应用KV-CBCT分析鼻咽癌调强放射治疗的摆位误差

目的:应用KV-CBCT分析鼻咽癌调强放射治疗时的摆位误差,为鼻咽癌调强放射治疗计划设计时CTV外扩PTV边界的大小提供参考。方法:选取30例IMRT的鼻咽癌患者,治疗过程中每周一次应用KV-CBCT采集患者治疗前的CT图像,将所得图像与定位CT图像进行匹配,分别测定X、Y、Z轴三个方向的摆位误差。结果:30例患者共拍摄168次KV-CBCT,获得168组摆位误差结果,群体摆位误差分别为X轴-0.15±1.43 mm,Y轴0.20±1.58 mm,Z轴-0.21±1.65 mm;根据Van Herk公式计算得到各方向的CTV-PTV外放边界值X、Y、Z轴分别为3.1 mm、3.3 mm和3.4 mm。结论:应用KV-CBCT影像系统可实时测量摆位误差并在线进行纠正,减小摆位误差,为CTV-PTV外放边界提供参考。     

Feasibility of intensity-modulated radiotherapy to treat gastric cancer

AimTo present a proposed gastric cancer intensity-modulated radiotherapy (IMRT) treatment planning protocol for an institution that have not introduced volumetric modulated arc therapy in clinical practice. A secondary aim was to determine the impact of 2DkV set-up corrections on target coverage and organ at risk (OAR).Methods and MaterialsTwenty consecutive patients were treated with a specially-designed non-coplanar 7-field IMRT technique. The isocenter-shift method was used to estimate the impact of 2DkV-based set-up corrections on the original base plan (BP) coverage. An alternative plan was simulated (SP) by taking into account isocenter shifts. The SP and BP were compared using dose-volume histogram (DVH) plots calculated for the internal target volume (ITV) and OARs.ResultsBoth plans delivered a similar mean dose to the ITV (100.32 vs. 100.40%), with no significant differences between the plans in internal target coverage (5.37 vs. 4.96%). Similarly, no significant differences were observed between the maximal dose to the spinal cord (67.70 and 67.09%, respectively) and volume received 50% of the prescribed dose of: the liver (62.11 vs. 59.84%), the right (17.62 vs. 18.58%) and left kidney (29.40 vs. 30.48%). Set-up margins (SM) were computed as 7.80 mm, 10.17 mm and 6.71 mm in the left-right, cranio-caudal and anterior-posterior directions, respectively.ConclusionPresented IMRT protocol (OAR dose constraints with selected SM verified by 2DkV verification) for stomach treatment provided optimal dose distribution for the target and the critical organs. Comparison of DVH for the base and the modified plan (which considered set-up uncertainties) showed no significant differences.     

Synthesis of new 4-[2-(alkylamino)ethylthio]pyrrolo[1,2-a]quinoxaline and 5-[2-(alkylamino)ethylthio]pyrrolo[1,2-a]thieno[3,2-e]pyrazine derivatives,as potential bacterial multidrug resistance pump inhibitors

The synthesis of new 4-[2-(alkylamino)ethylthio]pyrrolo[1,2-a]quinoxaline derivatives 1a-l is described in five or six steps starting from various substituted nitroanilines 2a-e. The bioisostere 5-[2-(alkylamino)ethylthio]pyrrolo[1,2-a]thieno[3,2-e]pyrazine 1m was also prepared. The new derivatives were evaluated as efflux pump inhibitors (EPIs) in a model targeting the NorA system of Staphylococcus aureus. The antibiotic susceptibility of two strains overproducing NorA, SA-1199B and SA-1, was determined alone and in combination with the neo-synthesised compounds by the agar diffusion method and MIC determination, in comparison with reserpine and omeprazole taken as reference EPIs. A preliminary structure-activity relationship study firstly allowed to clarify the influence of the substituents at positions 7 and/or 8 of the pyrrolo[1,2-a]quinoxaline nucleus. Methoxy substituted compounds, 1b and 1g, were more potent EPIs than the unsubstituted compounds (1a and 1f), followed by chlorinated derivatives (1c-d and 1h). Moreover, the replacement of the N,N-diethylamino group (compounds 1a-e) by a bioisostere such as pyrrolidine (compounds 1f-h) enhanced the EPI activity, in contrast with the replacement by a piperidine moiety (compounds 1i-k). Finally, the pyrrolo[1,2-a]thieno[3,2-e]pyrazine compound 1m exhibited a higher EPI activity than its pyrrolo[1,2-a]quinoxaline analogue 1a, opening the way to further pharmacomodulation.     

下丘脑LHA-VMH Ghrelin信号通路对肥胖大鼠摄食选择、胃肠道运动及自发活动的影响及机制研究

目的:探究下丘脑外侧区(LHA)-腹内侧核(VMH)ghrelin信号通路对肥胖大鼠的摄食选择、胃肠道运动及自发活动的影响。方法:采用免疫组织化学方法检测大鼠LHA中ghrelin受体的表达;观察LHA注射ghrelin对大鼠摄食选择胃肠道运动及自发活动的影响;电损毁VMH,观察LHA注射ghrelin对大鼠摄食的影响。结果:免疫组化结果显示,大鼠下丘脑LHA中存在ghrelin受体,且LHA-VMH之间存在纤维投射;大鼠LHA微量注射ghrelin后,肥胖(DIO)大鼠及肥胖抵抗(DR)大鼠的正常饮食、高脂饮食及高糖饮食均高于正常大鼠,但预注射ghrelin受体拮抗剂[D-Lys3]-GHRP-6 (DLS)能够阻断这种作用;而电损毁大鼠VMH,显著减弱了ghrelin对正常大鼠、DIO大鼠及DR大鼠的促摄食作用。大鼠LHA微量注射ghrelin后,正常大鼠、DIO大鼠及DR大鼠的自发活动中,X轴、Y轴方向上的活动增加,且总活动增加,但Z轴方向上活动无明显改变;此外,LHA注射ghrelin,DIO大鼠及DR大鼠的胃肠道转运速率明显加快,且DR大鼠胃肠道转运速率增加更为明显,而预注射ghrelin受体拮抗剂[D-Lys3]-GHRP-6(DLS)显著阻断ghrelin的促胃肠道转运作用。结论:下丘脑LHA-VMH ghrelin信号通路参与调节正常大鼠、DIO及DR大鼠的摄食选择、胃肠道运动及自发活动。     

C-2 phenyl replacements to obtain potent quinoline-based Staphylococcus aureus NorA inhibitors

Abstract

NorA is the most studied efflux pump of Staphylococcus aureus and is responsible for high level resistance towards fluoroquinolone drugs. Although along the years many NorA efflux pump inhibitors (EPIs) have been reported, poor information is available about structure-activity relationship (SAR) around their nuclei and reliability of data supported by robust assays proving NorA inhibition. In this regard, we focussed efforts on the 2-phenylquinoline as a promising chemotype to develop potent NorA EPIs. Herein, we report SAR studies about the introduction of different aryl moieties on the quinoline C-2 position. The new derivative 37a showed an improved EPI activity (16-fold) with respect to the starting hit 1. Moreover, compound 37a exhibited a high potential in time-kill curves when combined with ciprofloxacin against SA-1199B (norA+). Also, 37a exhibited poor non-specific effect on bacterial membrane polarisation and showed an improvement in terms of “selectivity index” in comparison to 1.     

Differences in the Head Movement During Baseball Batting between Skilled Players and Novices

ABSTRACT: Nakata, H, Miura, A, Yoshie, M, and Kudo, K. Differences in the head movement during baseball batting between skilled players and novices. J Strength Cond Res 26(10): 2632-2640, 2012-We investigated the pattern of head movement during baseball batting in 8 skilled players and 9 unskilled novices, using a high-speed video camera. The 2 directions of head movement were analyzed as an X-axis (from the home plate to the pitcher's plate) and Z-axis (vertical downward). On the X-axis, peak latency, peak value, the distance from the peak to the value at bat-ball impact, and data variability were compared between the 2 groups. On the Z-axis, peak latency, downward distance, and data variability were analyzed. Peak latency on the X-axis occurred significantly earlier in baseball players than in novices (p < 0.001), and the difference between the minimum peak and impact was significantly larger in the players (p < 0.05). The variability in peak latency on the X-axis was significantly larger in the novices (p < 0.05). The variability in peak value on the Z-axis was also significantly larger in the novices (p < 0.05). Our findings showed that the significant differences in head movement between the 2 groups should help baseball players, beginners, coaches, and strength and conditioning professionals to improve performance, be effectively applied to actual practice, and enhance coaching for batting.     

Acid pairs increase the N-terminal Ca2+ affinity of CaM by increasing the rate of Ca2+ association

A series of N-terminal calmodulin (CaM) mutants was generated to probe the relationship between the N-terminal Ca(2+) affinity and the number of paired, negatively charged Ca(2+) chelating residues in the N-terminal Ca(2+)-binding sites of CaM. When the number of acid pairs [negatively charged residues at positions +x and -x (X-axis), +y and -y (Y-axis), and +z and -z (Z-axis)] was increased from zero to one and then to two, a progressive increase was seen in the N-terminal Ca(2+) affinities. The maximal ranges of the increases observed in the N-terminal Ca(2+) affinity were approximately 8-8.5-fold for site I, approximately 4.5-5-fold for site II, and approximately 11-fold for both sites, in comparison to the mutants containing no acid pairs. The maximal values of N-terminal Ca(2+) affinity were bestowed by the presence of five acidic chelating residues in site I or II, individually. Addition of the sixth acidic chelating residue (third acid pair) to both N-terminal Ca(2+)-binding sites reduced the N-terminal Ca(2+) affinity. The increases in Ca(2+) affinity observed were caused by an increase in the Ca(2+) association rates for the Y- and Z-axis acid pairs, while the X-axis acid pair caused a reduction in the Ca(2+) dissociation rates.     

Measuring skin dose in CT examinations under complex geometries: Instruments,methods and considerations

ObjectiveTo investigate skin dose in Computed Tomography (CT) and its dependence on scanning geometry.Materials and methodsMeasurements of entrance surface air kerma (ESAK) in free air and entrance skin dose (ESD) on an anthropomorphic phantom were performed in a 64-slice CT scanner, using two different instruments: the Dose Profiler (DP) and the QED skin diode (QEDSD). Using DP and QEDSD, the ESAK rate profiles at the isocenter and at different distances from it, were measured using axial scans. Using DP and helical scans the ESAK rate profile in the Z-axis was acquired. The same profile was acquired with the QEDSD also, using many axial scans and manual table translation. ESD measurements were performed with the DP and QEDSD, in axial and helical scan mode.ResultsESAK measurements with DP and QEDSD were in good agreement, for both point dose and profile measurements. The agreement was also good for ESD measurements but not for helical scans, due to variable X-ray beam overlapping and different tube angular positions at each scan start. It was observed that the ESD values at different Y-axis offsets were comparable to the respective ESAK values recorded at the same Y-axis offset distances without the phantom.ConclusionsBoth DP and QEDSD were proven suitable for performing point ESD measurements. However, calculating the skin dose distribution in CT examinations is a very challenging task. A practical approach would be for CT scanners to provide a conservative estimate of the peak skin dose using the isocenter ESAK value.     

Environmental influences on the productivity of three desert succulents in the south-western United States

Abstract Net CO₂ uptake over 24 h periods for shoots of Agave deserti, Ferocactus acanthodes, and Opuntia ficus-indica was measured under the ranges of water status, air temperature, and photo-synthetically active radiation (PAR) that occur in the south-western U.S.A. An environmental productivity index (EPI) was constructed indicating the overall influence of these three factors on net CO₂ uptake. Using growth chambers whose conditions were changed monthly to simulate the environmental conditions at a field site, the observed shoot dry weight increases per unit surface area changed in concert with monthly changes in EPI. The observed dry weight gain of the shoot was 17–19% lower than the predicted shoot net CO₂ uptake, which could be accounted for by carbon diversion to the roots. Mean monthly EPI was also predicted for 21 sites in the south-western U.S.A. All three species had low EPIs in the Colorado River basin, which has low annual rainfall and high summer temperatures, and in the north-central part of the region, which has low temperatures and low PAR during winter when water is available. The two native species, A. deserti and F. acanthodes, had high EPIs beyond their range in coastal southern California, where competition by other vegetation for PAR may limit net CO₂ uptake. Such regions as well as south-central California and south-central Arizona had high EPIs for all three species, indicating that these areas would be appropriate for the cultivation of O. ficus-indica.     

The construction of the scoliosis 3D finite element model and the biomechanical analysis of PVCR orthopaedy

ObjectiveThe objective is to investigate the biomechanical conditions of the Posterior Vertebral Column Resection (PVCR) of the constructed scoliosis 3D finite element model.MethodsA patient with scoliosis was selected; before the PVCR orthopaedy, the patient was submitted to the radiography of normal and lateral full-length vertebral column scans and the total magnetic resonance imaging (MRI) scans; then, the idiopathic scoliosis model was constructed by the 3D finite element method, and the 3D finite element software utilized in the process of model construction included Mimics software, Geomagic Studio 12 software, and Unigraphic 8.0 (UG 8.0) software; in addition, PVCR orthopaedy was utilized to correct the scoliosis of the patient, and the biomechanical parameters, such as orthodontic force, vertebral body displacement, orthopedic rod stress, stress on the pin-bone interface of the vertebral body surface, and the stress on the intervertebral disc, were studied.ResultsThe 3D effective finite element model of scoliosis was successfully constructed by the Mimics software, the Geomagic Studio 12 software, and the UG 8.0 software, and the effectiveness was tested. PVCR orthopaedy could effectively solve the problem of scoliosis. The magnitude of the orthodontic force that a patient needed depended on the physical conditions and the personal orthodontic requirements of the patient. The maximum vertebral body displacement on the X-axis was the vertebral body L1, the maximum displacement on the Y-axis was the vertebral body T3, the maximum displacement on the Z-axis was the vertebral body T1, and the rang of orthopedic rod stress was 0.0050214e⁷ MPa to 0.045217e⁷ MPa, in which the maximum stress of 2 vertebral bodies in, above, and below the osteotomy area reached 0.045217e⁷ MPa, the stress on the pin-bone interface of the T10 vertebral body surface reached 11.83 MPa, and the stress of T8/T9 intervertebral disc reached 13.84 MPa.ConclusionThe 3D finite element model based on 3D finite element software was highly efficient, and its numerical simulation was accurate, which was important for the subsequent biomechanical analysis of PVCR orthopaedy. In addition, the vertebral stress of PVCR orthopaedy was different in each body part, which was mainly affected by the applied orthodontic force and the sites of the orthodontic area.     

CBCT引导放疗摆位误差对中上段食管癌患者受照射剂量的影响

摘要 目的：探究锥形束CT（CBCT）引导放疗摆位误差对中上段食管癌患者受照射剂量的影响。方法：选取2017年5月～2019年5月于我院收治的60例中上段食管癌患者为研究对象,所有患者均行CBCT图像、计划CT图像采集。在患者放疗前进行CBCT扫描,将CBCT图像与计划CT图像匹配,得到左右（x轴）、头脚（y轴）、前后（z轴）三个方向的线性误差,分析出现的误差及误差的分布规律。利用模拟实际照射系统,进行模拟计划,得到实际照射靶区及正常组织受照射剂量,将其与治疗前计划比较,研究摆位误差对患者受照剂量的影响。结果：患者整体摆位误差为x轴（2.91±2.20）mm,y轴（3.89±2.17）mm,z轴（2.44±1.64）mm,x轴的MPTV为4.054 mm,y轴的MPTV为8.183 mm,z轴的MPTV为3.482 mm。模拟计划的CI、PTV的Dmin、Dmean、D95%均低于标准计划差异显著（P均＜0.05）,而模拟计划的HI低于标准计划（P＜0.05）。模拟计划的脊髓Dmax高于标准计划（P＜0.05）,而标准计划与模拟计划的双肺V20、Dmean,心脏V40差异比较无统计学意义（P均＞0.05）。结论：CBCT引导放疗摆位误差对中上段食管癌患者影响较小,提高PTV受照射剂量及治疗准确程度,对脊髓有保护效果。摆位误差对心、肺的剂量分布无明显影响。     

Accuracy of real-time MR temperature mapping in the brain: A comparison of fast sequences

PurposeTo compare magnetic resonance (MR) thermometry based on the proton resonance frequency (PRF) method using a single shot echoplanar imaging (ss EPI) sequence to both of the standard sequences, gradient echo (GRE) and segmented echoplanar imaging (seg EPI) in the in vivo human brain, at 1.5T and 3T.Material and methodsRepetitive MR thermometry was performed on the brain of six volunteers using GRE, seg EPI, and ss EPI sequences on whole-body 1.5T and 3T clinical systems using comparable acquisition parameters. Phase stability and temperature data precision in the human head were determined over 12 min for the three sequences at both field strengths. An ex-vivo swine skeletal muscle model was used to evaluate temperature accuracy of the ss EPI sequence during heating by high intensity focused ultrasound (HIFU).ResultsIn-vivo examinations of brain revealed an average temperature precision of 0.37 °C/0.39 °C/0.16 °C at 3T for the GRE/seg EPI/ss EPI sequences. At 1.5T, a precision of 0.58 °C/0.63 °C/0.21 °C was achieved. In the ex-vivo swine model, a strong correlation of temperature data derived using ss EPI and GRE sequences was found with a temperature deviation <1 °C.ConclusionThe ss EPI sequence was the fastest and the most precise sequence for MR thermometry, with significantly higher accuracy compared to GRE.     

Determination of optimal planning target volume margins in patients with gynecological cancer

PurposeTo define optimal planning target volume (PTV) margins for intensity modulated radiotherapy (IMRT) ± knee-heel support (KHS) in patients treated with adjuvant radiotherapy.MethodsComputed tomography (CT) scans ± KHS of 10 patients were taken before and at 3rd and 5th week of treatment, fused and compared with initial IMRT plans.ResultsA PTV margin of 15 mm in anteroposterior (AP) and superoinferior (SI) directions and 5 mm in lateral directions were found to be adequate without any difference between ± KHS except for the SI shifts in CTV-primary at the 3rd week. Five mm margin for iliac CTV was found to be inadequate in 10–20% of patients in SI directions however when 7 mm margin was given for iliac PTV, it was found to be adequate. For presacral CTV, it was found that the most striking shift of the target volume was in the direction of AP. KHS caused significantly less volume of rectum and bladder in the treated volume.ConclusionsPTV margin of 15 mm in SI and AP, and 5 mm in lateral directions for CTV-primary were found to be adequate. A minimum of 7 mm PTV margin should be given to iliac CTV. The remarkable shifting in presacral CTV was believed to be due to the unforeseen hip malposition of obese patients. The KHS seems not to provide additional beneficial effect in decreasing the shifts both in CTV-primary and lymphatic, however it may have a beneficial effect of decreasing the OAR volume in PTV margins.     

Changes in the calcium current among different transmural regions contributes to action potential heterogeneity in rat heart

To clarify the transmural heterogeneity of action potential (AP) time course, we examined the regulation of L-type Ca²⁺ current (I_Ca,L) by voltage and Ca²⁺-dependent mechanisms. Currents were recorded using patch clamp of single rat subepicardial (EPI) and subendocardial (ENDO) of left ventricular, right ventricular (RV) and septal (SEP) cardiomyocytes. Voltage clamp commands were derived from ENDO and EPI APs or rectangular voltage pulses.During rectangular pulses, peak I_Ca,L was significantly greater in EPI than in other cells. The inactivation of I_Ca,L by Ca²⁺-dependent mechanisms (suppressed by ryanodine and BAPTA) was present in all cells but greater in extent in ENDO and SEP cells. Activation and inactivation curves for all regions show subtle differences that are Ca²⁺ sensitive, with Ca²⁺ inactivation shifting the activation variables negative by ∼ 7 mV and inactivation variables positive by 2-7 mV (EPI being least, RV greatest). In AP-clamps, the peak I_Ca,L was significantly smaller in ENDO than in EPI cells, while the integrated current was significantly larger in ENDO than in EPI cells. The results are discussed with regard to the interplay of AP time course and net Ca²⁺ influx.     

Real-time measurement of ICD lead motion during stereotactic body radiotherapy of ventricular tachycardia

BackgroundHere we aimed to evaluate the respiratory and cardiac-induced motion of a ICD lead used as surrogate in the heart during stereotactic body radiotherapy (SBRT) of ventricular tachycardia (VT). Data provides insight regarding motion and motion variations during treatment.Materials and methodsWe analyzed the log files of surrogate motion during SBRT of ventricular tachycardia performed in 20 patients. Evaluated parameters included the ICD lead motion amplitudes; intrafraction amplitude variability; correlation error between the ICD lead and external markers; and margin expansion in the superior-inferior (SI), latero-lateral (LL), and anterior-posterior (AP) directions to cover 90% or 95% of all amplitudes.ResultsIn the SI, LL, and AP directions, respectively, the mean motion amplitudes were 5.0 ± 2.6, 3.4. ± 1.9, and 3.1 ± 1.6 mm. The mean intrafraction amplitude variability was 2.6 ± 0.9, 1.9 ± 1.3, and 1.6 ± 0.8 mm in the SI, LL, and AP directions, respectively. The margins required to cover 95% of ICD lead motion amplitudes were 9.5, 6.7, and 5.5 mm in the SI, LL, and AP directions, respectively. The mean correlation error was 2.2 ± 0.9 mm.ConclusionsData from online tracking indicated motion irregularities and correlation errors, necessitating an increased CTV-PTV margin of 3 mm. In 35% of cases, the motion variability exceeded 3 mm in one or more directions. We recommend verifying the correlation between CTV and surrogate individually for every patient, especially for targets with posterobasal localization where we observed the highest difference between the lead and CTV motion.     

Effect of epiberberine from Coptis chinensis Franch on inhibition of tumor growth in MKN-45 xenograft mice

Background and purposeGastric cancer is one of the major malignancies worldwide. Epiberberine (EPI) is a major alkaloid from Coptis chinensis Franch and the antitumor property of EPI remains poorly understood.MethodThe inhibition on gastric cancer cells was observed by MTT assays and colony formation experiments. The apoptosis, cell cycle, and reactive oxygen species (ROS) and mitochondrial membrane potential (ΔΨm) in gastric cancer cells were analyzed by Flow cytometry. The anti-tumor effect of EPI was evaluated with the MKN-45-beraring nude mice, and the potential mechanisms were explored by RNA-seq, qPCR, siRNA silencing and western blotting.ResultsEPI inhibited the proliferation of human gastric cancer cell lines MKN-45 (harboring wild-type p53) and HGC-27 (harboring mutant p53) in a dose dependent manner. EPI induced the apoptosis and cell cycle arrest in these two cell lines, of which MKN-45 cells are more sensitive to EPI than HGC-27 cells. Further experiments indicated that EPI induced the accumulation of ROS and decreased of ΔΨm in MKN-45 cells. The significant differentially expressed genes obtained by RNA-seq were distinctly enriched in the p53 signaling pathway. The apoptosis induced by EPI in MKN-45 cells would be effectively inhibited with the treatment of p53 siRNA and p53 inhibitor PFT-α. Western blotting demonstrated that EPI diminished the expression of Bcl-2 and XIAP, and increased those of p53, Bax, p21, p27, Cytochrome C and Cleaved-caspase 3. Animal experiments confirmed that EPI significantly alleviated tumor growth in MKN-45 xenograft mice via p53/Bax pathway.ConclusionsThese data indicated that EPI could be a novel anti-tumor candidate against MKN-45-related gastric cancer via targeting p53-dependent mitochondria-associated pathway.     

Cone-beam CT-based inter-fraction localization errors for tumors in the pelvic region

PurposeTo evaluate inter-fraction tumor localization errors (TE) in the RapidArc® treatment of pelvic cancers based on CBCT. Appropriate CTV-to PTV margins in a non-IGRT scenario have been proposed.MethodsData of 928 patients with prostate, gynecological, and rectum/anal canal cancers were retrospectively analyzed to determine systematic and random localization errors. Two protocols were used: daily online IGRT (d-IGRT) and weekly IGRT. The latter consisted in acquiring a CBCT for the first 3 fractions and subsequently once a week. TE for patients who underwent d-IGRT protocol were calculated using either all CBCTs or the first 3.ResultsThe systematic (and random) TE in the AP, LL, and SI direction were: for prostate bed 2.7(3.2), 2.3(2.8) and 1.9(2.2) mm; for prostate 4.2(3.1), 2.9(2.8) and 2.3(2.2) mm; for gynecological 3.0(3.6), 2.4(2.7) and 2.3(2.5) mm; for rectum 2.8(2.8), 2.4(2.8) and 2.3(2.5) mm; for anal canal 3.1(3.3), 2.1(2.5) and 2.2(2.7) mm. CTV-to-PTV margins determined from all CBCTs were 14 mm in the AP, 10 mm in the LL and 9–9.5 mm in the SI directions for the prostate and the gynecological groups and 9.5–10.5 mm in AP, 9 mm in LL and 8–10 mm in the SI direction for the prostate bed and the rectum/anal canal groups. If assessed on the basis of the first 3 CBCTs, the calculated CTV-to-PTV margins were slightly larger.Conclusionswithout IGRT, large CTV-to-PTV margins up to 15 mm are required to account for inter-fraction tumor localization errors. Daily IGRT should be used for all hypo-fractionated treatments to reduce margins and avoid increased toxicity to critical organs.     

A constrained linear regression optimization algorithm for diaphragm motion tracking with cone beam CT projections

PurposeWe presented a feasibility study to extract the diaphragm motion from the inferior contrast cone beam computed tomography (CBCT) projection images using a constrained linear regression optimization algorithm.MethodsThe shape of the diaphragm was fitted by a parabolic function which was initialized by five manually placed points on the diaphragm contour of a pre-selected projection. A constrained linear regression model by exploiting the spatial, algebraic, and temporal constraints of the diaphragm, approximated by a parabola, was employed to estimate the parameters. The algorithm was assessed by a fluoroscopic movie acquired at anterior-posterior (AP) fixed direction and kilovoltage CBCT projection image sets from four lung and two liver patients using the Varian 21iX Clinac. The automatic tracing by the proposed algorithm and manual tracking were compared in both space and frequency domains for the algorithm evaluations.ResultsThe error between the results estimated by the proposed algorithm and those by manual tracking for the AP fluoroscopic movie was 0.54 mm with standard deviation (SD) of 0.45 mm. For the detected projections the average error was 0.79 mm with SD of 0.64 mm for all six enrolled patients and the maximum deviation was 2.5 mm. The mean sub-millimeter accuracy outcome exhibits the feasibility of the proposed constrained linear regression approach to track the diaphragm motion on rotational fluoroscopic images.ConclusionThe new algorithm will provide a potential solution to rendering diaphragm motion and possibly aiding the tumor target tracking in radiation therapy of thoracic/abdominal cancer patients.     

Definition of the margin of major coronary artery bifurcations during radiotherapy with electrocardiograph-gated 4D-CT

PurposeThe aim was to measure the cardiac motion-induced displacements of major coronary artery bifurcations utilizing electrocardiography (ECG)-gated four-dimensional computed tomography (4D-CT) and to determine the margin of coronary artery bifurcations.MethodsThirty-seven female patients who underwent retrospective ECG-gated 4D-CT in inspiratory breath hold (IBH) were enrolled. The left main coronary artery bifurcation (LM), the obtuse marginal branch bifurcation (OM), the first diagonal branch bifurcation (D₁), the second diagonal branch bifurcation (D₂), the caudal portion of the left anterior descending branch (APX), the first right ventricular artery bifurcation (V) and the acute marginal branch bifurcation (AM) were contoured. The center of the contour of the coronary arterial bifurcations at end systole was defined as the standard, and the margin were then calculated.ResultsThe margin in the left–right (LR), cranio-caudal (CC), and anterior-posterior (AP) coordinates were as follows: LM 3, 3, and 3 mm; D₁ 6, 3, and 3 mm; D₂ 3, 3, and 3 mm; APX 4, 4, and 4 mm; OM 4, 6, and 5 mm; V 6, 8, and 7 mm; and AM 6, 8, and 7 mm, respectively.ConclusionCoronary artery bifurcations should be considered a separate organ at risk (OAR), and different margin should be provided due to the differences resulting from motion displacement. The maximum margin in the LR, CC, and AP coordinates of left coronary artery bifurcations were 6, 6, and 5 mm, and those of the right coronary artery bifurcations were 6, 8, and 7 mm, respectively.