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Lefebvre TL, Sweeney PW, Gröhl J, Hacker L, Brown EL, Else TR, Oraiopoulou ME, Bloom A, Lewis DY, Bohndiek SE. Performance evaluation of image co-registration methods in photoacoustic mesoscopy of the vasculature. Phys Med Biol 2024; 69:215007. [PMID: 39321985 PMCID: PMC11483810 DOI: 10.1088/1361-6560/ad7fc7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 09/13/2024] [Accepted: 09/25/2024] [Indexed: 09/27/2024]
Abstract
Objective:The formation of functional vasculature in solid tumours enables delivery of oxygen and nutrients, and is vital for effective treatment with chemotherapeutic agents. Longitudinal characterisation of vascular networks can be enabled using mesoscopic photoacoustic imaging, but requires accurate image co-registration to precisely assess local changes across disease development or in response to therapy. Co-registration in photoacoustic imaging is challenging due to the complex nature of the generated signal, including the sparsity of data, artefacts related to the illumination/detection geometry, scan-to-scan technical variability, and biological variability, such as transient changes in perfusion. To better inform the choice of co-registration algorithms, we compared five open-source methods, in physiological and pathological tissues, with the aim of aligning evolving vascular networks in tumours imaged over growth at different time-points.Approach:Co-registration techniques were applied to 3D vascular images acquired with photoacoustic mesoscopy from murine ears and breast cancer patient-derived xenografts, at a fixed time-point and longitudinally. Images were pre-processed and segmented using an unsupervised generative adversarial network. To compare co-registration quality in different settings, pairs of fixed and moving intensity images and/or segmentations were fed into five methods split into the following categories: affine intensity-based using 1)mutual information (MI) or 2)normalised cross-correlation (NCC) as optimisation metrics, affine shape-based using 3)NCC applied to distance-transformed segmentations or 4)iterative closest point algorithm, and deformable weakly supervised deep learning-based using 5)LocalNet co-registration. Percent-changes in Dice coefficients, surface distances, MI, structural similarity index measure and target registration errors were evaluated.Main results:Co-registration using MI or NCC provided similar alignment performance, better than shape-based methods. LocalNet provided accurate co-registration of substructures by optimising subfield deformation throughout the volumes, outperforming other methods, especially in the longitudinal breast cancer xenograft dataset by minimising target registration errors.Significance:We showed the feasibility of co-registering repeatedly or longitudinally imaged vascular networks in photoacoustic mesoscopy, taking a step towards longitudinal quantitative characterisation of these complex structures. These tools open new outlooks for monitoring tumour angiogenesis at the meso-scale and for quantifying treatment-induced co-localised alterations in the vasculature.
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Affiliation(s)
- T L Lefebvre
- Department of Physics, University of Cambridge, JJ Thomson Avenue, Cambridge CB3 0HE, United Kingdom
- Cancer Research UK Cambridge Institute,University of Cambridge, Robinson Way, Cambridge CB2 0RE, United Kingdom
| | - P W Sweeney
- Department of Physics, University of Cambridge, JJ Thomson Avenue, Cambridge CB3 0HE, United Kingdom
- Cancer Research UK Cambridge Institute,University of Cambridge, Robinson Way, Cambridge CB2 0RE, United Kingdom
| | - J Gröhl
- Department of Physics, University of Cambridge, JJ Thomson Avenue, Cambridge CB3 0HE, United Kingdom
- Cancer Research UK Cambridge Institute,University of Cambridge, Robinson Way, Cambridge CB2 0RE, United Kingdom
| | - L Hacker
- Department of Oncology, University of Oxford, Roosevelt Drive, Oxford OX3 7DQ, United Kingdom
| | - E L Brown
- Cancer Research UK Scotland Institute, Garscube Estate, Glasgow G61 1BD, United Kingdom
- School of Cancer Sciences,University of Glasgow, Switchback Road, Glasgow G61 1BD, United Kingdom
| | - T R Else
- Department of Physics, University of Cambridge, JJ Thomson Avenue, Cambridge CB3 0HE, United Kingdom
- Cancer Research UK Cambridge Institute,University of Cambridge, Robinson Way, Cambridge CB2 0RE, United Kingdom
| | - M-E Oraiopoulou
- Department of Physics, University of Cambridge, JJ Thomson Avenue, Cambridge CB3 0HE, United Kingdom
- Cancer Research UK Cambridge Institute,University of Cambridge, Robinson Way, Cambridge CB2 0RE, United Kingdom
| | - A Bloom
- Cancer Research UK Scotland Institute, Garscube Estate, Glasgow G61 1BD, United Kingdom
- School of Cancer Sciences,University of Glasgow, Switchback Road, Glasgow G61 1BD, United Kingdom
| | - D Y Lewis
- Cancer Research UK Scotland Institute, Garscube Estate, Glasgow G61 1BD, United Kingdom
- School of Cancer Sciences,University of Glasgow, Switchback Road, Glasgow G61 1BD, United Kingdom
| | - S E Bohndiek
- Department of Physics, University of Cambridge, JJ Thomson Avenue, Cambridge CB3 0HE, United Kingdom
- Cancer Research UK Cambridge Institute,University of Cambridge, Robinson Way, Cambridge CB2 0RE, United Kingdom
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Heid I, Trajkovic-Arsic M, Lohöfer F, Kaissis G, Harder FN, Mayer M, Topping GJ, Jungmann F, Crone B, Wildgruber M, Karst U, Liotta L, Algül H, Yen HY, Steiger K, Weichert W, Siveke JT, Makowski MR, Braren RF. Functional biomarkers derived from computed tomography and magnetic resonance imaging differentiate PDAC subgroups and reveal gemcitabine-induced hypo-vascularization. Eur J Nucl Med Mol Imaging 2022; 50:115-129. [PMID: 36074156 PMCID: PMC9668793 DOI: 10.1007/s00259-022-05930-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Pancreatic ductal adenocarcinoma (PDAC) is a molecularly heterogeneous tumor entity with no clinically established imaging biomarkers. We hypothesize that tumor morphology and physiology, including vascularity and perfusion, show variations that can be detected by differences in contrast agent (CA) accumulation measured non-invasively. This work seeks to establish imaging biomarkers for tumor stratification and therapy response monitoring in PDAC, based on this hypothesis. METHODS AND MATERIALS Regional CA accumulation in PDAC was correlated with tumor vascularization, stroma content, and tumor cellularity in murine and human subjects. Changes in CA distribution in response to gemcitabine (GEM) were monitored longitudinally with computed tomography (CT) Hounsfield Units ratio (HUr) of tumor to the aorta or with magnetic resonance imaging (MRI) ΔR1 area under the curve at 60 s tumor-to-muscle ratio (AUC60r). Tissue analyses were performed on co-registered samples, including endothelial cell proliferation and cisplatin tissue deposition as a surrogate of chemotherapy delivery. RESULTS Tumor cell poor, stroma-rich regions exhibited high CA accumulation both in human (meanHUr 0.64 vs. 0.34, p < 0.001) and mouse PDAC (meanAUC60r 2.0 vs. 1.1, p < 0.001). Compared to the baseline, in vivo CA accumulation decreased specifically in response to GEM treatment in a subset of human (HUr -18%) and mouse (AUC60r -36%) tumors. Ex vivo analyses of mPDAC showed reduced cisplatin delivery (GEM: 0.92 ± 0.5 mg/g, vs. vehicle: 3.1 ± 1.5 mg/g, p = 0.004) and diminished endothelial cell proliferation (GEM: 22.3% vs. vehicle: 30.9%, p = 0.002) upon GEM administration. CONCLUSION In PDAC, CA accumulation, which is related to tumor vascularization and perfusion, inversely correlates with tumor cellularity. The standard of care GEM treatment results in decreased CA accumulation, which impedes drug delivery. Further investigation is warranted into potentially detrimental effects of GEM in combinatorial therapy regimens.
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Affiliation(s)
- Irina Heid
- School of Medicine, Institute of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany.
| | - Marija Trajkovic-Arsic
- Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, partner site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany
- Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Fabian Lohöfer
- School of Medicine, Institute of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Georgios Kaissis
- School of Medicine, Institute of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
- Department of Computing, Imperial College London, London, SW7 2AZ, UK
- School of Medicine, Institute for Artificial Intelligence in Medicine and Healthcare, Technical University of Munich, Munich, Germany
| | - Felix N Harder
- School of Medicine, Institute of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Moritz Mayer
- School of Medicine, Institute of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Geoffrey J Topping
- School of Medicine, Department of Nuclear Medicine, Technical University of Munich, Munich, Germany
| | - Friderike Jungmann
- School of Medicine, Institute of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Barbara Crone
- Institute of Inorganic and Analytical Chemistry, University of Muenster, Muenster, Germany
| | - Moritz Wildgruber
- Institute of Clinical Radiology, University Hospital Muenster, Muenster, Germany
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Uwe Karst
- Institute of Inorganic and Analytical Chemistry, University of Muenster, Muenster, Germany
| | - Lucia Liotta
- School of Medicine, Clinic and Policlinic of Internal Medicine II, Technical University of Munich, Munich, Germany
| | - Hana Algül
- Comprehensive Cancer Center Munich at the Klinikum rechts der Isar (CCCMTUM), Technical University of Munich, Munich, Germany
| | - Hsi-Yu Yen
- School of Medicine, Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Katja Steiger
- School of Medicine, Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Wilko Weichert
- School of Medicine, Institute of Pathology, Technical University of Munich, Munich, Germany
- German Cancer Consortium (DKTK, partner Site Munich), Munich, Germany
| | - Jens T Siveke
- Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, partner site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany
- Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Marcus R Makowski
- School of Medicine, Institute of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Rickmer F Braren
- School of Medicine, Institute of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany.
- German Cancer Consortium (DKTK, partner Site Munich), Munich, Germany.
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Chadwick EA, Suzuki T, George MG, Romero DA, Amon C, Waddell TK, Karoubi G, Bazylak A. Vessel network extraction and analysis of mouse pulmonary vasculature via X-ray micro-computed tomographic imaging. PLoS Comput Biol 2021; 17:e1008930. [PMID: 33878108 PMCID: PMC8594947 DOI: 10.1371/journal.pcbi.1008930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 11/16/2021] [Accepted: 03/31/2021] [Indexed: 01/02/2023] Open
Abstract
In this work, non-invasive high-spatial resolution three-dimensional (3D) X-ray micro-computed tomography (μCT) of healthy mouse lung vasculature is performed. Methodologies are presented for filtering, segmenting, and skeletonizing the collected 3D images. Novel methods for the removal of spurious branch artefacts from the skeletonized 3D image are introduced, and these novel methods involve a combination of distance transform gradients, diameter-length ratios, and the fast marching method (FMM). These new techniques of spurious branch removal result in the consistent removal of spurious branches without compromising the connectivity of the pulmonary circuit. Analysis of the filtered, skeletonized, and segmented 3D images is performed using a newly developed Vessel Network Extraction algorithm to fully characterize the morphology of the mouse pulmonary circuit. The removal of spurious branches from the skeletonized image results in an accurate representation of the pulmonary circuit with significantly less variability in vessel diameter and vessel length in each generation. The branching morphology of a full pulmonary circuit is characterized by the mean diameter per generation and number of vessels per generation. The methods presented in this paper lead to a significant improvement in the characterization of 3D vasculature imaging, allow for automatic separation of arteries and veins, and for the characterization of generations containing capillaries and intrapulmonary arteriovenous anastomoses (IPAVA).
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Affiliation(s)
- Eric A. Chadwick
- Thermofluids for Energy and Advanced Material Laboratory, Department of Mechanical and Industrial Engineering, Faculty of Applied Science and Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Takaya Suzuki
- Latner Thoracic Surgery Research Laboratories, University Health Network, Princess Margaret Cancer Research Tower, Toronto, Ontario, Canada
| | - Michael G. George
- Thermofluids for Energy and Advanced Material Laboratory, Department of Mechanical and Industrial Engineering, Faculty of Applied Science and Engineering, University of Toronto, Toronto, Ontario, Canada
| | - David A. Romero
- Advanced Thermal/Fluid Optimization, Modelling, and Simulation (ATOMS) Laboratory, Department of Mechanical and Industrial Engineering, Institute of Biomedical Engineering, Faculty of Applied Science and Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Cristina Amon
- Advanced Thermal/Fluid Optimization, Modelling, and Simulation (ATOMS) Laboratory, Department of Mechanical and Industrial Engineering, Institute of Biomedical Engineering, Faculty of Applied Science and Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Thomas K. Waddell
- Latner Thoracic Surgery Research Laboratories, University Health Network, Princess Margaret Cancer Research Tower, Toronto, Ontario, Canada
| | - Golnaz Karoubi
- Latner Thoracic Surgery Research Laboratories, University Health Network, Princess Margaret Cancer Research Tower, Toronto, Ontario, Canada
| | - Aimy Bazylak
- Thermofluids for Energy and Advanced Material Laboratory, Department of Mechanical and Industrial Engineering, Faculty of Applied Science and Engineering, University of Toronto, Toronto, Ontario, Canada
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Kannan P, Kretzschmar WW, Winter H, Warren D, Bates R, Allen PD, Syed N, Irving B, Papiez BW, Kaeppler J, Markelc B, Kinchesh P, Gilchrist S, Smart S, Schnabel JA, Maughan T, Harris AL, Muschel RJ, Partridge M, Sharma RA, Kersemans V. Functional Parameters Derived from Magnetic Resonance Imaging Reflect Vascular Morphology in Preclinical Tumors and in Human Liver Metastases. Clin Cancer Res 2018; 24:4694-4704. [PMID: 29959141 PMCID: PMC6171743 DOI: 10.1158/1078-0432.ccr-18-0033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/11/2018] [Accepted: 06/25/2018] [Indexed: 12/13/2022]
Abstract
Purpose: Tumor vessels influence the growth and response of tumors to therapy. Imaging vascular changes in vivo using dynamic contrast-enhanced MRI (DCE-MRI) has shown potential to guide clinical decision making for treatment. However, quantitative MR imaging biomarkers of vascular function have not been widely adopted, partly because their relationship to structural changes in vessels remains unclear. We aimed to elucidate the relationships between vessel function and morphology in vivo Experimental Design: Untreated preclinical tumors with different levels of vascularization were imaged sequentially using DCE-MRI and CT. Relationships between functional parameters from MR (iAUC, K trans, and BATfrac) and structural parameters from CT (vessel volume, radius, and tortuosity) were assessed using linear models. Tumors treated with anti-VEGFR2 antibody were then imaged to determine whether antiangiogenic therapy altered these relationships. Finally, functional-structural relationships were measured in 10 patients with liver metastases from colorectal cancer.Results: Functional parameters iAUC and K trans primarily reflected vessel volume in untreated preclinical tumors. The relationships varied spatially and with tumor vascularity, and were altered by antiangiogenic treatment. In human liver metastases, all three structural parameters were linearly correlated with iAUC and K trans For iAUC, structural parameters also modified each other's effect.Conclusions: Our findings suggest that MR imaging biomarkers of vascular function are linked to structural changes in tumor vessels and that antiangiogenic therapy can affect this link. Our work also demonstrates the feasibility of three-dimensional functional-structural validation of MR biomarkers in vivo to improve their biological interpretation and clinical utility. Clin Cancer Res; 24(19); 4694-704. ©2018 AACR.
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Affiliation(s)
- Pavitra Kannan
- CRUK and MRC Oxford Institute for Radiation Oncology Department of Oncology, University of Oxford, Oxford, United Kingdom.
| | - Warren W Kretzschmar
- School of Engineering Sciences in Chemistry, Biotechnology and Health, Department of Gene Technology, Science for Life Laboratory, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Helen Winter
- CRUK and MRC Oxford Institute for Radiation Oncology Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Daniel Warren
- CRUK and MRC Oxford Institute for Radiation Oncology Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Russell Bates
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Philip D Allen
- CRUK and MRC Oxford Institute for Radiation Oncology Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Nigar Syed
- CRUK and MRC Oxford Institute for Radiation Oncology Department of Oncology, University of Oxford, Oxford, United Kingdom
- NHS, Department of Radiology, Churchill Hospital, Oxford, United Kingdom
| | - Benjamin Irving
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Bartlomiej W Papiez
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Jakob Kaeppler
- CRUK and MRC Oxford Institute for Radiation Oncology Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Bosjtan Markelc
- CRUK and MRC Oxford Institute for Radiation Oncology Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Paul Kinchesh
- CRUK and MRC Oxford Institute for Radiation Oncology Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Stuart Gilchrist
- CRUK and MRC Oxford Institute for Radiation Oncology Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Sean Smart
- CRUK and MRC Oxford Institute for Radiation Oncology Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Julia A Schnabel
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Tim Maughan
- CRUK and MRC Oxford Institute for Radiation Oncology Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Adrian L Harris
- CRUK and MRC Oxford Institute for Radiation Oncology Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Ruth J Muschel
- CRUK and MRC Oxford Institute for Radiation Oncology Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Mike Partridge
- CRUK and MRC Oxford Institute for Radiation Oncology Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Ricky A Sharma
- CRUK and MRC Oxford Institute for Radiation Oncology Department of Oncology, University of Oxford, Oxford, United Kingdom
- NIHR University College London Hospitals Biomedical Research Centre, University College London, London, United Kingdom
| | - Veerle Kersemans
- CRUK and MRC Oxford Institute for Radiation Oncology Department of Oncology, University of Oxford, Oxford, United Kingdom
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5
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Grimes DR, Kannan P, Warren DR, Markelc B, Bates R, Muschel R, Partridge M. Estimating oxygen distribution from vasculature in three-dimensional tumour tissue. J R Soc Interface 2016; 13:20160070. [PMID: 26935806 PMCID: PMC4843681 DOI: 10.1098/rsif.2016.0070] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 02/09/2016] [Indexed: 12/25/2022] Open
Abstract
Regions of tissue which are well oxygenated respond better to radiotherapy than hypoxic regions by up to a factor of three. If these volumes could be accurately estimated, then it might be possible to selectively boost dose to radio-resistant regions, a concept known as dose-painting. While imaging modalities such as 18F-fluoromisonidazole positron emission tomography (PET) allow identification of hypoxic regions, they are intrinsically limited by the physics of such systems to the millimetre domain, whereas tumour oxygenation is known to vary over a micrometre scale. Mathematical modelling of microscopic tumour oxygen distribution therefore has the potential to complement and enhance macroscopic information derived from PET. In this work, we develop a general method of estimating oxygen distribution in three dimensions from a source vessel map. The method is applied analytically to line sources and quasi-linear idealized line source maps, and also applied to full three-dimensional vessel distributions through a kernel method and compared with oxygen distribution in tumour sections. The model outlined is flexible and stable, and can readily be applied to estimating likely microscopic oxygen distribution from any source geometry. We also investigate the problem of reconstructing three-dimensional oxygen maps from histological and confocal two-dimensional sections, concluding that two-dimensional histological sections are generally inadequate representations of the three-dimensional oxygen distribution.
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Affiliation(s)
- David Robert Grimes
- Cancer Research UK/MRC Oxford Institute for Radiation Oncology, Gray Laboratory, University of Oxford, Old Road Campus Research Building, Off Roosevelt Drive, Oxford OX3 7DQ, UK
| | - Pavitra Kannan
- Cancer Research UK/MRC Oxford Institute for Radiation Oncology, Gray Laboratory, University of Oxford, Old Road Campus Research Building, Off Roosevelt Drive, Oxford OX3 7DQ, UK
| | - Daniel R Warren
- Cancer Research UK/MRC Oxford Institute for Radiation Oncology, Gray Laboratory, University of Oxford, Old Road Campus Research Building, Off Roosevelt Drive, Oxford OX3 7DQ, UK
| | - Bostjan Markelc
- Cancer Research UK/MRC Oxford Institute for Radiation Oncology, Gray Laboratory, University of Oxford, Old Road Campus Research Building, Off Roosevelt Drive, Oxford OX3 7DQ, UK
| | - Russell Bates
- Engineering Sciences, University of Oxford, Oxford OX1 3PJ, UK
| | - Ruth Muschel
- Cancer Research UK/MRC Oxford Institute for Radiation Oncology, Gray Laboratory, University of Oxford, Old Road Campus Research Building, Off Roosevelt Drive, Oxford OX3 7DQ, UK
| | - Mike Partridge
- Cancer Research UK/MRC Oxford Institute for Radiation Oncology, Gray Laboratory, University of Oxford, Old Road Campus Research Building, Off Roosevelt Drive, Oxford OX3 7DQ, UK
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