VMAT-like plans for magnetic resonance guided radiotherapy: Addressing unmet needs

PurposeVMAT delivery technique is currently not applicable to Magnetic Resonance-guided radiotherapy (MRgRT) hybrid systems. Aim of this study is to evaluate an innovative VMAT-like (VML) delivery technique.Material and methodsFirst, planning and dosimetric evaluation of the MRgRT VML treatment have been performed on 10 different disease sites and the results have been compared with the corresponding IMRT plans. Then, in the second phase, 10 of the most dosimetrically challenging locally advanced pancreas treatment plans have been retrospectively re-planned using the VML approach to explore the potentiality of this new delivery technique. Finally, VML robustness was evaluated and compared with the IMRT plans, considering a lateral positioning error of ± 5 mm.ResultsIn phase one, all VML plans were within constraint for all OARs. When PTV coverage is considered, in the 50% of the cases VML PTV coverage is equal or higher than in IMRT plan. In the remaining 50%, the highest target under coverage difference in comparison with IMRT plan is −1.71%. The mean and maximum treatment time differences (VML-IMRT) is 0.2 min and 3.1 min respectively. In phase two, the treatment time variation (VML-IMRT), shows a mean, maximum and minimum variations of 1.3, 4.6 and −0.6 min respectively. All VML plans have a better target coverage if compared with IMRT plans, keeping in any case the OARs constraints within tolerance. VML doesn’t increase plan robustness.ConclusionVMAT-like treatment approach appeared to be an efficient planning solution and it was decided to clinically implement it in daily practice, especially in the frame of hypo fractionated treatments.     

The importance of image guided radiotherapy in small cell lung cancer: Case report and review of literature

AimDescribe the anatomical changes and tumor displacement due to a rapid response of a patient’s small cell lung cancer (SCLC) during definitive chemoradiotherapy (CRT).BackgroundThe treatment for SCLC is based on CRT. If interfractional changes during RT are incorrectly assessed they might compromise adequate coverage of the tumor or increase dose to organs at risk. Image guided RT with cone-beam computed tomography (CBCT) allows to identify daily treatment variations.Material and methodsDescribe a SCLC case with rapid changes in size, shape and location of the primary tumor during RT.Case reportA 62-year-old woman was diagnosed with SCLC with complete obstruction of the anterior and lingular bronchi and incomplete left thorax expansion due to a 12 × 15 cm mass. During CRT (45 Gy in 1.5 Gy per fraction, twice daily) the patient presented rapid tumor response, leading to resolution of bronchi obstruction and hemithorax expansion. Tumor shifted up to 4 cm from its original position. The identification of variations led to two new simulations and planning in a 3-week treatment course.ConclusionsThe complete radiological response was possible due to systematic monitoring of the tumor during CRT. We recommend frequent on-site image verification. Daily CBCT should be considered with pretreatment tumor obstruction, pleural effusion, atelectasis, large volumes or radiosensitive histology that might resolve early and rapidly and could lead to a miss of the tumor or increased toxicity. Further research should be made in replanning effect in coverage of microscopic disease since it increases uncertainty in this scenario.     

Addition of TLR9 agonist immunotherapy to radiation improves systemic antitumor activity

Radiotherapy (RT) has been used to control tumors by physically damaging DNA and inducing apoptosis; it also promotes antitumor immune responses via neoantigens release and augmenting immune-oncology agents to elicit systemic response. Tumor regression after RT can recruit inflammatory cells, such as tumor-associated macrophages and CD11b⁺ myeloid cell populations, a major subset of which may actually be immunosuppressive. However, these inflammatory cells also express Toll-like receptors (TLRs) that can be stimulated to reverse suppressive characteristics and promote systemic antitumor outcomes. Here, we investigated the effects of adding CMP-001, a CpG-A oligodeoxynucleotide TLR9 agonist delivered in a virus-like particle (VLP), to RT in two murine models (344SQ metastatic lung adenocarcinoma and CT26 colon carcinoma). High-dose RT (12Gy x 3 fractions) significantly increased the percentages of plasmacytoid dendritic cells within the tumor islets 3- and 5-days post-RT; adding CMP-001 after RT also enhanced adaptive immunity by increasing the proportion of CD4⁺ and CD8⁺ T cells. RT plus CMP-001-mediated activation of the immune system led to significant inhibition of tumor growth at both primary and abscopal tumor sites, thereby suggesting a new combinatorial treatment strategy for systemic disease.     

The role of imaging in adaptive radiotherapy for head and neck cancer

Radiotherapy (RT), alone or combined with surgery and/or chemotherapy is given to almost all head and neck cancer (HNC). The goal of RT is to increase as much as possible the dose in the tumor to cure the patient, while limiting the dose in the organs at risk, mainly the parotids gland to limit the xerostomia. HNC RT appears particularly challenging due to the complexity of the shape of the anatomical structures, which also changes during the 7 weeks of treatment. Advances in imaging-modalities, -processing and -integration at the different RT steps have been crucial to develop a new image and dose-guided adaptive RT (ART) strategy. Moreover, the integration of functional imaging such as FDG-PET (performed before and during the treatment) leads to an even more highly targeted and dose-escalated ART. This article is an overview of the place and role of imaging at the different steps of HNCART, from a medical point of view.     

Sex ratio in rabbits following modified artificial insemination

The possibility of modifying the sex ratio of rabbit litters was examined in two experiments involving artificial insemination (AI) with fresh semen. Three time periods of AI, relative to ovulation, were used in Experiment 1: (a) control, GnRH was administered immediately after AI with ovulation estimated to occur 10-12h after AI; (b) early AI, GnRH was given 6h after AI so that ovulation was delayed until 16-18 h after AI; (c) late AI, GnRH was administered 6h before AI, which was performed 4-6h before ovulation. There were 13 does per treatment, and each doe was used in the same treatment for three AIs at 42-day intervals. The second experiment involved two treatments in which the does were inseminated as for the control in Experiment 1 and AI was performed using semen prepared in the normal manner (Treatment 1) or after centrifugation through 11 discontinuous Percoll gradients (Treatment 2). There were 20 does per treatment, and each doe was used in the same treatment for three AIs at 42-day intervals. The proportion of female kits produced in Experiment 1 was: control 41.7+/-19.1%, early AI 49.8+/-17.8%, and late AI 41.4+/-16.4%. These proportions did not differ significantly between treatments or from the expected 50:50 sex ratio. Fertility was reduced by the early (60.0%) and late (73.7%) AI treatments relative to control AI (80.0%), and the difference between early and control AI almost achieved statistical significance (P<0.07). In Experiment 2, the proportion of female kits was not affected by treatment (control, 51.1%; Percoll, 54.8%), and there was a similar level of fertility for both treatments (control, 76.0%; Percoll, 74.1%). Prolificacy and perinatal mortality were not affected by treatment in either experiment. It was concluded that neither the timing of insemination nor Percoll centrifugation of semen affected the sex ratio at birth of rabbit litters.     

Hyperthermia in cervical cancer – current status

BackgroundThis article reviews the salient features of recent results of clinical studies. It puts a special emphasis on technical aspects, mechanisms of action together with radiotherapy and chemotherapy and points out areas for additional investigation.AimTo present the current state of knowledge on hyperthermia (HT) and to highlight its role in the treatment of cervical cancer.Materials and methodsThe literature on the clinical use of combined hyperthermia for cervical cancer was analyzed. Clinical outcomes together with the technical aspects and the role of HT were also evaluated.ResultsClinically randomized trials have demonstrated benefit including survival with the addition of hyperthermia to radiation or chemotherapy in the treatment of cervical cancer without significant acute or late morbidities. The technological advances have led to an effective and safer treatment delivery, thermal treatment planning, thermal dose monitoring and online adaptive temperature modulation.ConclusionsDue to rapid development over the last decade of hyperthermia systems and new studies at the basic science and clinical level, the perception of hyperthermia as a part of multimodality treatment in cervical cancer has been changed. However, there is still a need for multicentre randomized clinical trials.     

Artificial intelligence in radiotherapy

Artificial intelligence (AI) has already been implemented widely in the medical field in the recent years. This paper first reviews the background of AI and radiotherapy. Then it explores the basic concepts of different AI algorithms and machine learning methods, such as neural networks, that are available to us today and how they are being implemented in radiotherapy and diagnostic processes, such as medical imaging, treatment planning, patient simulation, quality assurance and radiation dose delivery. It also explores the ongoing research on AI methods that are to be implemented in radiotherapy in the future. The review shows very promising progress and future for AI to be widely used in various areas of radiotherapy. However, basing on various concerns such as availability and security of using big data, and further work on polishing and testing AI algorithms, it is found that we may not ready to use AI primarily in radiotherapy at the moment.     

SBRT and extreme hypofractionation: A new era in prostate cancer treatments?

AimRadiation therapy (RT) is a standard therapeutic option for prostate cancer (PC). In the last decades, several innovative technology applications have been introduced. 3-Dimensional conformal RT, volumetric/rotational intensity modulated RT associated or not with image-guided RT, are becoming largely diffused in the treatment of PC.BackgroundConsidering that PC could have a low α/β ratio, similar to late-reacting normal tissues, it could also be highly responsive to fraction size. Thus, the reduction of the number of fractions and the increase of the dose/fraction seem to be reasonable choices in the treatment of this cancer. This review reported the technology evolution, the radiobiological and the clinical data about the role of extreme hypofractionated RT in the treatment approach of PC patients.Materials and methodsMedline search and analysis of published studies containing key words: prostate cancer, radiotherapy, stereotactic radiotherapy.ResultsRecent technological developments, combined with an improved knowledge of the radiobiological models in favor of a high sensitivity of PC to larger fraction sizes are opening a new scenario in its treatment, reporting favorable efficacy and acceptable toxicity, despite short follow-up.ConclusionThus, thanks to technological improvement and the recent radiobiological data, “extreme hypofractionated RT” has been strongly introduced in the last years as a potential solid treatment option for PC.     

A comparison of two rotational stocking strategies on the foraging behaviour and herbage intake by grazing sheep

An understanding of the processes involved in grazing behaviour is a prerequisite for the design of efficient grassland management systems. The purpose of managing the grazing process is to identify sward structures that can maximize animal forage daily intake and optimize grazing time. Our aim was to evaluate the effect of different grazing management strategies on foraging behaviour and herbage intake by sheep grazing Italian ryegrass under rotational stocking. The experiment was carried out in 2015 in southern Brazil. The experimental design was a randomized complete block with two grazing management strategies and four replicates. The grazing management treatments were a traditional rotational stocking (RT), with pre- and post-grazing sward heights of 25 and 5 cm, respectively, and a ‘Rotatinuous’ stocking (RN) with pre- and post-grazing sward heights of 18 and 11 cm, respectively. Male sheep with an average live weight of 32 ± 2.3 kg were used. As intended, the pre- and post-grazing sward heights were according to the treatments. The pre-grazing leaf/stem ratio of the Italian ryegrass pasture did not differ between treatments (P > 0.05) (~2.87), but the post-grazing leaf/stem ratio was greater (P < 0.001) in the RN than in the RT treatment (1.59 and 0.76, respectively). The percentage of the non-grazed area was greater (P < 0.01) in post-grazing for RN compared with RT treatment, with an average of 29.7% and 3.49%, respectively. Herbage nutritive value was greater for the RN than for the RT treatment, with greater CP and lower ADF and NDF contents. The total time spent grazing, ruminating and resting did not differ between treatments (P > 0.05), with averages of 439, 167 and 85 min, respectively. The bite rate, feeding stations per min and steps per min by sheep were greater (P < 0.05) in the RN than in the RT treatment. The grazing time per hour and the bite rate were greater (P < 0.05) in the afternoon than in the morning in both treatments. The daily herbage intake by sheep grazing Italian ryegrass was greater (P < 0.05) in the RN than in the RT treatment (843.7 and 707.8 g organic matter/sheep, respectively). Our study supports the idea that even though the grazing time was not affected by the grazing management strategies when the animal behaviour responses drive management targets, such as in ‘Rotatinuous’ stocking, the sheep herbage intake is maximized, and the grazing time is optimized.     

A mathematical model of brain tumour response to radiotherapy and chemotherapy considering radiobiological aspects

Glioblastoma is the most frequent and malignant brain tumour. For many years, the conventional treatment has been maximal surgical resection followed by radiotherapy (RT), with a median survival time of less than 10 months. Previously, the use of adjuvant chemotherapy (given after RT) has failed to demonstrate a statistically significant survival advantage. Recently, a randomized phase III trial has confirmed the benefit of temozolomide (TMZ) and has defined a new standard of care for the treatment of patients with high-grade brain tumours. The results showed an increase of 2.5 months in median survival, and 16.1% in 2 year survival, for patients receiving RT with TMZ compared with RT alone. It is not clear whether the major benefit of TMZ comes from either concomitant administration of TMZ with RT, or from six cycles of adjuvant TMZ, or both.The objectives were to develop our original model, which addressed survival after RT, to construct a new module to assess the potential role of TMZ from clinical data, and to explore its synergistic contribution in addition to radiation. The model has been extended to include radiobiological parameters. The addition of the linear quadratic equation to describe cellular response to treatment has enabled us to quantify the effects of radiation and TMZ in radiobiological terms.The results indicate that the model achieves an excellent fit to the clinical data, with the assumption that TMZ given concomitantly with RT synergistically increases radiosensitivity. The alternative, that the effect of TMZ is due only to direct cell killing, does not fit the clinical data so well. The addition of concomitant TMZ appears to change the radiobiological parameters. This aspect of our results suggests possible treatment developments.Our observations need further evaluations in real clinical trials, may suggest treatment strategies for new trials, and inform their design.     

Factors influencing the use of adaptive radiation therapy in vulvar carcinoma

AimWe aim to evaluate the variables affecting the frequency of adaptive radiotherapy (ART) in vulvar cancer.BackgroundART may be needed throughout a definitive RT course for vulvar carcinoma due to changes in patient’s anatomy and tumor response.Materials and methodsCharts of patients charts who had been treated with definitive concurrent chemo-radiotherapy for vulvar carcinoma, between January 2015 and December 2019 were inquired. Radiation therapy was delivered using intensity modulated radiotherapy (IMRT) with daily image-guided radiotherapy (IGRT). ART was defined as re-simulation and re-planning based on deformation in the irradiated volume by more than 1 cm. Univariate analysis was conducted to study the impact of patient’s demographics as well as tumor characteristics on the frequency of ART.Results22 patients were eligible for analysis. Median age at diagnosis was 55 years (range 43–82). Radiotherapy dose was 60−66 Gy over 30–35 fractions (fx). Median primary tumor volume was 30cc (9–140). Median Body Mass Index (BMI) was 32 (range 21–40). Thirteen out of 22 patients (59%) required ART, with median timing at 25 fx (19–31). On univariate analysis, larger primary tumor volume (> = 30cc) was associated significantly with increased frequency of ART (p value = 0.0005). There was no significant impact of ART on the frequency with respect to patient’s age, BMI, tumor stage, grade and location.ConclusionChanges in radiation target volume are common among vulvar carcinoma patients who are treated with definitive radiotherapy, especially large primary tumors. This review highlights the importance of ART for patients with vulvar carcinoma treated with definitive radiotherapy.     

Human vs. machine: Detecting wildlife in camera trap images

As the capacity to collect and store large amounts of data expands, identifying and evaluating strategies to efficiently convert raw data into meaningful information is increasingly necessary. Across disciplines, this data processing task has become a significant challenge, delaying progress and actionable insights. In ecology, the growing use of camera traps (i.e., remotely triggered cameras) to collect information on wildlife has led to an enormous volume of raw data (i.e., images) in need of review and annotation. To expedite camera trap image processing, many have turned to the field of artificial intelligence (AI) and use machine learning models to automate tasks such as detecting and classifying wildlife in images. To contribute understanding of the utility of AI tools for processing wildlife camera trap images, we evaluated the performance of a state-of-the-art computer vision model developed by Microsoft AI for Earth named MegaDetector using data from an ongoing camera trap study in Arctic Alaska, USA. Compared to image labels determined by manual human review, we found MegaDetector reliably determined the presence or absence of wildlife in images generated by motion detection camera settings (≥94.6% accuracy), however, performance was substantially poorer for images collected with time-lapse camera settings (≤61.6% accuracy). By examining time-lapse images where MegaDetector failed to detect wildlife, we gained practical insights into animal size and distance detection limits and discuss how those may impact the performance of MegaDetector in other systems. We anticipate our findings will stimulate critical thinking about the tradeoffs of using automated AI tools or manual human review to process camera trap images and help to inform effective implementation of study designs.     

Transcervical artificial insemination in sheep: effects of a new transcervical artificial insemination instrument and traversing the cervix on pregnancy and lambing rates

Cervical anatomy limits the use of transcervical intrauterine artificial insemination (TC AI) in sheep. We have developed an instrument to cope atraumatically with the cervix; although this instrument has not affected fertilization rate or pregnancy rate through Day 3, the effects on sperm transport and pregnancy after Day 3 are not known. The objective of the present study was to determine whether our TC AI instrument affected sperm transport, pregnancy rates, or lambing rate. In Experiment 1, ewes were assigned to two treatments: TC AI using the new TC AI instrument (n=10) or AI via laparotomy using a laparoscopic AI instrument (n=10). Twenty hours after artificial insemination, the uterine horns and oviducts were recovered and flushed to collect spermatozoa. Sperm transport did not differ (P>0.05) between the two treatments. In Experiment 2, ewes were assigned to three treatments: TC AI using the new TC AI instrument+sham intrauterine AI via laparotomy (n=29); sham TC AI+intrauterine AI via laparotomy using a laparoscopic AI instrument (n=29); and sham TC AI+intrauterine AI via laparotomy using the new TC AI instrument (n=30). On Day 14 after AI, uteri were collected and flushed to recover blastocysts. Transcervical deposition of semen reduced (P<0.05) Day 14 pregnancy rate (17.2% versus 61%), but intrauterine deposition of semen using the TC AI instrument via midventral laparotomy increased (P<0.05) Day 14 pregnancy rate (76.6% versus 44.8%). In Experiment 3, ewes were assigned to two treatments: sham cervical manipulation (n=40) or cervical manipulation to mimic TC AI (n=40). Immediately after treatment, each ewe was mated with a ram and watched until the ram mounted and ejaculated into the ewe. Treatment did not affect Day 30 or 50 pregnancy rate (67.5 and 66.2%, respectively), determined ultrasonically, or lambing rate (62.5%). The differences between Days 30 and 50 pregnancy rates and lambing rate were not significant. In Experiment 4, ewes were assigned to two treatments: TC AI (n=99) or laparoscopic AI (n=99). Transcervical AI reduced (P<0.01) Day 30 (TC AI versus laparoscopic AI; 5.0% versus 46.0%) and Day 50 pregnancy rates (4.0% versus 41.0%), determined ultrasonically, and lambing rate (4.0% versus 41.0%). Although the TC AI procedure significantly reduced pregnancy and lambing rates, large numbers of spermatozoa deposited at natural insemination seemed to compensate. Because our TC AI procedure has all but eliminated any visual evidence of trauma, and because the procedure does not seem to affect sperm transport or embryonal survival until Day 3, we speculate that cervical manipulation associated with TC AI may activate pathways that interrupt pregnancy between Days 3 and 14.     

Mycorrhizae, crop growth, and crop phosphorus nutrition in maize-soybean rotations given various tillage treatments

Previously, tillage has been found to reduce early-season phosphorus (P) uptake from soil in continuous maize cropping systems. This reduced P uptake has often been associated with delayed colonization of roots by arbuscular mycorrhizal (AM) fungi. Our aim was to determine if similar responses occur in maize-soybean rotations, which are more typical of current farming in Ontario, Canada. Similar responses were expected because both are AM crops, and the mechanism by which tillage reduces P uptake is thought to be a negative impact on the development of effective mycorrhizae. Simultaneous field experiments with either maize-soybean-maize or soybean-maize-soybean rotations were conducted in 1992–4. Treatments imposed were no-till (NT), ridge-tillage (RT), and conventional tillage using a moldboard plow (MP). In 1993, early-season dry mass of maize was similar among treatments, but colonization of maize roots by AM fungi and P uptake of maize were stimulated by NT and RT, compared with MP. In 1994, early growth was more rapid overall than in 1993, but it was reduced in the NT and RT treatments compared with MP for reasons not related to P. For soybean, AM colonization in NT and RT systems was higher than with MP, but P uptake was unchanged. As was found for maize in 1994, early-season shoot dry mass of soybean was higher in the MP treatment than with NT, but both in 1993 and 1994. We conclude that colonization of both maize and soybean by AM fungi is susceptible to slower development in tilled systems, and that for maize, stimulation of P uptake under reduced tillage can occur in rotations with soybean just as easily as it does with continuous maize. Taken with other studies, the data here suggest that responses to tillage of colonization of roots by AM fungi and of P uptake could apply to many cropping systems. The slow early-season shoot growth seen in some years in response to reduced tillage is discussed.     

When your MR linac is down: Can an automated pipeline bail you out of trouble?

PurposeThe unique treatment delivery technique provided by magnetic resonance guided radiotherapy (MRgRT) can represent a significant drawback when system fail occurs. This retrospective study proposes and evaluates a pipeline to completely automate the workflow necessary to shift a MRgRT treatment to a traditional radiotherapy linac.Material and methodsPatients undergoing treatment during the last MRgRT system failure were retrospectively included in this study. The core of the proposed pipeline was based on a tool able to mimic the original MR linac dose distribution. The so obtained dose distribution (AUTO) has been compared with the distribution obtained in the conventional radiotherapy linac (MAN). Plan comparison has been performed in terms of time required to obtain the final dose distribution, DVH parameters, dosimetric indices and visual analogue scales scoring by radiation oncologists.ResultsAUTO plans generation has been obtained within 10 min for all the considered cases. All AUTO plans were found to be within clinical tolerance, showing a mean target coverage variation of 1.7% with a maximum value of 4.3% and a minimum of 0.6% when compared with MAN plans. The highest OARs mean variation has been found for rectum V60 (6.7%). Dosimetric indices showed no relevant differences, with smaller gradient measure in favour of AUTO plans. Visual analogue scales scoring has confirmed comparable plan quality for AUTO plans.ConclusionThe proposed workflow allows a fast and accurate generation of automatic treatment plans. AUTO plans can be considered equivalent to MAN ones, with limited clinical impact in the worst-case scenario.     

Radiation therapy in the last month of life

Aim

We sought to survey a large, multi-center patient sample to better characterize/quantify RT utilization at the end of life.

Background

Few objective data exist for radiation therapy (RT) delivery at end of life (EOL).

Materials and methods

Data were retrieved for all patients receiving RT in calendar year 2010 in the Department of Radiation Oncology at Indiana University (IU) and Howard University (HU) hospitals. Specific attention was made of the group of patients receiving RT in the last 30 days of life.

Results

A total of 852 patients received all or part of their RT during 2010 (HU: 139, IU: 713). At time of analysis in early 2012, 179 patients had died (21%). Fifty-four patients (6.3% of total; 30% of expired patients) died within 30 days of receiving their last treatment. Twenty patients (2.3% of total; 11.2% of expired patients) received RT within their last week of life. For both sites, the median time until death from completion of therapy was 12.5 days (range 2–30 days).

Conclusions

Radiation in the last month of life is likely to provide minimal palliation or survival benefit. This, coupled with the financial implications, time investment, and physical costs, suggests that physicians and patients should more strongly consider hospice, and minimize duration of palliative RT courses as far as possible. As with chemotherapy, RT utilization at EOL should be considered for collection as an overuse metric.     

Processing DNA molecules as text

Polymerase Chain Reaction (PCR) is the DNA-equivalent of Gutenberg’s movable type printing, both allowing large-scale replication of a piece of text. De novo DNA synthesis is the DNA-equivalent of mechanical typesetting, both ease the setting of text for replication. What is the DNA-equivalent of the word processor? Biology labs engage daily in DNA processing—the creation of variations and combinations of existing DNA—using a plethora of manual labor-intensive methods such as site-directed mutagenesis, error-prone PCR, assembly PCR, overlap extension PCR, cleavage and ligation, homologous recombination, and others. So far no universal method for DNA processing has been proposed and, consequently, no engineering discipline that could eliminate this manual labor has emerged. Here we present a novel operation on DNA molecules, called Y, which joins two DNA fragments into one, and show that it provides a foundation for DNA processing as it can implement all basic text processing operations on DNA molecules including insert, delete, replace, cut and paste and copy and paste. In addition, complicated DNA processing tasks such as the creation of libraries of DNA variants, chimeras and extensions can be accomplished with DNA processing plans consisting of multiple Y operations, which can be executed automatically under computer control. The resulting DNA processing system, which incorporates our earlier work on recursive DNA composition and error correction, is the first demonstration of a unified approach to DNA synthesis, editing, and library construction.

Electronic supplementary material

The online version of this article (doi:10.1007/s11693-010-9059-y) contains supplementary material, which is available to authorized users.     

A cost-effective technique for cardiac sparing with deep inspiration-breath hold (DIBH)

Deep inspiration breath hold (DIBH) is an effective technique to reduce cardiac and pulmonary dose during breast radiotherapy (RT). However, as a result of expense and the technical challenges of program implementation, DIBH has not been widely adopted in clinical practice.This report describes a program for DIBH this is relatively inexpensive to implement and has little impact on patient throughput. Multiple redundant mechanisms are incorporated to assure accurate and safe delivery of RT during DIBH. Laser alignment verifies that chest wall excursion is reliably reproduced and maintained during treatment. Chest wall excursion is also monitored independently using an infrared camera trained on a reflective marker on the chest wall. This system automatically triggers “beam off” in the event of movement of the target beyond pre-determined thresholds. Finally, physician review of cine imaging obtained during treatment provides an off-line verification of accurate RT delivery. The approach described herein lowers the investment necessary for implementation of DIBH and may facilitate broader adoption of this valuable technique.     

Induction of ovarian follicular wave emergence and ovulation in progestin-based timed artificial insemination protocols for Bos indicus cattle

The present study aimed to evaluate the efficacy of different inducers of new follicular wave emergence (FWE) and ovulation in fixed-time artificial insemination (FTAI) synchronization protocols using norgestomet ear implants (NORG) in Bos indicus cattle. In Experiment 1, the synchronization of FWE was evaluated when two different estradiol esters in different doses [2mg estradiol benzoate (EB), 2.5mg EV or 5mg estradiol valerate (EV)] were administered with NORG implant insertion in B. indicus cattle (estrous cyclic heifers and cows with suckling calves; n=10 per treatment). After estradiol treatment, ovarian ultrasonic exams were performed once daily to detect the interval between treatment and FWE. There were significant treatment-by-animal category interaction (P=0.05) on the interval from the estradiol treatment to FWE. An earlier (P<0.0001) and less variable (P=0.02) interval from estradiol treatment to FWE was observed in heifers treated with EB (2.5±0.2; mean±SE) than in those treated with 2.5mg EV (4.2±0.3) or 5mg EV (6.1±0.6). Cows treated with 5mg EV (4.0±0.5) had longer (P=0.05) interval than cows receiving EB (2.5±0.2), however, there was an intermediate interval in those cows treated with 2.5mg EV (3.1±0.4). In Experiment 2, the number of uses of the NORG implant (new; n=305 or previously used once; n=314) and three different ovulation induction hormones [0.5mg estradiol cypionate (EC) at implant removal (n=205), 1mg EB given 24h after implant removal (n=219), or 100μg gonadorelin (GnRH) given at FTAI (n=195)] were evaluated in Nelore heifers (2×3 factorial design). Similar pregnancy per AI (P/AI; 30 days after FTAI; P>0.05) were achieved using each of the three ovulation induction hormones (EB=40.6%; EC=48.3%, or GnRH=48.7%) and with a new (47.2%) or once-used NORG implant (44.3%). In Experiment 3, the effect of different ovulation induction hormones for FTAI [1mg EC at NORG implant removal (n=228), 10μg buserelin acetate at FTAI (GnRH; n=212) or both treatments (EC+GnRH; n=215)] on P/AI was evaluated in suckled beef cows treated with a once-used NORG implant and EB to synchronize the FWE. Similar P/AI (P=0.71) were obtained using GnRH (50.9%), EC (51.8%) or both treatments (54.9%) as ovulation induction hormones. Therefore, both doses of EV (2.5 or 5.0mg) with NORG implant delayed and increased the variation of the day of new FWE compared with EB in B. indicus cattle. These effects were more pronounced in B. indicus heifers than cows. Synchronization protocols for FTAI with either a new or once-used NORG implant with EB at insertion to induce a new FWE and either the use of EB, EC or GnRH as ovulation induction hormones may be successful in B. indicus heifers. Also, when a once-used NORG implant was used, either the administration of EC, GnRH or both as ovulation inducers resulted in similar P/AI in suckled B. indicus cows, showing no additive effect of the combination of both ovulation induction hormones.