Changes in force and tendinous tissue elongation during the early phase of tetanic summation in in vivo human tibialis anterior muscle

The purpose of this study was to determine the changes that occur in tendinous tissue properties during the early phase of tetanic summation in the in vivo human tibialis anterior muscle (TA). The torque response and tendinous tissue elongation following single stimuli, two-pulse trains, and three-pulse trains were recorded in the TA during isometric contractions. The elongation, compliance, and lengthening velocity of tendinous tissue were determined by real-time ultrasonography. The contribution of the response to the second stimulation (C2) was obtained by subtracting the response to the single stimulation (C1) from the response of doublet. The third contribution (C3) was obtained by subtracting the response to the doublet from that of the triplet. C2 (7.8±0.5 Nm) and C3 (7.3±0.6 Nm) had torque responses significantly higher than C1 (3.6±0.7 Nm). In contrast, the elongations of tendinous tissue for C2 (2.8±0.4 mm) and C3 (1.7±0.2 mm) were significantly lower than for C1 (4.9±0.3 mm), indicating that the summation pattern of tendinous tissue elongation is different from the summation pattern of torque response. In addition, this showed considerable difference both between C1 (0.12±0.01 mm/N; 83±4.6 mm/s) and C2 (0.03±0.005 mm/N; 50±6.3 mm/s) and between C1 and C3 (0.02±0.002 mm/N; 39±6.4 mm/s) in the compliance and lengthening velocity of tendinous tissue. These results suggest that changes in tendinous tissue properties between first and second contraction are related to different summation patterns of force and tendinous tissue elongation during early phase of tetanic summation.     

Extraction of trace amounts of pioglitazone as an anti-diabetic drug with hollow fiber liquid phase microextraction and determination by high-performance liquid chromatography-ultraviolet detection in biological fluids

The applicability of hollow fiber liquid phase microextraction (HF-LPME) for extraction and preconcentration of trace amounts of pioglitazone (PGL) as an anti-diabetic drug in biological fluids, prior to determination by high-performance liquid chromatography (HPLC), was evaluated. In this technique, the target drug was extracted into di-n-hexyl ether immobilized in the wall pores of a porous hollow fiber from 10 mL of the aqueous sample (source phase, SP) with pH 8.0, and then back extracted into the receiving phase (RP) with pH 2.2 located in the lumen of the hollow fiber. The extraction occurred due to a pH gradient between the two sides of the hollow fiber. After extracting for a prescribed time, 24 μL of the RP solution was taken back into the syringe and injected directly into a HPLC instrument for quantification. The Taguchi orthogonal array (OAD) experimental design with an OA₁₆ (4⁵) matrix was employed to optimize the HF-LPME conditions. Different factors affecting the HF-LPME efficiency such as the nature of organic solvent used to impregnate the membrane, pH of the SP and RP, stirring speed, extraction time and ionic strength were studied and optimized. Under the optimum conditions (di-n-hexyl ether as membrane impregnation solvent, pHs of the SP and RP equal to 8.0 and 2.2, respectively, extraction time of 30 min, stirring speed of 500 rpm and 10% (w/v) NaCl for adjusting the ionic strength), preconcentration factor of 180, linear dynamic range (LDR) of 2.5–250 μg L^?1 with good correlation of determination (r² > 0.998) and limit of detection (LOD) of 1.0 μg L^?1 were obtained for the target drug. The percent relative intra-day and inter-day standard deviations (RSDs%) based on five replicate determinations were 4.7 and 15%, respectively. Once LPME was optimized, the performance of the proposed technique was evaluated for the determination of PGL in different types of biological fluids such as plasma and urine samples. The results showed that the proposed HF-LPME method could be successfully applied to determine trace amounts of PGL in biological samples.     

Mechanical properties of the patellar tendon in adults and children

It is not currently known how the mechanical properties of human tendons change with maturation in the two sexes. To address this, the stiffness and Young's modulus of the patellar tendon were measured in men, women, boys and girls (each group, n=10). Patellar tendon force (F_pt) was calculated from the measured joint moment during a ramped voluntary isometric knee extension contraction, the antagonist knee extensor muscle co-activation quantified from its electromyographical activity, and the patellar tendon moment arm measured from magnetic resonance images. Tendon elongation was imaged using the sagittal-plane ultrasound scans throughout the contraction. Tendon cross-sectional area was measured at rest from ultrasound scans in the transverse plane. Maximal F_pt and tendon elongation were (mean±SE) 5453±307 N and 5±0.5 mm for men, 3877±307 N and 4.9±0.6 mm for women, 2017±170 N and 6.2±0.5 mm for boys and 2169±182 N and 5.9±0.7 mm for girls. In all groups, tendon stiffness and Young's modulus were examined at the level that corresponded to the maximal 30% of the weakest participant's F_pt and stress, respectively; these were 925–1321 N and 11.5–16.5 MPa, respectively. Stiffness was 94% greater in men than boys and 84% greater in women than girls (p<0.01), with no differences between men and women, or boys and girls (men 1076±87 N/mm; women 1030±139 N/mm; boys 555±71 N/mm and girls 561.5±57.4 N/mm). Young's modulus was 99% greater in men than boys (p<0.01), and 66% greater in women than girls (p<0.05). There were no differences in modulus between men and women, or boys and girls (men 597±49 MPa; women 549±70 MPa; boys 255±42 MPa and girls 302±33 MPa). These findings indicate that the mechanical stiffness of tendon increases with maturation due to an increased Young's modulus and, in females due to a greater increase in tendon cross-sectional area than tendon length.     

Feeding anatomy,filter-feeding rate,and diet of whale sharks Rhincodon typus during surface ram filter feeding off the Yucatan Peninsula,Mexico

The feeding anatomy, behavior and diet of the whale shark Rhincodon typus were studied off Cabo Catoche, Yucatan Peninsula, Mexico. The filtering apparatus is composed of 20 unique filtering pads that completely occlude the pharyngeal cavity. A reticulated mesh lies on the proximal surface of the pads, with openings averaging 1.2 mm in diameter. Superficial to this, a series of primary and secondary cartilaginous vanes support the pads and direct the water across the primary gill filaments. During surface ram filter feeding, sharks swam at an average velocity of 1.1 m/s with 85% of the open mouth below the water's surface. Sharks on average spent approximately 7.5 h/day feeding at the surface on dense plankton dominated by sergestids, calanoid copepods, chaetognaths and fish larvae. Based on calculated flow speed and underwater mouth area, it was estimated that a whale shark of 443 cm total length (TL) filters 326 m³/h, and a 622 cm TL shark 614 m³/h. With an average plankton biomass of 4.5 g/m³ at the feeding site, the two sizes of sharks on average would ingest 1467 and 2763 g of plankton per hour, and their daily ration would be approximately 14,931 and 28,121 kJ, respectively. These values are consistent with independently derived feeding rations of captive, growing whale sharks in an aquarium. A feeding mechanism utilizing cross-flow filtration of plankton is described, allowing the sharks to ingest plankton that is smaller than the mesh while reducing clogging of the filtering apparatus.     

An ex vivo experiment to reproduce a forward fall leading to fractured and non-fractured radii

Forward falls represent a risk of injury for the elderly. The risk is increased in elderly persons with bone diseases, such as osteoporosis. However, half of the patients with fracture were not considered at risk based on bone density measurement (current clinical technique). We assume that loading conditions are of high importance and should be considered. Real loading conditions in a fall can reach a loading speed of 2 m/s on average. The current study aimed to apply more realistic loading conditions that simulate a forward fall on the radius ex vivo. Thirty radii from elderly donors (79 y.o. ± 12 y.o., 15 males, 15 females) were loaded at 2 m/s using a servo-hydraulic testing machine to mimic impact that corresponds to a fall. Among the 30 radii, 14 had a fracture after the impact, leading to two groups (fractured and non-fractured). Surfacic strain fields were measured using stereovision and allow for visualization of fracture patterns. The average maximum load was 2963 ± 1274 N. These experimental data will be useful for assessing the predictive capability of fracture risk prediction methods such as finite element models.     

Assessing the accuracy and precision of musculoskeletal motion tracking using cine-PC MRI on a 3.0T platform

The rising cost of musculoskeletal pathology, disease, and injury creates a pressing need for accurate and reliable methods to quantify 3D musculoskeletal motion, fostering a renewed interest in this area over the past few years. To date, cine-phase contrast (PC) MRI remains the only technique capable of non-invasively tracking in vivo 3D musculoskeletal motion during volitional activity, but current scan times are long on the 1.5T MR platform (～2.5 min or 75 movement cycles). With the clinical availability of higher field strength magnets (3.0T) that have increased signal-to-noise ratios, it is likely that scan times can be reduced while improving accuracy. Therefore, the purpose of this study is to validate cine-PC MRI on a 3.0T platform, in terms of accuracy, precision, and subject-repeatability, and to determine if scan time could be minimized. On the 3.0T platform it is possible to limit scan time to 2 min, with sub-millimeter accuracy (<0.33 mm/0.97°), excellent technique precision (<0.18°), and strong subject-repeatability (<0.73 mm/1.10°). This represents reduction in imaging time by 25% (42 s), a 50% improvement in accuracy, and a 72% improvement in technique precision over the original 1.5T platform. Scan time can be reduced to 1 min (30 movement cycles), but the improvements in accuracy are not as large.     

Effects of diets of differing fiber contents on digestibility,passage rate of digesta and heat production in lesser mouse deer (Tragulus javanicus)

The effects of different levels of dietary fiber on feed intake, digestibility, mean retention times of solute and particle and heat production were studied in twelve male lesser mouse deer (Tragulus javanicus). The animals were randomly assigned into four groups of three mouse deer each and fed on individual basis. Four diets, namely A, B, C and D were prepared in pellet forms. Each diet contained ～14% crude protein and ～18 kJ/g gross energy. The crude fiber contents of diet A, B, C and D were 4.2, 11.3, 16.8 and 22.5%, respectively. The results showed that the crude fiber intake of mouse deer was 1.4 ± 0.04, 3.8 ± 0.4, 5.8 ± 0.7 and 6.0 ± 0.6 g/kg W^0.75/d fed diet A, B, C and D, respectively. Mouse deer fed diet D had significantly lower DM intake than those fed lower levels of fiber. The digestibility values of DM decreased gradually with increasing levels of fiber in the diet. The mean retention times (MRTs) of particles (～1.5 mm) in the reticulorumen were in the range of (19.0–22.9 h), with the shortest time for mouse deer fed diet D. However mouse deer fed diet C and D showed significant shorter solute MRT in the reticulorumen (17.1–18.5 h) when compared to mouse deer fed lower fiber diets (21.4–21.9 h). The selectivity factor in the reticulorumen was in the range of 1.04–1.18, indicating the mouse deer to be a ‘moose-type’ ruminant. Fiber levels had no significant effect on water intake of mouse deer. Heat production tended to decrease with increasing levels of fiber (448.3–435.7 kJ/kg W^0.75/d) but differences among the mouse deer fed the four diets were not significant.     

Can surface electromyography improve surgery planning? Electromyographic assessment and intraoperative verification of the nerve bundle entry point location of the gracilis muscle

Purpose: To verify the precision of surface electromyography (sEMG) in locating the innervation zone of the gracilis muscle, by comparing the location of the IZ estimated by means of sEMG with in vivo location of the nerve bundle entry point in patients before graciloplasty procedure due to fecal incontinence. Methods: Nine patients who qualified for the graciloplasty procedure underwent sEMG on both gracilis muscle before their operations. During surgery the nerve bundle was identified by means of electrical stimulation. The distance between the proximal attachment and the nerve entry point into the muscle’s body was measured. Both measurements (sEMG and in vivo identification) were compared for each subject. Results: On average, the IZ was located 65.5 mm from the proximal attachment. The mean difference in location of the innervation zones in each individual was 10 ± 9.7 mm, maximal – 30 mm, the difference being statistically significant (p = 0.017). It was intraoperatively confirmed, that the nerve entered the muscle an average of 62 mm from the proximal attachment. The largest difference between the EMG IZ estimation and nerve bundle entry point was 5 mm (mean difference 2.8 mm, p = 0.767). Conclusion: Preoperative surface electromyography of both gracilis muscles is a safe, precise and reliable method of assessing the location of the innervation zones of the gracilis muscles. The asymmetry of the IZ location in left and right muscles may be important in context of technical aspects of the graciloplasty procedure.     

Respiratory motion of adrenal gland metastases: Analyses using four-dimensional computed tomography images

PurposeTo evaluate the respiratory motion of adrenal gland metastases in three-dimensional directions using four-dimensional computed tomography (4DCT) images.MethodsFrom January 2013 to May 2016, 12 patients with adrenal gland metastases were included in this study. They all underwent 4DCT scans to assess respiratory motion of adrenal gland metastases in free breathing state. The 4DCT images were sorted into 10 image series according to the respiratory phase from the end inspiration to the end expiration, and then transferred to FocalSim workstation. All gross tumor volumes (GTVs) of adrenal gland metastases were drawn by a single physician and confirmed by a second. Relative coordinates of adrenal gland metastases were automatically generated to calculate adrenal gland metastases motion in different axial directions.ResultsThe average respiratory motion of adrenal gland metastases in left-right (LR), cranial-caudal (CC), anterior-posterior (AP), 3-dimensional (3D) vector directions was 3.4 ± 2.2 mm, 9.5 ± 5.5 mm, 3.8 ± 2.0 mm and 11.3 ± 5.3 mm, respectively. The ratios were 58.6% ± 11.4% and 63.2% ± 12.5% when the volumes of GTV_In0% and GTV _In100% were compared with volume of IGTV_10phase. The volume ratio of IGTV_10phase to GTV_3D was 1.73 ± 0.48.ConclusionsAdrenal gland metastasis is a respiration-induced moving target, and an internal target volume boundary should be provided when designing the treatment plan. The CC motion of adrenal gland metastasis is predominant and >5 mm, thus motion management strategies are recommended for patients undergoing external radiotherapy for adrenal gland metastasis.     

Weight gains of meat goat kids on wheat (Triticum aestivum L.) pastures fertilized at different nitrogen levels

Wheat (Triticum aestivum L.) pastures are increasingly being used for cool-season forages to complement range-based goat production systems in southern USA. Because goats are more selective than cattle, ideal nitrogen (N) fertilizer rates already established for wheat grazed by cattle may be different for goats. Weight gains of Boer X Spanish doe kids (average 17 kg) as well as forage yields and crude protein (CP), acid detergent fiber (ADF) and acid detergent lignin (ADL) concentrations were measured for two winter seasons on replicated wheat paddocks fertilized with 0, 56, 112 and 224 kg N/ha per season in split autumn/spring applications at Stephenville, TX, USA. Animals were stocked in the pasture at 20 head/ha from January to April 2003 (478 mm rainfall from September to March) and 2004 (355 mm rainfall). Available forage ranged from 50 to 200 kg/ha in January and from 2300 to 6300 kg/ha in April in the 0 and 224 kg N/ha paddocks, respectively. Crude protein dry matter (DM) concentration ranged from 25 to 34% (0 and 224 kg N/ha, respectively) in January, but down to 13 and 22% across treatments in April. Average daily gains (ADG) over the 90-day trial were similar both years, 68 g per head per day for the 0 N treatment and undifferentiated among the fertilized paddocks, all near 90 g per head per day. Results indicate that N fertilizer rates above 56 kg/ha per season do not increase ADG/kid, but will increase ADG/ha if stocking rates are adjusted for forage production.     

Spatial distribution of surface EMG on trapezius and lumbar muscles of violin and cello players in single note playing

Musicians activate their muscles in different patterns, depending on their posture, the instrument being played, and their experience level. Bipolar surface electrodes have been used in the past to monitor such activity, but this method is highly sensitive to the location of the electrode pair. In this work, the spatial distribution of surface EMG (sEMG) of the right trapezius and right and left erector spinae muscles were studied in 16 violin players and 11 cello players. Musicians played their instrument one string at a time in sitting position with/without backrest support. A 64 sEMG electrode (16 × 4) grid, 10 mm inter-electrode distance (IED), was placed over the middle and lower trapezius (MT and LT) of the bowing arm. Two 16 × 2 electrode grids (IED = 10 mm) were placed on the left and right erector spinae muscles. Subjects played each of the four strings of the instrument either in large (1 bow/s) or detaché tip/tail (8 bows/s) bowing in two sessions (two days). In each of two days, measurements were repeated after half an hour of exercise to see the effect of exercise on the muscle activity and signal stability. A “muscle activity index” (MAI) was defined as the spatial average of the segmented active region of the RMS map. Spatial maps were automatically segmented using the watershed algorithm and thresholding. Results showed that, for violin players, sliding the bow upward from the tip toward the tail results in a higher MAI for the trapezius muscle than a downward bow. On the contrary, in cello players, higher MAI is produced in the tail to tip movement. For both instruments, an increasing MAI in the trapezius was observed as the string position became increasingly lateral, from string 1 (most medial) toward string 4 (most lateral). Half an hour of performance did not cause significant differences between the signal quality and the MAI values measured before and after the exercise. The MAI of the left and right erector spinae was smaller in the case of backrest support, especially for violin players. Back muscles of violin and cello players were activated asymmetrically, specifically in fast movements (detaché tip/tail). These findings demonstrate the sensitivity and stability of the technique and justify more extensive investigation following this proof of concept.     

Micropipette aspiration of the Pacinian corpuscle

The Pacinian corpuscle (PC) is a cutaneous mechanoreceptor sensitive to high-frequency vibrations (20–1000 Hz). The PC is of importance due to its integral role in somatosensation and the critical need to understand PC function for haptic feedback system development. Previous theoretical and computational studies have modeled the physiological response of the PC to sustained or vibrating mechanical stimuli, but they have used estimates of the receptor’s mechanical properties, which remain largely unmeasured. In this study, we used micropipette aspiration (MPA) to determine an apparent Young’s modulus for PCs isolated from a cadaveric human hand. MPA was applied in increments of 5 mm H₂O (49 Pa), and the change in protrusion length of the PC into the pipette was recorded. The protrusion length vs. suction pressure data were used to calculate the apparent Young’s modulus. Using 10 PCs with long-axis lengths of 2.99 ± 0.41 mm and short-axis lengths of 1.45 ± 0.22 mm, we calculated a Young’s modulus of 1.40 ± 0.86 kPa. Our measurement is on the same order of magnitude as those approximated in previous models, which estimated the PC to be on the same order of magnitude as skin or isolated cells, so we recommend that a modulus in the kPa range be used in future studies.     

Using short columns to speed up LC–MS quantification in MS binding assays

The present study describes the use of short columns to speed up LC–MS quantification in MS binding assays. The concept of MS binding assays follows closely the principle of traditional radioligand binding but uses MS for the quantification of bound marker thus eliminating the need for a radiolabelled ligand. The general strategy of increasing the throughput of this type of binding assay by the use of short columns is exemplified for NO 711 binding addressing GAT1, the most prevalent GABA transporter in the CNS. Employing short RP-18 columns with the dimension of 20 mm × 2 mm and 10 mm × 2 mm at flow rates up to 1000 μL/min in an isocratic mode retention times of 8–9 s and chromatographic cycle times of 18 s could be achieved. Based on the internal standard [²H₁₀]NO 711 fast chromatography methods were developed for four different columns that enabled quantification of NO 711 in a range from 50 pM up to 5 nM directly out of reconstituted matrix samples without further sample preparation. A validation of the established methods with respect to linearity, intra- and inter-batch accuracy and precision showed that the requirements according to the FDA guideline for bioanalytical methods are met. Furthermore the established short column methods were applied to the quantification of NO 711 in saturation experiments. The results obtained (i.e., K_d- and B_max-values) were almost identical as compared to those determined employing standard column dimension (55 mm × 2 mm).     

Pacemaker Failure Due to Loss of Fluid Seal in a Patient with a 5/6 mm Pacemaker Header Port and a 5 mm Unipolar Lead

IntroductionBefore IS-1 (3.2 mm) standardization of pacemaker leads and connectors, 5/6 mm connector ports accomodated 5 mm or 6 mm diameter lead connector pins.Case reportA patient with sick sinus syndrome underwent implantation of a 5 mm unipolar atrial lead, mated to a 5/6 mm connector port Medtronic Spectrax Sx 5985 pacemaker. Pulse generator reached ERI in 2006, with change out to a Medtronic Sigma SSR306 (5/6 mm connector port) and preservation of the 5 mm lead. She was admitted in 2010 for atrial lead non capture from blood leak and corrosion of the header-connector pin apparatus.Discussion5/6 mm pacemaker header ports have a 5 mm flexible sealing ring at the port entrance to seal 5 mm or 6 mm lead connector pins. The inner barrel diameter of the connector port is 6 mm and insertion of a 5 mm lead results in a 0.5 mm tolerance circumferentially. Should the seal be compromised, blood can corrode the apparatus. To minimize this, we can employ (a) a cinching tie to further seal the silicone ring (b) universal adaptor sleeves (c) splice kits (d) lead adaptor kits. Aging leads, adaptor kits or sleeves themselves can result in lead failure. It may be safer to re-implant the entire system.ConclusionA 5/6 mm configuration pacemaker header connector port allows for significant tolerances when a 5 mm lead is used. Consideration must be made to prevent leaks.     

Evaluation of the technical performance of three different commercial digital breast tomosynthesis systems in the clinical environment

The aim of this work was to research and evaluate the performance of three different digital breast tomosynthesis (DBT) systems in the clinical environment (Siemens Mammomat Inspiration, Hologic Selenia Dimensions, and Fujifilm Amulet Innovality). The characterization included the study of the detector, the automatic exposure control, and the resolution of DBT projections and reconstructed planes.The modulation transfer function (MTF) of the DBT projections was measured with a 1 mm thick steel edge, showing a strong anisotropy (30–40% lower MTF_0.5 frequencies in the tube travel direction). The in-plane MTF_0.5, measured with a 25 μm tungsten wire, ranges from 1.3 to 1.8 lp/mm in the tube-travel direction and between 2.4 and 3.7 lp/mm in the chest wall–nipple. In the latter direction, the MTF peak shift is more emphasized for large angular range systems (2.0 versus 1.0 lp/mm). In-depth resolution of the planes, via the full width at half maximum (FWHM) from the point spread function of a 25 μm tungsten wire, is not only influenced by angular range and yields 1.3–4.6 mm among systems. The artifact spread function from 1 mm diameter tungsten beads depends mainly on angular range, yielding two tendencies whether large (FWHM is 4.5 mm) or small (FWHM is 10 mm) angular range is used. DBT delivers per scan a mean glandular dose between 1.4 and 2.7 mGy for a 45 mm thick polymethyl methacrylate (PMMA) block.In conclusion, we have identified and analysed specific metrics that can be used for quality assurance of DBT systems.     

Voluntary activation of the trapezius muscle in cases with neck/shoulder pain compared to healthy controls

Subjects reporting neck/shoulder pain have been shown to generate less force during maximal voluntary isometric contractions (MVC) of the shoulder muscles compared to healthy controls. This has been suggested to be caused by a pain-related decrease in voluntary activation (VA) rather than lack of muscle mass. The aim of the present study was to investigate VA of the trapezius muscle during MVCs in subjects with and without neck/shoulder pain by use of the twitch interpolation technique.Ten cases suffering from pain and ten age and gender matched, healthy controls were included in the study. Upper trapezius muscle thickness was measured using ultrasonography and pain intensity was measured on a 100 mm visual analog scale (VAS). VA was calculated from five maximal muscle activation attempts. Superimposed stimuli were delivered to the accessory nerve at peak force and during a 2% MVC following the maximal contraction.Presented as mean ± SD for cases and controls, respectively: VAS; 16.0 ± 14.4 mm and 2.1 ± 4.1 mm (P = 0.004), MVC; 545 ± 161 N and 664 ± 195 N (P = 0.016), upper trapezius muscle thickness; 10.9 ± 1.9 mm and 10.4 ± 1.5 mm (P = 0.20), VA; 93.6 ± 14.2% and 96.3 ± 6.0% (P = 0.29).In spite of significantly eight-fold higher pain intensity and ∼20% lower MVC for cases compared to controls, no difference was found in VA. Possible explanations for the reduction in MVC could be differences in co-activation of antagonists and synergists as well as muscle quality.     

Experimental assessment of the influence of beam hardening filters on image quality and patient dose in volumetric 64-slice X-ray CT scanners

Beam hardening filters have long been employed in X-ray Computed Tomography (CT) to preferentially absorb soft and low-energy X-rays having no or little contribution to image formation, thus allowing the reduction of patient dose and beam hardening artefacts. In this work, we studied the influence of additional copper (Cu) and aluminium (Al) flat filters on patient dose and image quality and seek an optimum filter thickness for the GE LightSpeed VCT 64-slice CT scanner using experimental phantom measurements. Different thicknesses of Cu and Al filters (0.5–1.6 mm Cu, 0.5–4 mm Al) were installed on the scanner’s collimator. A planar phantom consisting of 13 slabs of Cu having different thicknesses was designed and scanned to assess the impact of beam filtration on contrast in the intensity domain (CT detector’s output). To assess image contrast and image noise, a cylindrical phantom consisting of a polyethylene cylinder having 16 holes filled with different concentrations of K₂HPO₄ solution mimicking different tissue types was used. The GE performance and the standard head CT dose index (CTDI) phantoms were also used to assess image resolution characterized by the modulation transfer function (MTF) and patient dose defined by the weighted CTDI. A 100 mm pencil ionization chamber was used for CTDI measurement. Finally, an optimum filter thickness was determined from an objective figure of merit (FOM) metric. The results show that the contrast is somewhat compromised with filter thickness in both the planar and cylindrical phantoms. The contrast of the K₂HPO₄ solutions in the cylindrical phantom was degraded by up to 10% for a 0.68 mm Cu filter and 6% for a 4.14 mm Al filter. It was shown that additional filters increase image noise which impaired the detectability of low density K₂HPO₄ solutions. It was found that with a 0.48 mm Cu filter the 50% MTF value is shifted by about 0.77 lp/cm compared to the case where the filter is not used. An added Cu filter with approximately 0.5 mm thickness accounts for 50% reduction in radiation-absorbed dose as measured by the weighted CTDI. The FOM results indicate that with an additional filter of 0.5 mm Cu or minimum 4 mm Al, a good compromise between image quality and patient dose is achieved for CT images acquired at tube voltages of 120 and 140 kVp. The results seem to indicate that an optimum filter for high kVp acquisitions, routinely used in cardiovascular imaging, should be 0.5 mm copper or 4 mm aluminium minimum.     

Transrectal implantation and stability of gold markers in prostate bed for salvage radiotherapy of macroscopic recurrences

Background and purposeThe objective of the study was to verify the stability of gold markers in the prostatic bed (PB) during salvage radiotherapy.Material and methodsSeven patients, diagnosed with a macroscopic nodule visible on MRI, underwent targeted MRI-guided biopsies. Three gold markers were implanted into the PB close to the relapsing nodule for CT/MRI fusion. A dose of 60 Gy was delivered using IMRT to the PB followed by a dose escalation up to 72 Gy to the macroscopic nodule. Daily anterior and left-lateral kV-images were acquired for repositioning. The coordinates of the center of each marker were measured on the two kV-images. The distance variations (Dvar) of the markers in the first session and the subsequent ones were compared.ResultsNo marker was lost during treatment. The average distance between markers was 7.8 mm. The average Dvar was 0.8 mm, in absolute value. A total of 380/528 (72%) Dvar were ⩽1 mm. A Dvar greater than 2 mm was observed in 5.7% of measurements, with a maximum value of 4.8 mm.ConclusionsDespite the absence of the prostate, the implantation of gold markers in the PB remains feasible, with Dvar often less than 2 mm, and could be used to develop new approaches of salvage focal radiotherapy on the macroscopic relapse after prostatectomy.     

Biomechanics of simulated versus natural cross-country sit skiing

The purpose of this study was to investigate the biomechanics of cross-country sit-skiing in simulated and natural skiing. Thirteen international level athletes participated in a ski ergometer test (simulated conditions) and a test on snow in a ski-tunnel (natural conditions) using their personal sit-ski. Tests in both conditions were performed at individual maximal speed. When comparing the two conditions the main results were: (1) maximal speed in simulated conditions was lower (p < 0.05) but correlated well with the natural condition (r = 0.79, p < 0.001); (2) no differences in pole force variables were found; peak force (r = 0.77, p < 0.01) and average force (r = 0.78, p < 0.01) correlated well; (3) recovery time and time to peak did not differ and time to impact correlated with each other (r = 0.88, p < 0.01); (4) no differences were found in peak electromyography (EMG) and average EMG for Triceps, Pectoralis, and Erector Spinae; Rectus Abdominis did not differ in peak. EMG peak and average EMG of all muscles were correlated between the two conditions (r = 0.65–0.94; p < 0.05–0.01). Although some differences were observed, this study demonstrated that technical skill proficiency in natural and simulated cross-country skiing is comparable from a force production and muscle activation perspective.     

On-site audits to investigate the quality of radiation physics of radiation therapy institutions in the Republic of Korea

PurposeTo investigate and improve the domestic standard of radiation therapy in the Republic of Korea.MethodsOn-site audits were performed for 13 institutions in the Republic of Korea. Six items were investigated by on-site visits of each radiation therapy institution, including collimator, gantry, and couch rotation isocenter check; coincidence between light and radiation fields; photon beam flatness and symmetry; electron beam flatness and symmetry; physical wedge transmission factors; and photon beam and electron beam outputs.ResultsThe average deviations of mechanical collimator, gantry, and couch rotation isocenter were less than 1 mm. Those of radiation isocenter were also less than 1 mm. The average difference between light and radiation fields was 0.9 ± 0.6 mm for the field size of 20 cm × 20 cm. The average values of flatness and symmetry of the photon beams were 2.9% ± 0.6% and 1.1% ± 0.7%, respectively. Those of electron beams were 2.5% ± 0.7% and 0.6% ± 1.0%, respectively. Every institutions showed wedge transmission factor deviations less than 2% except one institution. The output deviations of both photon and electron beams were less than ±3% for every institution.ConclusionsThrough the on-site audit program, we could effectively detect an inappropriately operating linacs and provide some recommendations. The standard of radiation therapy in Korea is expected to improve through such on-site audits.