Natee Ina

Objectives: Establishing optimal sarcopenia cutoffs is essential, as L3 is not always included in CT imaging, and reference levels vary across populations. The absence of Southeast Asia-specific thresholds may lead to misclassification, highlighting the need for regionally appropriate diagnostic criteria. This study establishes population-specific sarcopenia cutoffs (T10-S1) in the Thai population and defines BMI-adjusted thresholds. It also assesses skeletal muscle index (SMI) correlations across vertebral levels to refine L3-based sarcopenia evaluation. Methods: This retrospective study analyzed 475 healthy Thai adults (aged 18-40 years) who underwent emergency department CT between January 2010 and June 2023. Skeletal muscle parameters were measured from T10 to S1 using custom software. Measurements included skeletal muscle area (SMA), skeletal muscle radiation attenuation (SMRA), SMI, and height-adjusted SMI (SMIH1). Sex-stratified analyses and correlations between vertebral levels were performed. Results: At L3, sarcopenia cutoffs using SMI and SMIH1 were 23.3 cm2/m2 and 37.1 cm2/m for females, and 31.3 cm2/m2 and 53.9 cm2/m for males, respectively. Strong correlations were observed between L3 and adjacent vertebral levels (r > 0.8), with correlation strength decreasing with anatomical distance. Application of international cutoffs to the Thai population resulted in overestimation of sarcopenia cases. BMI-adjusted variable thresholds demonstrated superior diagnostic accuracy compared to fixed cutoffs. Conclusions: This study establishes the first population-specific sarcopenia reference values for Thai adults and validates the use of alternative vertebral levels when L3 imaging is unavailable. Our findings emphasize the importance of population-specific and BMI-adjusted cutoff values for accurate sarcopenia diagnosis in Thai adults. Advances in knowledge: This study establishes the first population-specific sarcopenia cutoff values for healthy Thai adults, providing the first evidence-based reference standards for the Thai populations. At L3, the recommended cutoffs are SMI 23.3 cm2/m2 and SMIH1 37.1 cm2/m for females, and SMI 31.3 cm2/m2 and SMIH1 53.9 cm2/m for males. Strong correlations (r > 0.8) between L3 and adjacent vertebral levels validate the use of alternative assessment sites when L3 imaging is unavailable: T12-L1 for chest CT protocols, L3 for abdominal CT protocols, and L4-L5 for pelvic CT protocols. Application of Western cutoffs to the Thai populations results in significant overestimation of sarcopenia prevalence, emphasizing the critical importance of population-specific diagnostic criteria.

Background: Radiologic technology (RT) education faces challenges in bridging theory and practice due to limited clinical opportunities. While virtual reality (VR) enables safe and repeatable practice, a systematic instructional design framework is needed to develop scalable, procedure-focused modules. Objective: This study evaluates the Radiologic Technology Virtual Reality (RTVR) framework that integrates 360-degree video capture, instructional overlays, interactive assets, and an immersive content authoring platform to deliver a contrast-enhanced computed tomography (CECT) brain scan module. Methods: In this open-label, parallel-group, randomized controlled trial, 36 year-2 and year-3 RT students with no prior clinical training in diagnostic radiology at a university hospital in Thailand were randomly allocated (1:1) to a VR group or a conventional document-based instruction (control) group. The VR group completed the VR module, a grounded instructional design framework using 360-degree videos and a structured prebrief and debrief, for 20 minutes using a head-mounted display. The control group studied standard curriculum materials for the same duration. Blinding of participants was not possible. Outcome assessment was blinded. The primary outcome was declarative knowledge gain, assessed using a 20-item multiple-choice test before and after intervention. Secondary outcomes included technology acceptance, student satisfaction, and physiological responses during VR immersion. Results: All 36 randomized participants (VR: n=18, control: n=18) completed the study and were included in the analysis. Experts validated the module as suitable and highly appropriate. Students reported high technology acceptance and satisfaction. Both VR and conventional methods produced substantial gains in declarative knowledge. No statistically significant difference in knowledge gain was detected between groups (test × group: unstandardized regression coefficient β=.056, 95% CI −1.360 to 1.473, P =.94). Year-2 students, who had less prior clinical exposure, showed larger pretest to posttest knowledge gains compared to year-3 students. Physiological monitoring showed a reduction in heart rate across the session, while blood pressure remained stable. No adverse events or VR-related discomfort requiring discontinuation was observed. Conclusions: The RTVR framework, which uses a real 360-degree video of authentic clinical settings, offers a scalable approach to procedural VR content creation without requiring specialist technical skills, distinguishing it from prior VR studies in radiography. These findings support the RTVR framework as a feasible, evidence-informed supplement to RT curricula for knowledge-focused procedural teaching, with learning outcomes comparable to those of conventional instruction in this context.

Sarcopenia and sarcopenic obesity are increasingly recognized sequelae of anticancer therapy in children, yet a consensus definition remains elusive. Diminished skeletal muscle area (SMA) and increased adiposity have been associated with poor outcomes in several pediatric malignancies, but data for childhood lymphoma, particularly in Thailand, are lacking. We retrospectively analyzed 73 children with lymphoma treated with chemotherapy (CMT) between 2004 and 2024 at a single institution. SMA and adiposity parameters were measured using computed tomography (CT) at the L4/L5 intervertebral disc level using in-house software developed in MATLAB and freeware Python 3.6.13. Sarcopenia and sarcopenic obesity were determined, and survival analysis was performed. The cohort’s mean age was 8.9 ± 3.7 years. The prevalence of sarcopenia was 60.3% based on the SMA change rate (< 9.12% per 6 months) and 67.1% based on the skeletal muscle index (SMI) change rate (< 8.46% per 6 months); 65.8% met the criteria for sarcopenic obesity. Patients with Hodgkin lymphoma (HL) were more likely than those with non-Hodgkin lymphoma (NHL) to exhibit sarcopenia (SMA: odds ratio [OR] = 6.32, 95% confidence interval [CI] 2.16–21.58; SMI: OR = 5.65, 95% CI 1.82–21.64) and sarcopenic obesity (OR = 4.35, 95% CI 1.48–14.80). However, sarcopenia and sarcopenic obesity were not significantly associated with survival outcomes. Post-CMT sarcopenia and sarcopenic obesity are more prevalent in HL than in NHL. Nevertheless, the change in sarcopenia and sarcopenic obesity parameters after treatment may not significantly influence long-term survival outcomes in children with lymphoma, potentially due to ongoing muscle growth during development.