A patient immobilization device for prone breast radiotherapy: Dosimetric effects and inclusion in the treatment planning system

PurposeTo assess the dosimetric impact of a patient positioning device for prone breast radiotherapy and assess the accuracy of a treatment planning system (TPS) in predicting this impact.MethodsBeam attenuation and build-up dose perturbations, quantified by ionization chamber and radiochromic film dosimetry, were evaluated for 3 components of the patient positioning device: the carbon fiber baseplate, the support cushions and the support wedge for the contralateral breast. Dose calculations were performed using the XVMC dose engine implemented in the Monaco TPS. All components were included during planning CT acquisition.ResultsBeam attenuation amounted to 7.57% (6 MV) and 5.33% (15 MV) for beams obliquely intersecting the couchtop–baseplate combination. Beams traversing large sections of the support wedge were attenuated by 12.28% (6 MV) and 9.37% (15 MV). For the support cushion foam, beam attenuation remained limited to 0.11% (6 MV) and 0.08% (15 MV) per centimeter thickness. A substantial loss of dose build-up was detected when irradiating through any of the investigated components. TPS dose calculations accurately predicted beam attenuation by the baseplate and support wedge. A manual density overwrite was needed to model attenuation by the support cushion foam. TPS dose calculations in build-up regions differed considerably from measurements for both open beams and beams traversing the device components.ConclusionsIrradiating through the components of the positioning device resulted in a considerable degradation of skin sparing. Inclusion of the device components in the treatment planning CT allowed to accurately model the most important attenuation effect, but failed to accurately predict build-up doses.     

Radiological properties of 3D printed materials in kilovoltage and megavoltage photon beams

PurposeThis study evaluates the radiological properties of different 3D printing materials for a range of photon energies, including kV and MV CT imaging and MV radiotherapy beams.MethodsThe CT values of a number of materials were measured on an Aquilion One CT scanner at 80 kVp, 120 kVp and a Tomotherapy Hi Art MVCT imaging beam. Attenuation of the materials in a 6 MV radiotherapy beam was investigated.ResultsPlastic filaments printed with various infill densities have CT values of −743 ± 4, −580 ± 1 and −113 ± 3 in 120 kVp CT images which approximate the CT values of low-density lung, high-density lung and soft tissue respectively. Metal-infused plastic filaments printed with a 90% infill density have CT values of 658 ± 1 and 739 ± 6 in MVCT images which approximate the attenuation of cortical bone. The effective relative electron density RED_eff is used to describe the attenuation of a megavoltage treatment beam, taking into account effects relating to the atomic number and mass density of the material. Plastic filaments printed with a 90% infill density have RED_eff values of 1.02 ± 0.03 and 0.94 ± 0.02 which approximate the relative electron density RED of soft tissue. Printed resins have RED_eff values of 1.11 ± 0.03 and 1.09 ± 0.03 which approximate the RED of bone mineral.Conclusions3D printers can model a variety of body tissues which can be used to create phantoms useful for both imaging and dosimetric studies.     

Corticospinal responses of resistance-trained and un-trained males during dynamic muscle contractions

Little is known regarding the modulation and the plasticity of the neural pathway interconnecting elements of the central nervous system and skeletal muscle in resistant-trained individuals. The aim of the study was to compare corticospinal and spinal responses measured during dynamic muscle contractions of the tibialis anterior in resistance trained (RT) and un-trained (UT) males. Nine UT and 10 RT male volunteers reported to the laboratory 24 h following a familiarisation session. Motor evoked potentials (MEPs) and the cortical silent period were evoked using transcranial magnetic stimulation at a range of contraction intensities and was delivered as the ankle passed 90° during shortening and lengthening contractions. The Hoffmann reflex (H-reflex) and V-waves were evoked with peripheral nerve stimulation. Despite the RT group being significantly stronger during shortening (28%; P = 0.023: CI = 1.27–15.1 N m), lengthening (25%; P = 0.041: CI = 0.27–17.0 N m) and isometric muscle actions (20%; P = 0.041; CI = 0.77–14.9 N m), no differences between the groups existed for corticospinal or spinal variables. Lack of detectable differences between RT and UT individuals may be linked to minimal exposure to task specific, isolated high intensity resistance training of the TA muscle.     

Surface dose measurements with GafChromic EBT film for 6 and 18 MV photon beams

The aim of this study was to determine the surface doses using GafChromic EBT films and compare them with plane-parallel ionization chamber measurements for 6 and 18 MV high energy photon beams. The measurements were made in a water equivalent solid phantom in the build-up region of the 6 and 18 MV photon beams at 100 cm SSD for various field sizes. Markus type plane-parallel ion chamber with fixed-separation between collecting electrodes was used to measure the percent depth doses. GafChromic EBT film measurements were performed both on the phantom surface and maximum dose depth at the same geometry with ion chamber measurements. The surface doses found using GafChromic EBT film were 15%, 20%, 29%and 39% ± 2% (1SD) for 6 MV photons, 6%, 11%, 23% and 32% ± 2% (1SD) for 18 MV photons at 5, 10, 20 and 30 cm² field sizes, respectively. GafChromic EBT film provides precise measurements for surface dose in the high energy photons. Agreement between film and plane-parallel chamber measurements was found to be within ±3% for 18 MV photon beams. There was 5% overestimate on the surface doses when compared with the plane-parallel chamber measurements for all field sizes in the 6 MV photon beams.     

First proof of bismuth oxide nanoparticles as efficient radiosensitisers on highly radioresistant cancer cells

This study provides the first proof of the novel application of bismuth oxide as a radiosensitiser. It was shown that on the highly radioresistant 9L gliosarcoma cell line, bismuth oxide nanoparticles sensitise to both kilovoltage (kVp) or megavoltage (MV) X-rays radiation. 9L cells were exposed to a concentration of 50 μg.mL⁻¹ of nanoparticle before irradiation at 125 kVp and 10 MV. Sensitisation enhancement ratios of 1.48 and 1.25 for 125 kVp and 10 MV were obtained in vitro, respectively. The radiation enhancement of the nanoparticles is postulated to be a combination of the high Z nature of the bismuth (Z = 83), and the surface chemistry. Monte Carlo simulations were performed to elucidate the physical interactions between the incident radiation and the nanoparticle. The results of this work show that Bi₂O₃ nanoparticles increase the radiosensitivity of 9L gliosarcoma tumour cells for both kVp and MV energies. Monte Carlo simulations demonstrate the advantage of a platelet morphology.     

Resistance exercise modulates lipid plasma profile and cytokine content in the adipose tissue of tumour-bearing rats

Cancer cachexia is a multifactorial syndrome characterised by progressive weight loss, frequently accompanied by anorexia, sarcopenia, and chronic systemic inflammation. The white adipose tissue is markedly affected by cachexia and contributes to this syndrome throught the secretion of pro-inflammatory factors which reach the adjacent tissues and the circulation. A nonpharmacologic intervention that may attenuate cancer cachexia is chronic physical activity, but the effect of resistance training upon adipose tissue inflammation in cachexia has never been examined. For that purpose we designed a protocol in which animals were randomly assigned to a control group (CT, n = 7), a Tumour bearing group (TB, n = 7), a Resistance Trained group (RT, n = 7) and a Resistance Trained tumour bearing group (RTTB, n = 7). Trained rats climbed a vertical ladder with an extra load attached to the tail, representing 75–90% of total body mass, 3 times per week, for 8 weeks. In the 6th week of resistance training, tumour cells (3 × 10⁷ Walker 256 carcinosarcoma) were inoculated in the tumour groups. Body, adipose tissue, muscle and tumour mass was determined, as well a blood biochemical parameters, and the hormone and cytokine profile assessed. The glycogen content of the liver and muscle was measured. IL-10, IL-6 and TNF-α protein expression was evaluated in the mesenteric adipose tissue (MEAT) examined. Resistance training increased by 9% body weight gain in RTTB (final weight 310.8 ± 9.8 g), when compared with TB (final weight 288.3 ± 4.9 g). LDL-c levels were decreased in RTTB (0.28 ± 0.9 mmol/L) by 43% when compared with TB (0.57 ± 0.1 mmol/L). HDL-c levels were increased in RTTB (1.31 ± 0.12 mmol/L) by 15% in regard to CT (1.13 ± 0.7 mmol/L) and 22% as compared with TB (1.07 ± 0.07 mmol/L). RTTB testosterone levels (577 ± 131 ng/mL) were 55% higher when compared with CT (254 ± 41.3 ng/mL) and 63% higher when compared with TB (221 ± 23.1 ng/mL). Adiponectin levels were augmented in RT (23 μg/mL) by 43% when compared with TB (11 μg/mL). Protein expression of IL-6 was increased 38% in TB MEAT (5.95 pg/μg), as compared with CT (3.64 pg/μg) and 50% compared with RTTB (2.91 pg/μg). Similar results with respect to TNF-α TB (7.18 pg/μg) were observed: 39% and 46%, higher protein expression in comparison with CT (4.63 pg/μg) and RTTB (3.8 pg/μg), respectively. IL-10 protein expression was found to be increased in TB (4.4 pg/μg) and RTTB (3.2 pg/μg) 50% and 47%, respectively, in comparison with CT (1.2 pu/μg). The IL-10/TNF-α ratio was higher in RTTB in relation to all others experimental groups. The results show a robust effect of resistance exercise training in preventing important symptoms of cancer cachexia, thus strongly suggesting it may appear as an alternative to endurance exercise as a non-pharmacological therapy in the management of this syndrome.     

Novel 6 MV X-ray photoneutron detection and dosimetry of medical accelerators

PurposeDosimetry of fast, epithermal and thermal photoneutrons in 6 MV X-ray beams of two medical accelerators were studied by novel dosimetry methods.MethodsA Siemens ONCOR and an Elekta COMPACT medical accelerators were used. Fast, epithermal and thermal photoneutron dose equivalents in 10 cm × 10 cm 6 MV X-rays fields were determined in air and on surface of a polyethylene phantom in X and Y directions. Polycarbonate dosimeters as bare or with enriched ¹⁰B convertors (with or without cadmium covers) were used applying a 50 Hz-HV electrochemical etching method.ResultsFast, epithermal and thermal photoneutron dose equivalents were efficiently determined respectively as ∼1145.8, ∼45.3 and ∼170.6 μSv in air and ∼1888.5, ∼96.1 and ∼640.6 μSv on phantom per 100 Gy X-rays at the isocenter of Siemens ONCOR accelerator in air. The dose equivalent is maximum at the isocenter which decreases as distance from it increases reaching a constant level. Tissue-to-air ratios are constants up to 15 cm from the isocenter. No photoneutrons was detected in the Elekta COMPACT accelerator.ConclusionsFast, epithermal and thermal photoneutron dosimetry of 6 MV X-rays were made by novel dosimetry methods in a Siemens ONCOR accelerator with sum dose equivalent per Gy of ∼0.0014% μSv with ∼0.21 MeV mean energy at the isocenter; i.e. ∼150 times smaller than that of 18 MV X-rays. This observation assures clinical safety of 6 MV X-rays in particular in single-mode machines like Elekta COMPACT producing no photoneutrons due to no “beryllium exit window” in the head structure.     

Surveillance,Epidemiology, and End Results-based analysis of the impact of preoperative or postoperative radiotherapy on survival outcomes for T3N0 rectal cancer

Purpose: Preoperative chemoradiation has been established as standard of care for T3/T4 node-positive rectal cancer. Recent work, however, has called into question the overall benefit of radiation for tumors with lower risk characteristics, particularly T3N0 rectal cancers. We retrospectively analyzed T3N0 rectal cancer patients and examined how outcomes differed according to the sequence of treatment received. Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used to analyze T3N0 rectal cancer cases diagnosed between 1998 and 2008. Treatment consisted of surgery alone (No RT), preoperative radiation followed by surgery (Neo-Adjuvant RT), or surgery followed by postoperative radiation (Adjuvant RT). Demographic and tumor characteristics of the three groups were compared using t-tests for the comparison of means. Survival information from the SEER database was utilized to estimate cause-specific survival (CSS) and to generate Kaplan–Meier survival curves. Multivariate analysis (MVA) of features associated with outcomes was conducted using Cox proportional hazards regression models with Adjuvant RT, Neo-Adjuvant RT, No RT, histological grade, tumor size, year of diagnosis, and demographic characteristics as covariates. Results: 10-Year CSS estimates were 66.1% (95% CI 62.3–69.6%; P = 0.02), 73.5% (95% CI 68.9–77.5%; P = 0.02), and 76.1% (95% CI 72.4–79.4%; P = 0.02), for No RT, Neo-Adjuvant RT, and Adjuvant RT, respectively. On MVA, Adjuvant RT (HR = 0.688; 95% CI, 0.578–0.819; P < 0.001) was associated with significantly decreased risk for cancer death. By contrast, Neo-Adjuvant RT was not significantly associated with improved cancer survival (HR = 0.863; 95% CI, 0.715–1.043; P = 0.127). Conclusion: Adjuvant RT was associated with significantly higher CSS when compared with surgery alone, while the benefit of Neo-Adjuvant RT was not significant. This indicates that surgery followed by Adjuvant RT may still be an important treatment plan for T3N0 rectal cancer with potentially significant survival advantages over other treatment sequences.     

Ecological-economic assessment of ecological sanitation development in the cities of Chinese Loess Plateau

Many cities in Chinese Loess Plateau have inadequate sanitation. Ecological sanitation (ecosan) is a systemic approach to solve environmental and sanitary problems. Thus, suitable ecosan technologies and systems were analyzed, and three alternative developing models of sanitation were compared, namely, centralized traditional (CT) model, centralized ecosan (CE) model, and centralized and decentralized mixed ecosan (ME) model. Their ecological-economic assessment was made in the theoretical framework of social–economic–natural complex ecological system. Main results were (1) CE and ME reduced the emission of greenhouse gases, and the maximum reduction was 96.8% of CT. (2) ME reduced the water pollutants at a comparatively lower capital and running cost, and BOD₅ emission could be reduced to 85–88% of CT. (3) CE and ME reclaimed more nutrients than CT. Attributing to reclaiming nutrients, CE and ME could produce 461.4 and 809.9 Gg foods, respectively, and CT was 32.1 Gg. (4) The sequence of health risk caused by sanitation was CT > CE > ME. (5) Urban ecosan system could bring forward a maximum net benefit of 0.267 billion RMB. In addition, the bottlenecks of developing ecosan in China were also discussed in this paper.     

Radiation dose comparison between V/P-SPECT and CT-angiography in the diagnosis of pulmonary embolism

PurposeThe aim of this study is to compare two routine protocols at our institution, CTPA and V/P-SPECT, in terms of radiation dose to the most exposed organs (lungs and breast) and to the embryo/fetus in the case of pregnant patients.MethodsAt our institution, the CTPA protocol includes a contrast enhanced CT (scan parameters: 100 kVp, 700 mA, 0.5 s/rot, pitch 0.984) and in some cases a non-contrast enhanced CT acquisition (120 kVp, 400 mA, 0.5 s/rot, pitch 1.375).In the V/P-SPECT protocol, ventilation SPECT was performed after inhalation of 99mTc-Technegas, reaching 30 MBq in the lungs; perfusion was performed after intravenous administration of 60–120 MBq of 99mTc-MAA.The absorbed doses (mGy) to lungs and breast from CTPA were estimated using the “ImPACT CT Patient Dosimetry Calculator”. The embryo/fetus dose was estimated for different gestational stages (0–7, 8–12, 13–25 and 26–40 weeks) using the web based calculation tool “COnceptus Dose Estimation” (CODE).Doses to organs and embryo/fetus from V/P-SPECT were estimated based on published dose data normalized to administered activity (mGy/MBq).ResultsEmbryo/fetus absorbed doses are similar for CTPA and V/P-SPECT and bellow 1 mGy. The calculated dose to the lungs (breast) was 1.3–10.6 (27–136) times higher from CTPA when compared with V/P-SPECT.ConclusionFor the diagnosis of PE in women, if both imaging modalities are available, it is recommended to proceed with V/P-SPECT rather than CTPA due to the considerably lower radiation dose to the breast.     

Indirubin derivatives as potent FLT3 inhibitors with anti-proliferative activity of acute myeloid leukemic cells

Indirubin derivatives were identified as potent FLT3 tyrosine kinase inhibitors with anti-proliferative activity at acute myeloid leukemic cell lines, RS4;11 and MV4;11 which express FLT3-WT and FLT3-ITD mutation, respectively. Among several 5 and 5′-substituted indirubin derivatives, 5-fluoro analog, 13 exhibited potent inhibitory activity at FLT3 (IC₅₀ = 15 nM) with more than 100-fold selectivity versus 6 other kinases and potent anti-proliferative effect for MV4;11 cells (IC₅₀ = 72 nM) with 30-fold selectivity versus RS4;11 cells. Cell cycle analysis indicated that compound 13 induced cell cycle arrest at G₀/G₁ phase in MV4;11 cells.     

An in vitro evaluation of epigallocatechin gallate (eGCG) as a biocompatible inhibitor of ricin toxin

The catechin, epigallocatechin gallate (eGCG), found in green tea, has inhibitory activity against a number of protein toxins and was investigated in relation to its impact upon ricin toxin (RT) in vitro. The IC₅₀ for RT was 0.08 ± 0.004 ng/mL whereas the IC₅₀ for RT + 100 μM eGCG was 3.02 ± 0.572 ng/mL, indicating that eGCG mediated a significant (p < 0.0001) reduction in ricin toxicity. This experiment was repeated in the human macrophage cell line THP-1 and IC₅₀ values were obtained for RT (0.54 ± 0.024 ng/mL) and RT + 100 μM eGCG (0.68 ± 0.235 ng/mL) again using 100 μM eGCG and was significant (p = 0.0013). The documented reduction in ricin toxicity mediated by eGCG was found to be eGCG concentration dependent, with 80 and 100 μg/mL (i.e. 178 and 223 μM respectively) of eGCG mediating a significant (p = 0.0472 and 0.0232) reduction in ricin toxicity at 20 and 4 ng/ml of RT in Vero and THP-1 cells (respectively). When viability was measured in THP-1 cells by propidium iodide exclusion (as opposed to the MTT assays used previously) 10 ng/mL and 5 ng/mL of RT was used. The addition of 1000 μM and 100 μM eGCG mediated a significant (p = 0.0015 and < 0.0001 respectively) reduction in ricin toxicity relative to an identical concentration of ricin with 1 μg eGCG. Further, eGCG (100 μM) was found to reduce the binding of RT B chain to lactose-conjugated Sepharose as well as significantly (p = 0.0039) reduce the uptake of RT B chain in Vero cells. This data suggests that eGCG may provide a starting point to refine biocompatible substances that can reduce the lethality of ricin.     

Megavoltage 2D topographic imaging: An attractive alternative to megavoltage CT for the localization of breast cancer patients treated with TomoDirect

PurposeTo show the usefulness of topographic 2D megavoltage images (MV2D) for the localization of breast cancer patients treated with TomoDirect (TD), a radiotherapy treatment technique with fixed-angle beams performed on a TomoTherapy system.MethodsA method was developed to quickly localize breast cancer patients treated with TD by registering the MV2D images produced before a TD treatment with reference images reconstructed from a kilovoltage CT simulation scanner and by using the projection of the beam-eye-view TD treatment field. Dose and image quality measurements were performed to determine the optimal parameters for acquiring MV2D images. A TD treatment was simulated on a chest phantom equipped with a breast attachment. MVCT and MV2D images were performed for 7 different shifted positions of the phantom and registered by 10 different operators with the simulation kilovoltage CT images.ResultsCompared to MVCT, MV2D imaging reduces the dose by a factor of up to 45 and the acquisition time by a factor of up to 49. Comparing the registration shift values obtained for the phantom images obtained with MVCT in the coarse mode to those obtained with MV2D, the mean difference is 1.0 ± 1.1 mm, −1.1 mm ± 1.1, and −0.1 ± 2.2 mm, respectively, in the lateral, longitudinal, and vertical directions.ConclusionsWith dual advantages (very fast imaging and a potentially reduced dose to the heart and contralateral organs), MV2D topographic images may be an attractive alternative to MVCT for the localization of breast cancer patients treated with TomoDirect.     

Validation of a method for “dose of the day” calculation in head-neck tomotherapy by using planning ct-to-MVCT deformable image registration

PurposeThe aim of this study was to test the feasibility and dosimetric accuracy of a method that employs planning CT-to-MVCT deformable image registration (DIR) for calculation of the daily dose for head and neck (HN) patients treated with Helical Tomotherapy (HT).MethodsFor each patient, the planning kVCT (CTplan) was deformably registered to the MVCT acquired at the 15th therapy session (MV15) with a B-Spline Free Form algorithm using Mattes mutual information (open-source software 3D Slicer), resulting in a deformed CT (CTdef). On the same day as MVCT15, a kVCT was acquired with the patient in the same treatment position (CT15). The original HT plans were recalculated both on CTdef and CT15, and the corresponding dose distributions were compared; local dose differences <2% of the prescribed dose (DD2%) and 2D/3D gamma-index values (2%-2 mm) were assessed respectively with Mapcheck SNC Patient software (Sun Nuclear) and with 3D-Slicer.ResultsOn average, 87.9% ± 1.2% of voxels were found for DD2% (on average 27 slices available for each patient) and 94.6% ± 0.8% of points passed the 2D gamma analysis test while the 3D gamma test was satisfied in 94.8% ± 0.8% of body’s voxels.ConclusionsThis study represents the first demonstration of the dosimetric accuracy of kVCT-to-MVCT DIR for dose of the day computations. The suggested method is sufficiently fast and reliable to be used for daily delivered dose evaluations in clinical strategies for adaptive Tomotherapy of HN cancer.     

Concomitant chemo-radiotherapy for unresectable oesophageal cancer: A mono-institutional study on 40 patients

Background/AimTo analyse clinical response, overall (OS) and disease free survival (DFS) and toxicity in patients with unresectable oesophageal cancer treated by concomitant chemo-radiotherapy (CRT).Materials and methodsForty patients with stage IIa–IVa biopsy proven oesophageal carcinoma were treated with CRT. All patients were studied with endoscopy and CT and judged unresectable after multidisciplinary discussion. CRT consisted of 3 cycles of cisplatin 100 mg/m² or carboplatin 300 mg/m² on day 1 and 5-fluorouracil 1000 mg/m² as a continuous infusion of 96 h associated with concurrent 3D-conformal RT. By using 15 MeV X-rays, a total dose of 60–66 Gy was delivered with daily fractions of 1.8–2.0 Gy.ResultsComplete response (CR), partial response (PR) and no response (NR) were observed in 50%, 20% and 20% of cases, respectively. Of the 20 patients with CR, 15 developed loco-regional recurrent disease. OS and DFS rates at 3 and 5 years were 38%, 8%, 49% and 10%, respectively. Total radiation dose ≥60 Gy improved loco-regional control and complete response (CR vs. PR + NR; p = 0.004) influenced both DFS and loco-regional control. Grade 3 gastrointestinal and haematological acute toxicity occurred in 3/40 patients (7.5%). One patient developed grade 4 renal failure. Late toxicity was reported in 2/40 patients (5.0%), consisting of grade 3 radiation pneumonitis.ConclusionsConcomitant CRT for unresectable oesophageal cancer can result in an acceptable loco-regional control with limited toxicity. Response after treatment and total radiation dose influenced the outcome.     

Measurement of waist circumference for retrospective studies – Prospective validation of use of CT images to assess abdominal circumference

IntroductionTo validate the use of supine position and CT images for assessing abdominal circumference (AC).MethodA prospective study in consecutive patients undergoing scheduled abdominal CT at our center between 17 and 25 September 2012.AC was measured four times:

• 1.Standing.
• 2.While lying on the CT table.
• 3.On CT images with a skin contour line, using OsiriX software.
• 4.On CT images with an ellipse perimeter formula, using RAIM Alma 2010 software.

Measurements 1 and 2 were sequentially done by the same trained nurse before abdominal CT just above the iliac crest, while measurements 3 and 4 were done on the last abdominal CT slice not showing the iliac bone. Student's t tests and Q-Q and Bland–Altman plots were used for statistical analysis.ResultsA total of 102 patients were recruited. Mean age, 60 (35–78) years. Mean BMI, 25 (18–39) kg/m². Mean AC, 93.2 (73–135) cm.No significant differences were found between the four ACs measured (Student's t test, P = 0.83).Q-Q and Bland–Altman plots showed good overlapping for the low and central values (73–110 cm) with a greater scatter for extremely high values.For the ellipse estimation, R² was 0.987 with a mean error of 0.4 cm and a stretch dispersion between 1.1 and −0.3 cm.ConclusionSupine (either measured or estimated on CT images by free hand elliptical ROI or ellipse formula) and standing measurements appear to be equivalent for abdominal circumferences <110 cm.     

Reciprocal influences on performances of a postural–suprapostural task by manipulating the level of task-load

The objective of this study was to investigate the reciprocal influences of stance pattern (bilateral stance vs. unilateral stance) and thumb-index precision grip task (static target vs. dynamic target) on postural–suprapostural tasks by manipulating task-load. Fifteen healthy volunteers participated in four postural–suprapostural tasks, including static force-matching in bilateral/unilateral stance (BS_static; US_static), dynamic force-matching in bilateral/unilateral stance (BS_dynamic; US_dynamic), and two control tasks in bilateral and unilateral stances without a finger task. The normalized force error (NFE), reaction time (RT) of the finger tasks, and normalized change in center of pressure sway (ΔNCoP) were measured. For suprapostural task performance, a significant interaction effect between postural and suprapostural tasks on NFE of the finger tasks was noted (static: BS < US; dynamic: BS > US), but RT was not different among the four tasks. For postural task performance, negative ΔNCoP during unilateral stance indicated a spontaneous reduction in postural sway due to added force-matching. In contrast, addition of force-matching tended to increase postural sway during bilateral stance, but postural fluctuations decreased as task-load of suprapostural task increased (BS_dynamic < BS_static). In conclusion, performance of postural–suprapostural tasks was differently modulated by task-load increment. Our observations favored adaptive resource-sharing and implicit expansion of resource capacity for a postural task with a motor suprapostural goal.     

Heart position variability during voluntary moderate deep inspiration breath-hold radiotherapy for breast cancer determined by repeat CBCT scans

Voluntary moderate deep inspiration breath hold (vmDIBH) in left-sided breast cancer radiotherapy reduces cardiac dose. The aim of this study was to investigate heart position variability in vmDIBH using CBCT and to compare this variability with differences in heart position between vmDIBH and free breathing (FB).For 50 patients initial heart position with respect to the field edge (HP-FE) was measured on a vmDIBH planning CT scan. Breath-hold was monitored using an in-house developed vertical plastic stick. On pre-treatment CBCT scans, heart position variability with respect to the field edge (Δ_HP-FE) was measured, reflecting heart position variability when using an offline correction protocol. After registering the CBCT scan to the planning CT, heart position variability with respect to the chest wall (Δ_HP-CW) was measured, reflecting heart position variability when using an online correction protocol. As a control group, vmDIBH and FB computed tomography (CT) scans were acquired for 30 patients and registering both scans on the chest wall.For 34 out of 50 patients, the average HP-FE and HP-CW increased over the treatment course in comparison to the planning CT. Averaged over all patients and all treatment fractions, the Δ_HP-FE and the Δ_HP-CW was 0.8 ± 4.2 mm (range −9.4–+10.6 mm) and 1.0 ± 4.4 mm (range −8.3–+10.4 mm) respectively. The average gain in heart to chest wall distance was 11.8 ± 4.6 mm when using vmDIBH instead of FB. In conclusion, substantial variability in heart position using vmDIBH was observed during the treatment course.