practice in Ipoh, Perak, Malaysia
    Mathews A, Azad AK, Abbas SA, Bin Che Rose FZ, Helal Uddin ABM
    J Pharm Bioallied Sci, 2018 12 21;10(4):226-231.
    PMID: 30568380 DOI: 10.4103/JPBS.JPBS_80_18
    Background: In Malaysia, community pharmacies play an important and vital role in both urban and rural areas with approximately 30% of 12,000 registered pharmacists with annual retention certificate practicing in community pharmacies. The main objective of this study was to find the perception of respondents on the value and necessity of pharmacists.

    Materials and Methods: The questionnaire was divided into two sections: the first section assessed the visits to community pharmacies, purpose, interaction with pharmacy staffs, professional fee, and improvements to pharmacy practices; the second section evaluated the characteristics of respondents including an e-consent form. Data were analyzed using the Statistical Package for the Social Sciences software (version 11.5).

    Results: The highest number of respondents (66.1%) consulted with the pharmacists for cough and cold, 33.1% for gastric and stomach ailments, and 28.9% for diarrhea and constipation. Only 34% of cases were handled by the pharmacists, whereas 52.1% by the sales assistant. Approximately 88.5% showed satisfaction with the counseling provided. A total of 46.3% did not know whom they dealt with, whereas 51.2% wanted personal attention of the pharmacists instead of the sales assistants. However, 66.9% of respondents preferred to a private consultation room. Records of only 32.2% of respondents were secured by the pharmacies, whereas 42.1% showed interest to pay a professional fee. Moreover, 83.3% agreed the fee of RM5 only, whereas 20.8% agreed to RM10. Among the respondents, majority agreed to pay a fee willingly, but approximately 30% stayed neutral.

    Conclusion: There is a need for the community pharmacists to play vital roles firsthand at the front desk to serve the patients professionally instead of handing over the responsibilities to the sales assistant.

  4. An empirical study of construction and demolition waste generation and implication of recycling
    Islam R, Nazifa TH, Yuniarto A, Shanawaz Uddin ASM, Salmiati S, Shahid S
    Waste Manag, 2019 Jul 15;95:10-21.
    PMID: 31351595 DOI: 10.1016/j.wasman.2019.05.049
    Associated with the continuing increase of construction activities such as infrastructure projects, commercial buildings and housing programs, Bangladesh has been experiencing a rapid increase of construction and demolition (C&D) waste. Till now, the generation rate of C&D waste has not been well understood or not explicitly documented in Bangladesh. This study aims to provide an approach to estimate C&D waste generation using waste generation rates (WGR) through regression analysis. Furthermore, analyses the economic benefit of recycling C&D waste. The results revealed that WGR 63.74 kg/m2 and 1615 kg/m2 for construction and demolition activities respectively. Approximately, in financial year (FY) 2016, 1.28 million tons (0.149 construction and 1.139 demolition) waste were generated in Dhaka city, of which the three largest proportions were concrete (60%), brick/block (21%) and mortar (9%). After collection they were dumped in either landfills or unauthorized places. Therefore, it can be summarized as: waste is a resource in wrong place. The results of this study indicate that rapid urbanization of Dhaka city would likely experience the peak in the generation of C&D waste. This paper thus designates that C&D waste recycling is an entrepreneurial activity worth venturing into and an opportunity for extracting economic and environmental benefits from waste. The research findings also show that recycling of concrete and brick waste can add economic value of around 44.96 million USD. In addition, recycling of C&D waste leads to important reductions in CO2 emissions, energy use, natural resources and illegal landfills. Therefore, the findings of WGR and economic values provide valuable quantitative information for the future C&D waste management exercises of various stakeholders such as government, industry and academy.
  5. Data of chemical analysis and electrical properties of SnO2-TiO2 composite nanofibers
    Bakr ZH, Wali Q, Ismail J, Elumalai NK, Uddin A, Jose R
    Data Brief, 2018 Jun;18:860-863.
    PMID: 29900250 DOI: 10.1016/j.dib.2018.03.110
    In this data article, we provide energy dispersive X-ray spectroscopy (EDX) spectra of the electrospun composite (SnO2-TiO2) nanowires with the elemental values measured in atomic and weight%. The linear sweep voltammetry data of composite and its component nanofibers are provided. The data collected in this article is directly related to our research article "Synergistic combination of electronic and electrical properties of SnO2 and TiO2 in a single SnO2-TiO2 composite nanowire for dye-sensitized solar cells" [1].
  6. Investigation of the Effects of Excipients in the Compounding of Amlodipine Besylate Orally Disintegrating Tablets
    Azmi NHS, Ming LC, Uddin ABMH, Sarker ZI, Bin LK
    Int J Pharm Compd, 2022 1 27;26(1):80-87.
    PMID: 35081048
    Oral drug delivery has been recognized as the most desirable drug administration method among other drug delivery routes due to its ease of administration, long shelf life, and low cost. Orally disintegrating tablets disintegrate within seconds in the mouth without the need of water for swallowing. This unique feature of orally disintegrating tablets is favorable to special populations such as geriatric and pediatric patients. Formulation optimization is significant to obtain the optimal combination of tablet constituents, as the tablet composition is influential on dosage-form characteristics. The objective of this study was to investigate the effect of different types of fillers and percentage on the physical properties of orally disintegrating tablets by using amlodipine as the model drug. Blank orally disintegrating tablets containing different fillers, namely, Sorbolac 400, Granulac 200, and CombiLac with different percentages, were prepared using the wet granulation method and were evaluated based on weight variation, hardness, thickness, friability, and disintegration time. Formulation 5 that consists of 25% Granulac 200 showed the optimal result among all formulations with the fastest disintegration time (96.17 s Å} 18.40) and sufficient tablet hardness (4.59 kg Å} 0.70). Hence, formulation 5 was selected as the optimal formulation and incorporated with amlodipine. From this study, it can be concluded that excipients have an essential role in determining the physical properties of orally disintegrating tablets.
  7. Fulltext Colon and lung cancer classification from multi-modal images using resilient and efficient neural network architectures
    Uddin AH, Chen YL, Akter MR, Ku CS, Yang J, Por LY
    Heliyon, 2024 May 15;10(9):e30625.
    PMID: 38742084 DOI: 10.1016/j.heliyon.2024.e30625
    Automatic classification of colon and lung cancer images is crucial for early detection and accurate diagnostics. However, there is room for improvement to enhance accuracy, ensuring better diagnostic precision. This study introduces two novel dense architectures (D1 and D2) and emphasizes their effectiveness in classifying colon and lung cancer from diverse images. It also highlights their resilience, efficiency, and superior performance across multiple datasets. These architectures were tested on various types of datasets, including NCT-CRC-HE-100K (set of 100,000 non-overlapping image patches from hematoxylin and eosin (H&E) stained histological images of human colorectal cancer (CRC) and normal tissue), CRC-VAL-HE-7K (set of 7180 image patches from N = 50 patients with colorectal adenocarcinoma, no overlap with patients in NCT-CRC-HE-100K), LC25000 (Lung and Colon Cancer Histopathological Image), and IQ-OTHNCCD (Iraq-Oncology Teaching Hospital/National Center for Cancer Diseases), showcasing their effectiveness in classifying colon and lung cancers from histopathological and Computed Tomography (CT) scan images. This underscores the multi-modal image classification capability of the proposed models. Moreover, the study addresses imbalanced datasets, particularly in CRC-VAL-HE-7K and IQ-OTHNCCD, with a specific focus on model resilience and robustness. To assess overall performance, the study conducted experiments in different scenarios. The D1 model achieved an impressive 99.80 % accuracy on the NCT-CRC-HE-100K dataset, with a Jaccard Index (J) of 0.8371, a Matthew's Correlation Coefficient (MCC) of 0.9073, a Cohen's Kappa (Kp) of 0.9057, and a Critical Success Index (CSI) of 0.8213. When subjected to 10-fold cross-validation on LC25000, the D1 model averaged (avg) 99.96 % accuracy (avg J, MCC, Kp, and CSI of 0.9993, 0.9987, 0.9853, and 0.9990), surpassing recent reported performances. Furthermore, the ensemble of D1 and D2 reached 93 % accuracy (J, MCC, Kp, and CSI of 0.7556, 0.8839, 0.8796, and 0.7140) on the IQ-OTHNCCD dataset, exceeding recent benchmarks and aligning with other reported results. Efficiency evaluations were conducted in various scenarios. For instance, training on only 10 % of LC25000 resulted in high accuracy rates of 99.19 % (J, MCC, Kp, and CSI of 0.9840, 0.9898, 0.9898, and 0.9837) (D1) and 99.30 % (J, MCC, Kp, and CSI of 0.9863, 0.9913, 0.9913, and 0.9861) (D2). In NCT-CRC-HE-100K, D2 achieved an impressive 99.53 % accuracy (J, MCC, Kp, and CSI of 0.9906, 0.9946, 0.9946, and 0.9906) with training on only 30 % of the dataset and testing on the remaining 70 %. When tested on CRC-VAL-HE-7K, D1 and D2 achieved 95 % accuracy (J, MCC, Kp, and CSI of 0.8845, 0.9455, 0.9452, and 0.8745) and 96 % accuracy (J, MCC, Kp, and CSI of 0.8926, 0.9504, 0.9503, and 0.8798), respectively, outperforming previously reported results and aligning closely with others. Lastly, training D2 on just 10 % of NCT-CRC-HE-100K and testing on CRC-VAL-HE-7K resulted in significant outperformance of InceptionV3, Xception, and DenseNet201 benchmarks, achieving an accuracy rate of 82.98 % (J, MCC, Kp, and CSI of 0.7227, 0.8095, 0.8081, and 0.6671). Finally, using explainable AI algorithms such as Grad-CAM, Grad-CAM++, Score-CAM, and Faster Score-CAM, along with their emphasized versions, we visualized the features from the last layer of DenseNet201 for histopathological as well as CT-scan image samples. The proposed dense models, with their multi-modality, robustness, and efficiency in cancer image classification, hold the promise of significant advancements in medical diagnostics. They have the potential to revolutionize early cancer detection and improve healthcare accessibility worldwide.
  8. Lactoferrin-tethered betulinic acid nanoparticles promote rapid delivery and cell death in triple negative breast and laryngeal cancer cells
    Halder A, Jethwa M, Mukherjee P, Ghosh S, Das S, Helal Uddin ABM, et al.
    Artif Cells Nanomed Biotechnol, 2020 Nov 17;48(1):1362-1371.
    PMID: 33284038 DOI: 10.1080/21691401.2020.1850465
    Cancer management presents multifarious problems. Triple negative breast cancer (TNBC) is associated with inaccurate prognosis and limited chemotherapeutic options. Betulinic acid (BA) prevents angiogenesis and causes apoptosis of TNBC cells. NIH recommends BA for rapid access in cancer chemotherapy because of its cell-specific toxicity. BA however faces major challenges in therapeutic practices due to its limited solubility and cellular entree. We report lactoferrin (Lf) attached BA nanoparticles (Lf-BAnp) for rapid delivery in triple negative breast (MDA-MB-231) and laryngeal (HEp-2) cancer cell types. Lf association was confirmed by SDS-PAGE and FT-IR analysis. Average hydrodynamic size of Lf-BAnp was 147.7 ± 6.20 nm with ζ potential of -28.51 ± 3.52 mV. BA entrapment efficiency was 75.38 ± 2.70% and the release mechanism followed non-fickian pattern. Impact of Lf-BAnp on cell cycle and cytotoxicity of triple negative breast cancer and its metastatic site laryngeal cancer cell lines were analyzed. Lf-BAnp demonstrated strong anti-proliferative and cytotoxic effects, along with increased sub-G1 population and reduced number of cells in G1 and G2/M phases of the cell cycle, confirming reduced cell proliferation and significant cell death. Speedy intracellular entry of Lf-BAnp occurred within 30 min. Lf-BAnp design was explored for the first time as safer chemotherapeutic arsenals against complex TNBC conditions.
  9. Isolation and characterization of novel antibacterial compound from an untapped plant, Stereospermum fimbriatum
    Izyani Awang AF, Ahmed QU, Shah SAA, Jaffri JM, Ghafoor K, Uddin ABMH, et al.
    Nat Prod Res, 2020 Mar;34(5):629-637.
    PMID: 30470132 DOI: 10.1080/14786419.2018.1494170
    Stereospermum fimbriatum or locally known as "Chicha" is traditionally used for itchy skin, earache, stomachache and postpartum treatments. This study was designed to evaluate the antimicrobial potential of S. fimbriatum's stem bark against 11 pathogens and isolate its bioactive compound. Successive soxhlet extraction was conducted using n-hexane, dichloromethane (DCM) and methanol. Disc diffusion, minimum inhibitory and bactericidal concentration (MIC & MBC) assays were done to examine the antimicrobial activity. Bioassay-guided isolation was conducted on S. fimbriatum's extract. The DCM extract of stem bark (DS) was the most potent extract followed by n-hexane extract of the stem bark (NS). A novel compound was isolated and coded as C1 which demonstrated potent antibacterial effects with the MIC values as low as 3.13 µg/mL to 6.25 µg/mL, against S. epidermidis, MRSA and S. aureus. Thus, S. fimbriatum could be a potential source of antimicrobial agents for the treatment of skin infections, specifically, MRSA.
  10. A Review on the Mechanisms, Applications, and Clinical Trials of Advanced Technologies in the Transdermal Drug Delivery System
    Abdul Aziz AF, Beh YQ, Farahiyah II, Syahrul Azmir S, Kee PE, Helal Uddin ABM, et al.
    Curr Pharm Biotechnol, 2024 Aug 22.
    PMID: 39177135 DOI: 10.2174/0113892010318519240813053106
    Transdermal Drug Delivery Systems (TDDS) have emerged as a promising method for administering therapeutic agents due to their non-invasive nature and patient-friendly approach. However, the effectiveness of this system is limited to drugs with specific physicochemical properties that allow for transdermal delivery as the skin acts as a barrier. To address this limitation, researchers have been exploring alternative approaches to improve drug delivery through the stratum corneum, ensuring consistent drug distribution at controlled rates. Thirdgeneration delivery systems have been developed to facilitate the delivery of various drugs across the skin barrier by disrupting the stratum corneum while protecting deeper skin tissues from injury. This review has explored various approaches that have gained popularity in enhancing drug delivery through TDDS, including microneedle-mediated, nanoparticle-enabled, thermal ablation-enhanced, and electroporation-driven delivery systems. It has discussed the mechanisms of drug delivery and potential applications for different types of drugs and detailed the clinical studies. This review has also highlighted the significant advancements in TDDS, offering valuable insights into both the pharmaceutical field and biomedical applications. The continued exploration and refinement of these delivery systems, particularly with the incorporation of Internet-of-Things (IoT) technology, Artificial Intelligence (AI), and machine learning, hold promise for expanding the scope of therapeutic interventions.
  11. Fulltext Methotrexate-Loaded Gelatin and Polyvinyl Alcohol (Gel/PVA) Hydrogel as a pH-Sensitive Matrix
    Akhlaq M, Azad AK, Ullah I, Nawaz A, Safdar M, Bhattacharya T, et al.
    Polymers (Basel), 2021 Jul 14;13(14).
    PMID: 34301057 DOI: 10.3390/polym13142300
    The aim was to formulate and evaluate Gel/PVA hydrogels as a pH-sensitive matrix to deliver methotrexate (MTX) to colon. The primed Gel/PVA hydrogels were subjected to evaluation for swelling behavior, diffusion coefficient, sol-gel characteristic and porosity using an acidic (pH 1.2) and phosphate buffer (PBS) (pH 6.8 & pH 7.4) media. Fourier transform infrared spectroscopy (FTIR) and thermal gravimetric analysis (TGA) were performed to evaluate the chemical compatibility of the Gel/PVA hydrogel. The shape alteration and release of Gel/PVA hydrogel was conducted at pH 1.2, pH 6.8 and pH 7.4. The drug release kinetic mechanism was determined using various kinetic equations. The physicochemical evaluation tests and drug release profile results were found to be significant (p < 0.01). However, it was dependent on the polymers' concentration, the pH of the release media and the amount of the cross-linking agent. Hydrogels containing the maximum amount of gel showed a dynamic equilibrium of 10.09 ± 0.18 and drug release of 93.75 ± 0.13% at pH 1.2. The kinetic models showed the release of MTX from the Gel/PVA hydrogel was non-Fickian. The results confirmed that the newly formed Gel/PVA hydrogels are potential drug delivery systems for a controlled delivery of MTX to the colon.
  12. Development of a novel direct compressible co-processed excipient and its application for formulation of Mirtazapine orally disintegrating tablets
    Loke YH, Chew YL, Janakiraman AK, Lee SK, Uddin ABMH, Goh CF, et al.
    Drug Dev Ind Pharm, 2024 Jan;50(1):36-44.
    PMID: 38149637 DOI: 10.1080/03639045.2023.2294095
    INTRODUCTION: Orally disintegrating tablets (ODTs) are designed to dissolve in the oral cavity within 3 min, providing a convenient option for patients as they can be taken without water. Direct compression is the most common method used for ODTs formulations. However, the availability of single composite excipients with desirable characteristics such as good compressibility, fast disintegration, and a good mouthfeel suitable for direct compression is limited.

    OBJECTIVE: This research was proposed to develop a co-processed excipient composed of xylitol, mannitol, and microcrystalline cellulose for the formulation of ODTs.

    METHODS: A total of 11 formulations of co-processed excipients with different ratios of ingredients were prepared, which were then compressed into ODTs, and their characteristics were thoroughly examined. The primary focus was on evaluating the disintegration time and hardness of the tablets, as these factors are important in ensuring the ODTs meet the desired criteria. The model drug, Mirtazapine was then incorporated into the chosen optimized formulation.

    RESULTS: The results showed that the formulation comprised of 10% xylitol, 10% mannitol and 80% microcrystalline cellulose demonstrated the fastest disintegration time (1.77 ± 0.119 min) and sufficient hardness (3.521 ± 0.143 kg) compared to the other formulations. Furthermore, the drug was uniformly distributed within the tablets and fully released within 15 min.

    CONCLUSION: Therefore, the developed co-processed excipients show great potential in enhancing the functionalities of ODTs, offering a promising solution to improve the overall performance and usability of ODTs in various therapeutic applications.

  13. Fulltext Preliminary survey of 3D image-guided brachytherapy for cervical cancer at representative hospitals in Asian countries
    Okonogi N, Wakatsuki M, Mizuno H, Fukuda S, Cao J, Kodrat H, et al.
    J Radiat Res, 2020 Jul 06;61(4):608-615.
    PMID: 32367130 DOI: 10.1093/jrr/rraa025
    3D image-guided brachytherapy (3D-IGBT) has become a standard therapy for cervical cancer. However, the use of 3D-IGBT is limited in East and Southeast Asia. This study aimed to clarify the current usage patterns of 3D-IGBT for cervical cancer in East and Southeast Asia. A questionnaire-based survey was performed in 11 countries within the framework of the Forum for Nuclear Cooperation in Asia. The questionnaire collected the treatment information of patients with cervical cancer who underwent 3D-IGBT. The cumulative external beam radiotherapy and 3D-IGBT doses were summarized and normalized to a biological equivalent dose of 2 Gy per fraction (EQD2) using a linear-quadratic model. Of the 11 institutions representing the participating countries, six (55%) responded to the questionnaire. Overall, data of 36 patients were collected from the six institutions. Twenty-one patients underwent whole-pelvic irradiation and 15 underwent whole-pelvic irradiation with central shielding. Patients received a median of four treatment sessions of 3D-IGBT (range, 2-6). All 3D-IGBT sessions were computed tomography (CT)-based and not magnetic resonance image-based. The median doses to the high-risk clinical target volume D90, bladder D2cc, rectum D2cc and sigmoid colon D2cc were 80.9 Gy EQD2 (range, 58.9-105.9), 77.7 Gy EQD2 (range, 56.9-99.1), 68.0 Gy EQD2 (range, 48.6-90.7) and 62.0 Gy EQD2 (range, 39.6-83.7), respectively. This study elucidated the current patterns of 3D-IGBT for the treatment of cervical cancer in East and Southeast Asia. The results indicate the feasibility of observational studies of CT-based 3D-IGBT for cervical cancer in these countries.
  14. Disproportionate COVID-19 vaccine acceptance rate among healthcare professionals on the eve of nationwide vaccine distribution in Bangladesh
    Alam ABMM, Azim Majumder MA, Haque M, Ashraf F, Khondoker MU, Mashreky SR, et al.
    Expert Rev Vaccines, 2021 09;20(9):1167-1175.
    PMID: 34224292 DOI: 10.1080/14760584.2021.1951248
    BACKGROUND: Acceptance of the COVID-19 vaccine by the target groups would play a crucial role in stemming the pandemic. Healthcare professionals (HCPs) are the priority group for vaccination due to them having the highest risk of exposure to infection. This survey aimed to assess their acceptance of COVID-19 vaccines in Bangladesh.

    RESEARCH DESIGN AND METHODS: A cross-sectional survey using an online questionnaire was conducted between January 3 to 25, 2021, among HCPs (n = 834) in Bangladesh.

    RESULTS: Less than 50% of HCPs would receive the vaccine against COVID-19 if available and 54% were willing to take the vaccine at some stage in the future. Female participants (OR:1.64;95%CI:1.172-2.297), respondents between 18-34 years old (OR:2.42; 95% CI:1.314-4.463), HCPs in the public sector (OR:2.09; 95% CI:1.521-2.878), and those who did not receive a flu vaccine in the previous year (OR:3.1; 95% CI:1.552-6.001) were more likely to delay vaccination.

    CONCLUSIONS: The study revealed that, if available, less than half of the HCPs would accept a COVID-19 vaccine in Bangladesh. To ensure the broader success of the vaccination drive, tailored strategies and vaccine promotion campaigns targeting HCPs and the general population are needed.

  15. Potential of E-Learning Interventions and Artificial Intelligence-Assisted Contouring Skills in Radiotherapy: The ELAISA Study
    Rasmussen ME, Akbarov K, Titovich E, Nijkamp JA, Van Elmpt W, Primdahl H, et al.
    JCO Glob Oncol, 2024 Aug;10:e2400173.
    PMID: 39236283 DOI: 10.1200/GO.24.00173
    PURPOSE: Most research on artificial intelligence-based auto-contouring as template (AI-assisted contouring) for organs-at-risk (OARs) stem from high-income countries. The effect and safety are, however, likely to depend on local factors. This study aimed to investigate the effects of AI-assisted contouring and teaching on contouring time and contour quality among radiation oncologists (ROs) working in low- and middle-income countries (LMICs).

    MATERIALS AND METHODS: Ninety-seven ROs were randomly assigned to either manual or AI-assisted contouring of eight OARs for two head-and-neck cancer cases with an in-between teaching session on contouring guidelines. Thereby, the effect of teaching (yes/no) and AI-assisted contouring (yes/no) was quantified. Second, ROs completed short-term and long-term follow-up cases all using AI assistance. Contour quality was quantified with Dice Similarity Coefficient (DSC) between ROs' contours and expert consensus contours. Groups were compared using absolute differences in medians with 95% CIs.

    RESULTS: AI-assisted contouring without previous teaching increased absolute DSC for optic nerve (by 0.05 [0.01; 0.10]), oral cavity (0.10 [0.06; 0.13]), parotid (0.07 [0.05; 0.12]), spinal cord (0.04 [0.01; 0.06]), and mandible (0.02 [0.01; 0.03]). Contouring time decreased for brain stem (-1.41 [-2.44; -0.25]), mandible (-6.60 [-8.09; -3.35]), optic nerve (-0.19 [-0.47; -0.02]), parotid (-1.80 [-2.66; -0.32]), and thyroid (-1.03 [-2.18; -0.05]). Without AI-assisted contouring, teaching increased DSC for oral cavity (0.05 [0.01; 0.09]) and thyroid (0.04 [0.02; 0.07]), and contouring time increased for mandible (2.36 [-0.51; 5.14]), oral cavity (1.42 [-0.08; 4.14]), and thyroid (1.60 [-0.04; 2.22]).

    CONCLUSION: The study suggested that AI-assisted contouring is safe and beneficial to ROs working in LMICs. Prospective clinical trials on AI-assisted contouring should, however, be conducted upon clinical implementation to confirm the effects.

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