Brian Vala Nahed

BACKGROUND AND OBJECTIVES: Case logging is essential for competency-based evaluation in residency but requires manual entry, which is susceptible to error, leading to delayed submission and underreporting. We present a novel, fully automated electronic health record (EHR)–integrated platform that extracts data from clinical documentation and logs it into the Accreditation Council for Graduate Medical Education (ACGME) case log system. We aim to evaluate the feasibility and effectiveness of an automated EHR extraction and case-logging system linked to the ACGME. METHODS: We evaluated case logs from 20 residents (post-graduate year 1-7) at an academic neurosurgery department from June to September 2025. Automated case logs were extracted from our digital EHR data warehouse, current procedural terminology codes were mapped to procedure code IDs, and residents verified automated logs before ACGME transmission. Manual case logs were extracted from operative reports in Epic by 2 staff members for comparison. Accuracy, precision, and sensitivity were assessed by comparing automated logs against manual logs. Time savings was estimated by comparing manual and automated per case-logging time across clinical residency years. RESULTS: A total of 1977 cases were automatically pulled compared with 2041 cases pulled from manual chart review. After review by each resident, 1955 of the automatically pulled cases were correctly logged and categorized when compared with manual cases (94.8% accuracy), with a 98.9% precision and 95.8% sensitivity. Traditional self-reported case logging took, on average, 199.9 ± 99.1 seconds per case. In comparison, reviewing and confirming automated case logs required an average of 68.4 ± 75.1 seconds per case. Per ACGME case minimums, automated logging reduced time by 66%, saving a neurosurgical resident 58 hours over the course of 5 operative, clinical years. CONCLUSION: Automated case logs provide an accurate, time-effective tool that can reduce administrative burden. Future studies should evaluate how to further improve and broaden the application of automated case logs to other specialties.

Study Representativeness Table.

Organs at risk dose constraints.

Purpose:Outcomes for grade 2 and 3 meningiomas are poor. A few studies suggest a benefit from radiotherapy dose escalation. This trial evaluates the safety and efficacy of dose escalation with intensity-modulated proton therapy (IMPT) for grade 2 and 3 meningiomas. Patients and Methods:This prospective single-arm phase I trial enrolled patients with grade 2 meningioma with residual disease or recurrence or patients with grade 3 meningioma after gross total resection. Patients underwent dose-escalated IMPT to 66 Gy relative biological effectiveness [Gy(RBE)] for grade 2 gross disease and 63 Gy(RBE) for grade 3 tumor beds. The primary endpoint was acute dose-limiting toxicity (DLT). Secondary endpoints included progression-free survival (PFS), overall survival (OS), and late toxicity. Results:Twenty-one patients with 16 grade 2 and 5 grade 3 meningiomas were enrolled and treated between 2016 and 2023. The median clinical and radiographic follow-up periods were 3.4 and 3.2 years, respectively. No DLT was observed. Five new late grade 3 toxicities occurred in four patients. Three treatment failures were observed in two grade 2 and one grade 3 tumors. Two deaths occurred in patients with grade 2 meningiomas. The 1-, 2-, and 3-year PFS rates were 100%, 95%, and 88.2%, respectively. The corresponding OS rates were 100%, 95%, and 95%, respectively. Conclusions:This first prospective trial investigating dose-escalated IMPT for high-grade meningiomas demonstrated a favorable early safety profile and clinical outcomes. Phase II and III studies are warranted to confirm the superiority of dose escalation for high-grade meningiomas.

Overall survival. A: Complete cohort. B: Stratified by WHO grading. C: Stratified by treatment indication.

Local failure rates, progression-free survival, and overall survival.

Background: Outcomes for grade 2 and 3 meningiomas are poor. A few studies suggest a benefit from radiation therapy dose escalation. This trial evaluates the safety and efficacy of dose escalation with intensity-modulated proton therapy (IMPT) for grade 2 and 3 meningiomas. Methods: This prospective single-arm phase 1 trial enrolled patients with grade 2 meningioma with residual disease or recurrence, or patients with grade 3 meningioma after gross total resection. Patients underwent dose-escalated IMPT to 66 Gy (relative biological effectiveness, RBE) for grade 2 gross disease and 63 Gy(RBE) for grade 3 tumor beds. The primary endpoint was acute dose-limiting toxicity (DLT). Secondary endpoints included progression-free survival (PFS), overall survival (OS), and late toxicity. Results: Twenty-one patients with 16 grade 2 and five grade 3 meningiomas were enrolled and treated between 2016 and 2023. The median clinical and radiographic follow-up periods were 3.4 and 3.2 years, respectively. No DLT was observed. Five new late grade 3 toxicities occurred in four patients. Three treatment failures were observed in two grade 2 and one grade 3 tumors. Two deaths occurred in patients with grade 2 meningiomas. The 1-, 2-, and 3-year PFS rates were 100%, 95.0%, and 88.2%, respectively. The corresponding OS rates were 100%, 95.0%, and 95.0%, respectively. Conclusions: This first prospective trial investigating dose-escalated IMPT for high-grade meningiomas demonstrated a favorable early safety profile and clinical outcomes. Phase 2 and 3 studies are warranted to confirm the superiority of dose escalation for high-grade meningiomas.