A support vector machine tool for adaptive tomotherapy treatments: Prediction of head and neck patients criticalities

PurposeAdaptive radiation therapy (ART) is an advanced field of radiation oncology. Image-guided radiation therapy (IGRT) methods can support daily setup and assess anatomical variations during therapy, which could prevent incorrect dose distribution and unexpected toxicities. A re-planning to correct these anatomical variations should be done daily/weekly, but to be applicable to a large number of patients, still require time consumption and resources. Using unsupervised machine learning on retrospective data, we have developed a predictive network, to identify patients that would benefit of a re-planning.Methods1200 MVCT of 40 head and neck (H&N) cases were re-contoured, automatically, using deformable hybrid registration and structures mapping. Deformable algorithm and MATLAB^® homemade machine learning process, developed, allow prediction of criticalities for Tomotherapy treatments.ResultsUsing retrospective analysis of H&N treatments, we have investigated and predicted tumor shrinkage and organ at risk (OAR) deformations. Support vector machine (SVM) and cluster analysis have identified cases or treatment sessions with potential criticalities, based on dose and volume discrepancies between fractions. During 1st weeks of treatment, 84% of patients shown an output comparable to average standard radiation treatment behavior. Starting from the 4th week, significant morpho-dosimetric changes affect 77% of patients, suggesting need for re-planning. The comparison of treatment delivered and ART simulation was carried out with receiver operating characteristic (ROC) curves, showing monotonous increase of ROC area.ConclusionsWarping methods, supported by daily image analysis and predictive tools, can improve personalization and monitoring of each treatment, thereby minimizing anatomic and dosimetric divergences from initial constraints.     

The Use of a Quadripolar Left Ventricular Lead Increases Successful Implantation Rates in Patients with Phrenic Nerve Stimulation and/or High Pacing Thresholds Undergoing Cardiac Resynchronisation Therapy with Conventional Bipolar Leads

BackgroundPhrenic nerve stimulation (PNS) and high pacing thresholds (HPT) hinder biventricular stimulation in patients (pts) undergoing cardiac resynchronization therapy (CRT). A new quadripolar left ventricular (LV) lead (Quartet 1458Q, St. Jude Medical) with increased number of pacing configuration, might overcome this problem.MethodsAll consecutive pts in whom a standard bipolar lead intraoperatively resulted in PNS and/or HPT (≥ 4.00 V/1 mV), received, during the same implant, a quadripolar LV lead. Aim of the study was to evaluate acute and short term outcome.Results26 pts [24 (92%) male, mean age 74 ± 6 years)] with PNS (22 pts; 85%) and HPT (4 pts; 15%) were included. Permanent right ventricular pacing was the reason for broad QRS complex in 4 (15%) pts, whereas all other pts had a left bundle branch block. Severely symptomatic (NYHA Class ≥ 3) heart failure with reduced ejection fraction (EF 31 ± 9%) was mostly caused by ischemic heart disease (14 pts; 54%). Idiopathic dilated cardiomyopathy and valvular heart disease were diagnosed in 6 (23%) pts each. In most (24/26, 92%) pts the use of the Quartet lead led to successful biventricular pacing due to a significant reduction in intraoperative pacing threshold (5.2 V/1.0 ms vs. 1.4 V/0.8 ms; p = 0.03), which was maintained (1.2 V/0.7 ms) at follow-up. PNS never represented reason for failed LV pacing, neither acutely nor during follow-up.ConclusionsExcessively HPT and/or PNS are frequently encountered when conventional bipolar leads are used for CRT. A new quadripolar LV lead increases the rate of successful biventricular stimulation. Lower pacing threshold and freedom from PNS are maintained at follow-up.     

DEMAT: A multi-institutional dosimetry audit of rotational and static intensity-modulated radiotherapy

PurposeStatic beam intensity-modulated-radiation-therapy (IMRT) and/or Volumetric-Modulated-Arc-Therapy (VMAT) are now available in many regional radiotherapy departments. The aim of this multi-institutional audit was to design a new methodology based on radiochromic films to perform an independent quality control.MethodsA set of data were sent to all participating centres for two clinical localizations: prostate and Head and Neck (H&N) cancers. The agreement between calculations and measurements was verified in the Octavius phantom (PTW) by point measurements using ionization chambers and by 2D measurements using EBT3 radiochromic films. Due to uncertainties in the whole procedure, criteria were set to 5% and 3% in local dose and 3 mm in distance excluding doses lower than 10% of the maximum doses. No normalization point or area was used for the quantitative analysis.Results13 radiotherapy centres participated in this audit involving 28 plans (12 IMRT, 16 VMAT). For point measurements, mean errors were −0.18 ± 1.54% and 0.00 ± 1.58% for prostate and H&N cases respectively. For 2D measurements with 5%/3 mm criteria, gamma map analysis showed a pixel pass rate higher than 95% for prostate and H&N. Mean gamma index was lower than 0.4 for prostate and 0.5 for H&N. Both techniques yielded similar results.ConclusionThis study showed the feasibility of an independent quality control by peers for conventional IMRT and VMAT. Results from all participating centres were found to be in good agreement. This regional study demonstrated the feasibility of our new methodology based on radiochromic films without dose normalization on a specific point.     

Assessment of monitor unit limiting strategy using volumetric modulated arc therapy for cancer of hypopharynx

PurposeTo quantify relative merit of MU deprived plans against freely optimized plans in terms of plan quality and report changes induced by progressive resolution optimizer algorithm (PRO3) to the dynamic parameters of RapidArc.Materials and methodsTen cases of carcinoma hypopharynx were retrospectively planned in three phases without using MU tool. Replicas of these baseline plans were reoptimized using “Intermediate dose” feature and “MU tool” to reduce MUs by 20%, 35%, and 50%. Overall quality indices for target and OAR, integral dose, dose-volume spread were assessed. All plans were appraised for changes induced in RapidArc dynamic parameters and pre-treatment quality assurance (QA).ResultsWith increasing MU reduction strength (MURS), MU/Gy values reduced, for all phases with an overall range of 8.6–34.7%; mean dose rate decreased among plans of each phase, phase3 plans recorded greater reductions. MURS20% showed good trade-off between MUs and plan quality. Dose-volume spread below 5 Gy was higher for baseline plans while lower between 20 and 35 Gy. Integral dose was lower for MURS0%, not exceeding 1.0%, compared against restrained plans. Mean leaf aperture and control point areas increased systematically, correlated negatively with increasing MURS. Absolute delta dose rate variations were least for MURS0%. MU deprived plans exhibited GAI (>93%), better than MURS0% plans.ConclusionBaseline plans are superior to MU restrained plans. However, MURS20% offers equivalent and acceptable plan quality with mileage of MUs, improved GAI for complex cases. MU tool may be adopted to tailor treatment plans using PRO3.     

Prediagnostic serum calcium and albumin and ovarian cancer: A nested case-control study in the Norwegian Janus Serum Bank Cohort

BackgroundWomen with higher serum calcium may be more likely to be diagnosed and die of ovarian cancer. We evaluated that finding in a large, prospective cohort.MethodsWe conducted a nested case-control study using a population-based biobank from Norway. We compared 202 ovarian cancer cases and 202 controls, matched for age, date at blood draw, and county of residence, with respect to serum calcium and albumin, adjusted for anthropometric variables. We evaluated risks using the entire follow-up period as well as 2–15 years and 16–25 years (“early” and “late”, respectively).ResultsFor the entire follow-up, risk was significantly increased in the highest tertile of albumin and for high albumin and calcium jointly. Risks for ovarian cancer differed markedly by follow-up time. In early follow-up, women in the highest tertile of serum calcium had a 2.5-fold increased risk, adjusted for height and body mass index (OR = 2.47, 95% C.I. 1.12–5.45) with a significant dose-response (p = 0.024). Risk was not elevated in late follow-up (OR = 0.62, 95% C.I. 0.27–1.36). Similarly, in early follow-up, women in the highest tertile of serum albumin had an increased risk (OR = 2.55, 95% C.I.1.22–5.49) with a significant dose-response (p = 0.009). Conversely, risk was not increased in late follow-up (OR = 1.36, 95% C.I. 0.65–2.83).ConclusionsThese data confirm a prospective association between higher serum calcium and ovarian cancer. An association in early, but not late, follow-up suggests that the higher calcium reflects the presence of existing cancer. A positive association with serum albumin is novel and should be interpreted cautiously.     

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.     

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.     

Faisabilité et intérêt d’un nouvel algorithme de reconstruction des images TEP-18FDG (AW OSEM DR) pour la délimitation des volumes cibles en radiothérapie. À propos d’un cas de néoplasie ORL

ObjectiveWe compared two reconstruction methods for 18fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET) images with “attenuation weighted ordered subset expectation maximization” using either the manufacturer-provided (AW-OSEM) or a “Detector response” (AW-OSEM DR) tomographic operator. We looked at the feasibility of using the latter reconstruction for radiotherapy target volumes definition in cancers of the superior aero-digestive tract (VADS). In this preliminary study, we first assessed the spatial resolution of images obtained with AW-OSEM and AW-OSEM DR on a Biograph™ 6, and secondly target volumes of radiotherapy “Gross Tumor Volume” (GTV), “Clinical Target Volume” (CTV) and “Planning Target Volume” (PTV) obtained with each of these reconstruction methods.Material and methodsThe spatial resolution was measured on a test object containing 4 radioactive point sources. Furthermore, radiotherapy target volumes have been defined with the software Eclipse™ on injected scanner (CT IV) and PET/CT (PET AW-OSEM and PET AW-OSEM DR) images.ResultsSpatial resolution was improved with AW-OSEM DR algorithm reconstruction compared to images obtained with AW-OSEM reconstruction (from 7.5 mm down to 5.4 mm for the highest reduction). GTV from AW-OSEM DR reconstruction with 42 and 50% of the “Standard uptake value maximum” (SUVmax) semi-automatic threshold (1.2 and 0.7 cm³ respectively) were lower than those obtained with AW-OSEM (3.6 and 2.2 cm³ respectively). They were also lower than GTV defined with CT IV (5.5 cm³). It was the same for CTV and PTV.ConclusionThis study showed that AW-OSEM DR reconstruction method allows less impaired spatial resolution than AW-OSEM. In the case of radiotherapy target volumes delineation, AW-OSEM DR may decrease the GTV, CTV and PTV and therefore the risk of side effects associated with organs at risk.     

Sedentary work and the risks of colon and rectal cancer by anatomical sub-site in the Canadian census health and environment cohort (CanCHEC)

BackgroundSedentary behaviour is a potential risk factor for colorectal cancer. We examined the association between sedentary work, based on body position, and colorectal cancer risk in Canadians.MethodsA working body position category (a. sitting; b. standing and walking; c. sitting, standing, and walking; d. other) was assigned to occupations reported by 1991 Canadian Census respondents based on national occupational counselling guidelines. Adjusted hazard ratios (HRs) and 95% confidence intervals (CI) were estimated for cancers of the colon (overall, proximal, and distal) and rectum in men and women newly diagnosed from 1992 to 2010.ResultsCompared to “sitting” jobs, men in occupations with “other” (non-sitting, −standing, or −walking) body positions had a weakly significant reduced colon cancer risk (HR = 0.93, 95% CI: 0.89, 0.98) primarily attributed to protection at the distal site (HR = 0.90, 95% CI: 0.84, 0.97). Men in “standing and walking” and “sitting, standing, and walking” jobs did not have significantly reduced colon cancer risks. No effects were observed for rectal cancer in men or colon and rectal cancer in women.ConclusionThe two significant findings of this analysis should be followed-up in further investigations with additional information on potential confounders. Null findings for rectal cancer were consistent with other studies.     

Rapid torque development in older female fallers and nonfallers: A comparison across lower-extremity muscles

The objective of this study was to compare reaction time, joint torque, rate of torque development, and magnitude of neuromuscular activation of lower-extremity muscles in elderly female fallers and nonfallers. Participants included 11, elderly, female fallers (71.3 ± 5.4 years) and twelve nonfallers (71.3 ± 6.2 years) who completed a fall risk questionnaire. Then, maximal, voluntary, isometric contractions of the knee and ankle muscles were performed in reaction to a visual cue to determine joint torque, rate of torque development, reaction time, and nervous activation of agonists and antagonists. Results indicated that significantly more fallers reported “dizziness upon rising”, “use of balance altering medications”, “stress or depression”, “not enough sleep”, “arthritis in lower body”, “chronic pain in lower body”, and “tiring easily while walking” (all P < 0.05). Normalized dorsiflexion and plantarflexion strength scores (summation of peak torque, rate of torque development and impulse) were lower in fallers than in nonfallers (P < 0.05). When summed across lower-extremity muscle groups, fallers demonstrated 19% lower peak torque and 29% longer motor time (P < 0.05). In conclusion, comprehensive fall risk screening and prevention programs should address both neuromuscular and non-muscular factors, and, weakness of the ankle dorsiflexors and plantarflexors should be further studied as potential contributors to falls in older adults.     

Actividad antifúngica in vitro de la micafungina

BackgroundMicafungin is a new and very useful pharmacological tool for the treatment of invasive mycoses with a wide antifungal spectrum for the most common pathogenic fungi. Micafungin is especially active against the genera Candida and Aspergillus. Its antifungal mechanism is based on the inhibition of the β-1,3- D-glucan synthesis, an essential molecule for the cell wall architecture, with different con sequences for Candida and Aspergillus, being micafungin fungicide for the former and fungistatic for the latter.AimTo describe the in vitro antifungal spectrum of micafungin based in the scientific and medical lite rature of recent years.MethodsWe have done a bibliographic retrieval using the scientific terms, “micafungin”, “activity”, “Candida”, “Aspergillus”, “fungi”, “mycos*”, “susceptibility”, in PubMed/Medline from the National Library of Medicine de EE.UU. from 2005 to 2009.ResultsWe can underline that most than 99% of Candida isolates are susceptible to ≤ 2 μg/ml of micafungin. MIC are very low (≤ 0.125 μg/ml) for most clinical isolates of the species Candida albicans, Candida glabrata, Candida tropicalis and Candida krusei while Candida parapsilosis and Candida guilliermondii isolates are susceptible to anidulafungin concentrations ≤ 2 μg/ml. The activity of micafungin is excellent against those medical important species of Aspergillus. However, its activity is very low against Cryptococcus and the Zygomycetes.ConclusionsThe excellent activity of micafungin has made this antifungal a first line therapeutic indication for candidemia and invasive candidiasis in non-neutropenic patients.     

SIMBOSPROST: Prevalence of metabolic syndrome and osteoporosis in prostate cancer patients treated with radiotherapy and androgen deprivation therapy: A multicentre,cross-sectional study

AimTo assess the prevalence of metabolic syndrome (MetS) and osteoporosis in patients with prostate cancer (PCa) treated with radical radiotherapy (RT) with or without androgen deprivation therapy (ADT).BackgroundWorldwide, the prevalence of MetS is estimated to range from 20% to 25% of the adult population. However, prevalence rates are much higher in PCa patients (pts) who undergo ADT.Materials and methodsMulticentre cross-sectional study of 270 pts in Spain with PCa. Patients were divided into 3 groups based on the duration of ADT (6, 12–18, ≥24 months) and compared to a control group without ADT. MetS was defined according to NCEP ATP III criteria. Osteoporosis was assessed by DEXA.ResultsA total of 270 pts, treated from November 2011 to October 2012, were included. Of these, 122 pts (47%) fulfilled the criteria for MetS. The median age of this group was significantly higher (71.3 vs. 69.38 years, p = 0.028). MetS prevalence was 50% in the control group. In pts who received ADT, prevalence was 44.8% after 6 months of ADT, 45.3% after 12–18 months, and 50% after ≥24 months (pns). Most pts (168/270; 62%) underwent DEXA. Of those tested, 78 (46.4%) had osteopenia and only 11 (6.5%) had osteoporosis.ConclusionsThe prevalence of MetS in pts with PCa treated with radical RT was higher (47%) than in the general population. However, there were no significant differences in the duration of ADT administration. The prevalence of osteoporosis was low. These findings suggest that the prevalence of MetS in PCa patients may be higher than previously reported.     

High-field MR spectroscopy in the multiparametric MRI evaluation of breast lesions

IntroductionThe aim of this work was to assess the role of 3T-MR spectroscopy (MRS) in the multi-parametric MRI evaluation of breast lesions, using a pattern-recognition based classification method.Methods291 patients (301 lesions, median 2.3 cm³) were enrolled in the study (age 18–85 y, mean 54.2 y). T1-TSE (TR/TE = 400/10 ms) and T2-STIR imaging (TR/TE = 5000/60 ms), dynamic-contrast-enhanced MRI (DCE-MRI), apparent diffusion coefficient (ADC) (b = 0–800 s/mm²), and single-voxel MRS (10 × 10 × 10 mm³, PRESS, TR/TE = 3000 ms/135 ms) were performed by means of a 3T scanner. MRS results were accepted if the FWHM of the water peak was ⩽45 Hz. Total choline (tCho) was considered detected if the signal-to-noise ratio (SNR) of the 3.2 ppm peak was ⩾2. A classifier-based analysis (support-vector-machines, SVM) was performed with 4-dimensional vectors including type of margin, DCE-MRI kinetic curve type, ADC mean value, and tCho SNR. A comparison with 3-dimensional vectors (without tCho SNR) was used to assess MRS impact on sensitivity, specificity, and positive-negative predictive values (PPV-NPV) for malignancy.Results228 lesions (180 malignant/48 benign) showed acceptable spectral quality. Comparison of classification results with histopathological examination of surgical specimens showed sensitivity = 93.7%, specificity = 84.9%, PPV = 95.2%, NPV = 81.5% without the inclusion of MRS in the SVM analysis. When MRS was included, the figures increased to 95.1%, 90.7%, 97.2%, and 85.0%, respectively.ConclusionsInclusion of 3T-MRS in the multi-parametric MRI evaluation of breast lesions improved the performance of the SVM-based classifier, showing a possible role of high-field MR spectroscopy in the differential diagnosis between benign and malignant breast lesions. Further research is however needed to confirm this initial evidence.     

Dosimétrie rénale du 177Lu-Dotatate : mise en place au sein du Groupement hospitalier Est des Hospices Civils de Lyon

IntroductionThe kidney is considered as a critical dose-limiting organ with ¹⁷⁷Lu-Dotatate. Renal dosimetry could play a role in optimizing treatment. We present a feedback on the implementation of renal dosimetry in our medical center.Material and methodThe renal dosimetry of the 1st administration of ¹⁷⁷Lu-Dotatate (approximately 7.4 GBq) has been performed for seven patients. The reference dosimetry strategy included 4 post-therapeutic SPECT/CT at 6 h, 24 h, 72 h and 168 h and anatomical renal volume delineation (VOI). Alternative dosimetric strategies consisted of 72 h or 168 h time point eviction (time sampling A or B) and delimitation of 1 or 3 spherical VOIs (3 mL each) per kidney (“1 sVOI” or “3 sVOI” methods). The quantitative scintigraphic processing was performed by 4 operators using Dosimetry Toolkit®. The renal dose was calculated with OLINDA/EXM® 2.0.ResultsThe calculated mean absorbed renal dose was 3.68 ± 0.68 Gy with the reference method, with no significant impact of interoperator variability (P = 0.41). It was in satisfactory agreement with time sampling A or B. The “1 sVOI” and “3 sVOI” methods overestimated the renal dose (5.01 ± 0.94 Gy and 4.91 ± 0.79 Gy respectively), with a significant impact on interoperator variability (P < 0.05), despite a reduction in processing time.ConclusionThe main logistic constraint of ¹⁷⁷Lu-Dotatate renal dosimetry in our center is the time-consumption due to SPECT/CT acquisitions. A possible approach supported by our preliminary results is a reduction in the number of scintigraphic acquisitions.     

Modeling of couch transmission in the RayStation treatment planning system

PurposeTo present our methods and results regarding the modeling of a carbon fiber couch (Varian Exact IGRT) in the RayStation treatment planning system (TPS).MethodsThree geometrical-models (GMs) were implemented in the TPS to represent the three different regions of the couch (thick, medium and thin). The materials and densities of each GM component were tuned to maximize the agreement between measured and calculated attenuations. Moreover, a couch computed-tomography (CT) scan was acquired and dosimetrically compared with the GMs. For validation, plan-specific quality assurance (QA) of VMAT plans (TG-119 cases, 5 prostate and 5 H&N clinical cases) was performed by comparing measured dose distributions with doses computed with and without including the GMs in the TPS.ResultsCouch attenuations up to 4.3% were measured (energy: 6MV). Compared to couch CT, GMs could be modified to optimize the agreement with measurements and reduce dependence on the dose grid resolution. For both couch CT and GM, absolute deviations between measured and calculated attenuations were within 1.0%. When including the GMs in plan-specific QA, global 2%/2 mm γ-pass rates showed an average improvement of 4.8% (p-value < 0.001, max +18.6%). The couch reduced the mean dose to targets by up to 2.4% of the prescribed dose for prostate cases and up to 1.4% for H&N cases.ConclusionsRayStation accurately considers the implemented couch GMs replicating measured attenuations within an uncertainty of 1.0%. Materials and densities are proposed for the Varian Exact IGRT couch. The results obtained justify introducing couch GMs in clinical routine.     

Dose warping performance in deformable image registration in lung

PurposeIt is unclear that spatial accuracy can reflect the impact of deformed dose distribution. In this study, we used dosimetric parameters to compare an in-house deformable image registration (DIR) system using NiftyReg, with two commercially available systems, MIM Maestro (MIM) and Velocity AI (Velocity).MethodsFor 19 non-small-cell lung cancer patients, the peak inspiration (0%)-4DCT images were deformed to the peak expiration (50%)-4DCT images using each of the three DIR systems, which included computation of the deformation vector fields (DVF). The 0%-gross tumor volume (GTV) and the 0%-dose distribution were also then deformed using the DVFs. The agreement in the dose distributions for the GTVs was evaluated using generalized equivalent uniform dose (gEUD), mean dose (D_mean), and three-dimensional (3D) gamma index (criteria: 3 mm/3%). Additionally, a Dice similarity coefficient (DSC) was used to measure the similarity of the GTV volumes.ResultsD_mean and gEUD demonstrated good agreement between the original and deformed dose distributions (differences were generally less than 3%) in 17 of the patients. In two other patients, the Velocity system resulted in differences in gEUD of 50.1% and 29.7% and in D_mean of 11.8% and 4.78%. The gamma index comparison showed statistically significant differences for the in-house DIR vs. MIM, and MIM vs. Velocity.ConclusionsThe finely tuned in-house DIR system could achieve similar spatial and dose accuracy to the commercial systems. Care must be taken, as we found errors of more than 5% for D_mean and 30% for gEUD, even with a commercially available DIR tool.     

Biological treatment of n-hexane and methanol in trickle bed air biofilters under acidic conditions

This study focuses on evaluating the degradation of n-hexane/methanol mixture in trickle-bed-air-biofilters (TBABs). Two different concentration ratios of methanol:n-hexane were evaluated (3:1) for TBAB “A” and (5:1) for TBAB “B”. Both TBABs were run and fed with nutrients buffered at pH 4 for encouraging the growth of fungi. The TBABs were loaded with pelletized diatomaceous earth support media and were run at an empty bed residence time of 120 s. n-Hexane loading rates (LRs) ranged from 0.9 to 13.2 g/m³ h for both TBABs. The corresponding methanol LRs varied from 2.3 to 37.7 g/m³ h and from 4.6 to 64.5 g/m³ h for TBABs “A” and “B”, respectively. Experimental results have shown that the degradation of n-hexane in presence of methanol is enhanced for n-hexane LRs less than 10.6 g/m³ h as compared to previous study for sole-fed n-hexane, but for n-hexane LRs of 13.2 g/m³ h, the performance of TBABs in eliminating n-hexane depended on the methanol to n-hexane ratios. The impact was less severe for TBAB “A” (RE 85%) as compared to TBAB “B” (RE 72%). This is attributed to the high LRs of methanol in TBAB “B”. n-Hexane performance stability was another advantage attained.     

Characteristics of cases with unknown stage prostate cancer in a population-based cancer registry

BackgroundThe New South Wales Central Cancer Registry (NSW CCR) is the only population-based cancer registry in Australia that has routinely collected summary stage at diagnosis since its inception in 1972. However, a large proportion of prostate cancer cases have “unknown” stage recorded by the registry. We investigated the characteristics of prostate cancer cases with “unknown” stage recorded by the NSW CCR, and examined survival for this group.MethodsData were obtained from the NSW CCR for all first primary prostate cancer cases diagnosed in 1999–2007. Summary stage was recorded as localised, regional, distant or “unknown”. Associations between disease stage and patient characteristics (age, place of residence at diagnosis, year of diagnosis and country of birth) and prostate cancer specific survival were investigated using multivariable logistic regression and Cox proportional hazards models respectively.ResultsOf 39 852 prostate cancer cases, 41.8% had “unknown” stage recorded by the NSW CCR. This proportion decreased significantly over time, increased with increasing age at diagnosis and was higher for those living in socio-economically disadvantaged areas. The proportion with “unknown” stage varied across area health services. Prostate cancer specific survival for cases with “unknown” stage was significantly poorer than for those with localised stage but better than for those with regional or distant stage.ConclusionsResearchers or others using cancer registry stage data to examine prostate cancer outcomes need to consider the differences between cases with “unknown” stage at diagnosis and those with known stage recorded by the registry, and what impact this may have on their results.     

Investigating micronucleus assay applicability for prediction of normal tissue intrinsic radiosensitivity in gynecological cancer patients

BackgroundPelvic organs morbidity after irradiation of cancer patients remains a major problem although new technologies have been developed and implemented. A relatively simple and suitable method for routine clinical practice is needed for preliminary assessment of normal tissue intrinsic radiosensitivity. The micronucleus test (MNT) determines the frequency of the radiation induced micronuclei (MN) in peripheral blood lymphocytes, which could serve as an indicator of intrinsic cell radiosensitivity.AimTo investigate a possible use of the micronucleus test (MNT) for acute radiation morbidity prediction in gynecological cancer patients.Materials and methodsForty gynecological cancer patients received 50 Gy conventional external pelvic irradiation after radical surgery. A four-field “box” technique was applied with 2D planning. The control group included 10 healthy females.Acute normal tissue reactions were graded according to NCI CTCAE v.3.0. From all reaction scores, the highest score named “summarized clinical radiosensitivity” was selected for a statistical analysis.MNT was performed before and after in vitro irradiation with 1.5 Gy. The mean radiation induced frequency of micronuclei per 1000 binucleated cells (MN/1000) and lymphocytes containing micronuclei per 1000 binucleated cells (cells with MN/1000) were evaluated for both patients and controls.An arbitrary cut off value was created to pick up a radiosensitive individual: the mean value of spontaneous frequency of cells with MN/1000 ± 2SD, found in the control group.ResultsBoth mean spontaneous frequency of cells with MN/1000 and MN/1000 were registered to be significantly higher in cancer patients compared to the control group (t = 2.46, p = 0.02 and t = 2.51, p = 0.02). No statistical difference was registered when comparing radiation induced MN frequencies between those groups.Eighty percent (32) of patients developed grade 2 summarized clinical radiosensitivity, with great variations in MNT parameters. Only three patients with grade 2 “summarized clinical radiosensitivity” had values of cells with MN/1000 above the chosen radiosensitivity threshold.ConclusionThe present study was not able to confirm in vitro MNT applicability for radiosensitivity prediction in pelvic irradiation.