Dual-responsive magnetic nanodroplets for controlled oxygen release via ultrasound and magnetic stimulation

Magnetic oxygen-loaded nanodroplets (MOLNDs) are a promising class of nanomaterials dually sensitive to ultrasound and magnetic fields, which can be employed as nanovectors for drug delivery applications, particularly in the field of hypoxic tissue treatment. Previous investigations were primarily focused on the application of these hybrid systems for hyperthermia treatment, exploiting magnetic nanoparticles for heat generation and nanodroplets as carriers and ultrasound contrast agents for treatment progress monitoring. This work places its emphasis on the prospect of obtaining an oxygen delivery system that can be activated by both ultrasound and magnetic fields. To achieve this goal, Fe3O4 nanoparticles were employed to decorate and induce the magnetic vaporization of OLNDs, allowing oxygen release. We present an optimized method for preparing MOLNDs by decorating nanodroplets made of diverse fluorocarbon cores and polymeric coatings. Furthermore, we performed a series of characterizations for better understanding how magnetic decoration can influence the physicochemical properties of OLNDs. Our comprehensive analysis demonstrates the efficacy of magnetic stimulation in promoting oxygen release compared to conventional ultrasound-based methods. We emphasize the critical role of selecting the appropriate fluorocarbon core and polymeric coating to optimize the decoration process and enhance the oxygen release performance of MOLNDs.

Piezo/sono-catalytic activity of ZnO micro/nanoparticles for ROS generation as function of ultrasound frequencies and dissolved gases

We report an accurate study on sonocatalytic properties of different ZnO micro and nanoparticles to enhance OH radical production activated by cavitation. In order to investigate some of the still unsolved aspects related to the piezocatalytic effect, the degradation of Methylene Blue and quantification of radicals production have been evaluated as function of different ultrasonic frequencies (20 kHz and 858 kHz) and dissolved gases (Ar, N₂ and air). The results shown that at low frequency the catalytic effect of ZnO particles is well evident and influenced by particle dimension while at high frequency a reduction of the degradation efficiency have been observed using larger particles. An increase of radical production have been observed for all ZnO particles tested while the different saturating gases have poor influence. In both ultrasonic set-up the ZnO nanoparticles resulted the most efficient on MB degradation revealing that the enhanced radical production may arise more from bubbles collapse on particles surface than the discharge mechanism activate by mechanical stress on piezoelectric particles. An interpretation of these effects and a possible mechanism which rules the sonocatalytic activity of ZnO will be proposed and discussed.

Improvement of Hyperthermia Properties of Iron Oxide Nanoparticles by Surface Coating

Magnetic hyperthermia is an oncological therapy that exploits magnetic nanoparticles activated by radiofrequency magnetic fields to produce a controlled temperature increase in a diseased tissue. The specific loss power (SLP) of magnetic nanoparticles or the capability to release heat can be improved using surface treatments, which can reduce agglomeration effects, thus impacting on local magnetostatic interactions. In this work, Fe₃O₄ nanoparticles are synthesized via a coprecipitation reaction and fully characterized in terms of structural, morphological, dimensional, magnetic, and hyperthermia properties (under the Hergt-Dutz limit). Different types of surface coatings are tested, comparing their impact on the heating efficacy and colloidal stability, resulting that sodium citrate leads to a doubling of the SLP with a substantial improvement in dispersion and stability in solution over time; an SLP value of around 170 W/g is obtained in this case for a 100 kHz and 48 kA/m magnetic field.

3D Extrusion Printing of Biphasic Anthropomorphic Brain Phantoms Mimicking MR Relaxation Times Based on Alginate-Agarose-Carrageenan Blends

The availability of adapted phantoms mimicking different body parts is fundamental to establishing the stability and reliability of magnetic resonance imaging (MRI) methods. The primary purpose of such phantoms is the mimicking of physiologically relevant, contrast-creating relaxation times T₁ and T₂. For the head, frequently examined by MRI, an anthropomorphic design of brain phantoms would imply the discrimination of gray matter and white matter (WM) within defined, spatially distributed compartments. Multichannel extrusion printing allows the layer-by-layer fabrication of multiple pastelike materials in a spatially defined manner with a predefined shape. In this study, the advantages of this method are used to fabricate biphasic brain phantoms mimicking MR relaxation times and anthropomorphic geometry. The printable ink was based on purely naturally derived polymers: alginate as a calcium-cross-linkable gelling agent, agarose, ι-carrageenan, and GdCl₃ in different concentrations (0-280 μmol kg^-1) as the paramagnetic component. The suggested inks (e.g., 3Alg-1Agar-6Car) fulfilled the requirements of viscoelastic behavior and printability of large constructs (>150 mL). The microstructure and distribution of GdCl₃ were assessed by scanning electron microscopy (SEM) with energy-dispersive X-ray spectroscopy (EDX). In closely monitored steps of technological development and characterization, from monophasic and biphasic samples as printable inks and cross-linked gels, we describe the construction of large-scale phantom models whose relaxation times were characterized and checked for stability over time.

Dextran-shelled oxygen-loaded nanodroplets modulate macrophages killing and inflammatory response to Enterococcus faecalis

Chronic wounds are associated with inflammation, infections, and hypoxic environment. Macrophages play a crucial role in wound healing removing bacteria and secreting signal molecules to coordinate tissue repair. Recently, dextran-shelled Oxygen-Loaded NanoDroplets (OLNDs) have been proposed as new tools to counteract hypoxia in chronic wounds. Here we investigated the effects of OLNDs on Enterococcus faecalis (E. faecalis) killing and the secretion of inflammatory and angiogenic factors by murine (BMDM) and human (dTHP-1, differentiated THP-1) macrophages, in normoxia and hypoxia. Both OLNDs and Oxygen-Free NanoDroplets (OFNDs) significantly increased reactive oxygen species production by BMDM in normoxia (4.1 and 4 fold increase by 10% OLNDs and OFNDs, respectively, after 120 min) and hypoxia (3.8 and 4 fold increase by 10% OLNDs and OFNDs respectively) but not by dTHP-1. Moreover, only OLNDs induced nitric oxide secretion by BMDM in normoxia. Consequently, both nanodroplets improved E. faecalis killing by BMDM in normoxia (% of killing OLNDs = 44.2%; p < 0.01; OFNDs = 41.4%; p < 0.05) and hypoxia (% of killing OLNDs = 43.1%; p < 0.01; OFNDs = 37.7%; p < 0.05), while dTHP-1-mediated killing was not affected. The secretion of the inflammatory cytokines (TNFα, IL-6, IL-1β) induced by E. faecalis infection in dTHP-1 was reduced by both types of nanodroplets, suggesting a novel anti-inflammatory activity of the dextran shell. Instead, the increase of VEGF induced by hypoxia was reduced only by OLNDs. These data provide new knowledge on the effects of OLNDs as innovative adjuvant in chronic wounds healing promoting bacterial killing and reducing inflammation.

Antibacterial and Antifungal Efficacy of Medium and Low Weight Chitosan-Shelled Nanodroplets for the Treatment of Infected Chronic Wounds

Purpose

Medium versus low weight (MW vs LW) chitosan-shelled oxygen-loaded nanodroplets (cOLNDs) and oxygen-free nanodroplets (cOFNDs) were comparatively challenged for biocompatibility on human keratinocytes, for antimicrobial activity against four common infectious agents of chronic wounds (CWs) – methicillin-resistant Staphylococcus aureus (MRSA), Streptococcus pyogenes, Candida albicans and C. glabrata – and for their physical interaction with cell walls/membranes.

Methods

cNDs were characterized for morphology and physico-chemical properties by microscopy and dynamic light scattering. In vitro oxygen release from cOLNDs was measured through an oximeter. ND biocompatibility and ability to promote wound healing in human normoxic/hypoxic skin cells were challenged by LDH and MTT assays using keratinocytes. ND antimicrobial activity was investigated by monitoring upon incubation with/without MW or LW cOLNDs/cOFNDs either bacteria or yeast growth over time. The mechanical interaction between NDs and microorganisms was also assessed by confocal microscopy.

Results

LW cNDs appeared less toxic to keratinocytes than MW cNDs. Based on cell counts, either MW or LW cOLNDs and cOFNDs displayed long-term antimicrobial efficacy against S. pyogenes, C. albicans, and C. glabrata (up to 24 h), whereas a short-term cytostatic effects against MRSA (up to 6 h) was revealed. The internalization of all ND formulations by all four microorganisms, already after 3 h of incubation, was showed, with the only exception to MW cOLNDs/cOFNDs that adhered to MRSA walls without being internalized even after 24 h.

Conclusion

cNDs exerted bacteriostatic and fungistatic effects, due to the presence of chitosan in the outer shell and independently of oxygen addition in the inner core. The duration of such effects strictly depends on the characteristics of each microbial species, and not on the molecular weight of chitosan in ND shells. However, LW chitosan was better tolerated by human keratinocytes than MW. For these reasons, the use of LW NDs should be recommended in future research to assess cOLND efficacy for the treatment of infected CWs.

Insight into Sonoluminescence Augmented by ZnO-Functionalized Nanoparticles

Recent advances in optical imaging techniques rely on the use of nanosized contrast agents for in vitro and in vivo applications. We report on an imaging method based on the inertial cavitation of ultrasound-irradiated water solutions that lead to sonoluminescence (SL), here, newly proposed in combination with semiconductor nanoparticles, in particular, aminopropyl-functionalized zinc oxide nanocrystals. The obtained measurements confirm the ability of such nanocrystals to increase the sonoluminescence emission, together with the ability to modify the SL spectrum when compared to the pure water behavior. In particular, it is shown that the UV component of SL is absorbed by the semiconductor behavior that is also confirmed in different biologically relevant media. Finally, optical images of nanocrystal-assisted SL are acquired for the first time, in particular, in biological buffers, revealing that at low ultrasound intensities, SL is measurable only when the nanocrystals are present in solution. All of these results witness the role of amine-functionalized zinc oxide nanocrystals for sonoluminescence emission, which makes them very good candidates as efficient nanocontrast agents for SL imaging for biological and biomedical applications.

Functional mechanical attributes of natural and synthetic gel-based scaffolds in tissue engineering: strain-stiffening effects on apparent elastic modulus and compressive toughness

The accurate identification and determination of elastic modulus and toughness, as well as other functional mechanical attributes of artificial tissues, are of paramount importance in several fields of tissue science, tissue engineering and technology, since biomechanical and biophysical behavior is strongly linked to biological features of the medical implants and tissue-engineering scaffolds. When soft or ultra-soft materials are investigated, a relevant dispersion of elastic modulus values can be achieved, due to the strain-stiffening effects, inducing a typical non-linear behavior of these materials, as a function of strain-range. In this short communication, the Apparent elastic modulus strain-range dependence is estimated from a segmentation of the strain stiffening curve, and the related compressive toughness is investigated and discussed, based on experimental evidence, for 6 different kinds of gels, used for artificial tissue fabrication; experimental results are compared to mechanical properties of native human tissues.

Leveraging re-chargeable nanobubbles on amine-functionalized ZnO nanocrystals for sustained ultrasound cavitation towards echographic imaging

Nanoparticles able to promote inertial cavitation when exposed to focused ultrasound have recently gained much attention due to their vast range of possible applications in the biomedical field, such as enhancing drug penetration in tumor or supporting ultrasound contrast imaging. Due to their nanometric size, these contrast agents could penetrate through the endothelial cells of the vasculature to target tissues, thus enabling higher imaging resolutions than commercial gas-filled microbubbles. Herein, Zinc Oxide NanoCrystals (ZnO NCs), opportunely functionalized with amino-propyl groups, are developed as novel nanoscale contrast agents that are able, for the first time, to induce a repeatedly and over-time sustained inertial cavitation as well as ultrasound contrast imaging. The mechanism behind this phenomenon is investigated, revealing that re-adsorption of air gas nanobubbles on the nanocrystal surface is the key factor for this re-chargeable cavitation. Moreover, inertial cavitation and significant echographic signals are obtained at physiologically relevant ultrasound conditions (MI < 1.9), showing great potential for low side-effects in in-vivo applications of the novel nanoscale agent from diagnostic imaging to gas-generating theranostic nanoplatforms and to drug delivery.

The Synergistic Effect of Nanocrystals Combined With Ultrasound in the Generation of Reactive Oxygen Species for Biomedical Applications

Reactive oxygen species (ROS) effects on living cells and tissues is multifaceted and their level or dose can considerably affect cell proliferation and viability. It is therefore necessary understand their role also designing ways able to regulate their amount inside cells, i.e., using engineered nanomaterials with either antioxidant properties or, for cancer therapy applications, capable to induce oxidative stress and cell death, through tunable ROS production. In this paper, we report on the use of single-crystalline zinc oxide (ZnO) round-shaped nanoparticles, yet ZnO nanocrystals (NCs) functionalized with amino-propyl groups (ZnO-NH2 NCs), combined with pulsed ultrasound (US). We show the synergistic effects produced by NC-assisted US which are able to produce different amount of ROS, as a result of inertial cavitation under the pulsed US exposure. Using Passive Cavitation Detection (PCD) and Electron Paramagnetic Resonance (EPR) spectroscopy, we systematically study which are the key parameters, monitoring, and influencing the amount of generated ROS measuring their concentration in water media and comparing all the results with pure water batches. We thus propose a ROS generation mechanism based on the selective application of US to the ZnO nanocrystals in water solutions. Ultrasound B-mode imaging is also applied, proving in respect to pure water, the enhanced ecographic signal generation of the aqueous solution containing ZnO-NH2 NCs when exposed to pulsed ultrasound. Furthermore, to evaluate the applicability of ZnO-NH2 NCs in the biomedical field, the ROS generation is studied by interposing different tissue mimicking materials, like phantoms and ex vivo tissues, between the US transducer and the sample well. As a whole, we clearly proof the enhanced capability to produce ROS and to control their amount when using ZnO-NH2 NCs in combination with pulsed ultrasound anticipating their applicability in the fields of biology and health care.

Sonochemical hydrogenation of metallic microparticles

We report the sonochemical synthesis of hydrogenated metallic microparticles through room-temperature ultrasonic irradiation of aqueous metallic slurries. The role of saturating gases and of reduction-oxidation mechanism on promoting the hydride formation is investigated. The method is then applied to study the synthesis of different metallic hydrides (Mn, Ti) and the hydrogenation of La(Fe,Mn,Si)₁₃, an intermetallic compound with magnetocaloric properties used in magnetic refrigeration applications. The samples were characterized by X-ray diffraction to identify the presence of hydrogenated phases, by differential scanning calorimetry to evaluate hydrogen release and temperature stability of the hydrides and by electron microscopy to identify morphological modifications induced by acoustic cavitation. The hydrogenation of metallic microparticles and intermetallic compounds is reported for the first time by means of this experimental technique which could represent a new tool for fast and cheap hydrogenation of materials for different technological applications, such as hydrogen storage and magnetic refrigeration.

Insight into ultrasound-mediated reactive oxygen species generation by various metal-porphyrin complexes

Ultrasound is used to trigger the cytotoxicity of chemical compounds, known as sonosensitisers, in an approach called sonodynamic therapy (SDT), which is under investigation herein. The generation of reactive oxygen species (ROS) has been proposed as the main biological occurrence that leads to the cytotoxic effects, which are achieved via the synergistic action of two components: the energy-absorbing sonosensitiser and ultrasound (US), which are both harmless per se. Despite some promising results, a lack of investigation into the mechanisms behind US sonosensitiser-mediated ROS generation has prevented SDT from reaching its full potential. The aim of this work is to investigate the US-responsiveness of a variety of metal-porphyrin complexes, free-base porphyrin and Fe(III), Zn(II) and Pd(II) porphyrin, by analyzing their ROS generation under US exposure and related bio-effects. All experiments were also carried out under light exposure and the results were used as references. Our results show that porphyrin ultrasound-responsiveness depends on the metal ion present, with Zn(II) and Pd(II) porphyrin being the most efficient in generating singlet oxygen and hydroxyl radicals. ROS production efficiency is lower after ultrasound exposure than after light exposure, because of the various physico-chemical mechanisms involved in sensitiser activation. US and porphyrin-mediated ROS generation is oxygen-dependent and the activation of porphyrin by US appears to be more compatible with sonoluminescence-based photo-activation rather than a radical path process that occurs via the homolytic bond rupture of water. Notably, the cytotoxicity results reported herein, which are mirrored by ex-cellulo data, confirm that the type of ROS generation achieved by the US activation of intracellular porphyrins is pivotal to the effectiveness of cancer cell killing.

Sonochemistry and bubble dynamics

The details of bubble behaviour in chemically active cavitation are still not sufficiently well understood. Here we report on experimental high-speed observations of acoustically driven single-bubble and few-bubble systems with the aim of clarification of the connection of their dynamics with chemical activity. Our experiment realises the sonochemical isomerization reaction of maleic acid to fumaric acid, mediated by bromine radicals, in a bubble trap set-up. The main result is that the reaction product can only be observed in a parameter regime where a small bubble cluster occurs, while a single trapped bubble stays passive. Evaluations of individual bubble dynamics for both cases are given in form of radius-time data and numerical fits to a bubble model. A conclusion is that a sufficiently strong collapse has to be accompanied by non-spherical bubble dynamics for the reaction to occur, and that the reason appears to be an efficient mixing of liquid and gas phase. This finding corroborates previous observations and literature reports on high liquid phase sonochemical activity under distinct parameter conditions than strong sonoluminescence emissions.

Acoustical characterization of polysaccharide polymers tissue-mimicking materials

Tissue-mimicking phantoms play a crucial role in medical ultrasound research because they can simulate biological soft tissues. In last years, many types of polymeric tissues have been proposed and characterized from an acoustical and a thermal point of view, but, rarely, a deep discussion about the quality of the measurements, in terms of the uncertainty evaluation, has been reported. In this work, considering the necessity to develop laboratory standards for the measurement of ultrasonic exposure and dose quantities, a detailed description of the experimental apparatuses for the sound speed and the attenuation coefficient measurements is given, focusing the attention on the uncertainty evaluation both of the results and analysis algorithms. In particular, this algorithm reveals a novel empirical relation, fixing a limit to the energy content (therefore limits the number of cycles) of the three parts in which the authors have proposed to divide the acoustical signal. Furthermore, the realisation of multi-components phantoms, Agar and Phytagel based tissue-mimicking gels along with others long chain molecules (dextrane or polyvinyl alcohol) and scattering materials (silicon carbide and kieselguhr) are investigated. This paper reports accurate speed of sound and attenuation coefficient measurements. Speed of sound is measured by a pulse-echo technique in far-field condition, using an optical glass buffer rod; while attenuation coefficient is determined by an insertion technique, using demineralized water as reference material. The experimental sound speed results are subjected to an overall estimated relative uncertainty of about 1.5% and the attenuation coefficient uncertainty is less than 2.5%. For the development of laboratory standards, a detailed analysis of the measurement uncertainty is fundamental to make sample properties comparable. The authors believe this study could represent the right direction to make phantoms characterizations referable and traceable.

Ultrasound-activated decafluoropentane-cored and chitosan-shelled nanodroplets for oxygen delivery to hypoxic cutaneous tissues

Ultrasound-activated decafluoropentane/chitosan nanodroplets effectively release oxygen to the skin.

The role of vapour pressure in multibubble sonoluminescence from organic solvents

The action of high intensity cavitation on several liquid halocarbons (C(2)Cl(4) CCl(4), CHCl(3), C(2)H(2)Br(4)) and other organic solvents (acetone, benzene and their mixtures) was investigated by recording multibubble sonoluminescence UV-Vis spectra over the temperature range between 246 and 298 K. The temperature induced variation of some thermophysical properties of the solvents Favours the interpretations of their role in determining the salient characteristics of the recorded spectra. We observed that high volatility does not necessarily quench sonoluminescence emission and that argon flow plays a key role in the appearance of radical emission lines. While for each investigated substance the intensity of C*(2) emission lines was clearly correlated to temperature, a comparative test between different halocarbons did not show a clear correlation with vapour pressure. Following recently reported results which evidenced the formation of dynamically differentiated populations of emitting bubbles in sulphuric acid, we performed MBSL experiments in liquid mixtures of halocarbons and sulphuric acid to investigate the correlation between the production of emitting species and the halocarbon volatility.

Preparation of tunable silicon q-dots through ultrasound

Silicon quantum dots (QDs) have been prepared through ultrasound treatments of light-emitting porous silicon layers (PSL) electrochemically etched from a p(+) type crystalline silicon (c-Si). The sonication treatments allowed separating the porous fraction from the bulk of c-Si as well as to mechanically reduce their dimensions. The ultrasounds processes have been carried out in two different organic solvents (toluene and tetrahydrofuran), and allowed obtaining silicon QDs emitting light in the blue-green part of the visible spectrum (estimated QDs diameter around 5 nm). Moreover, by adding the proper chemicals in the solvents, such as alkenes, or simply paraffin oil, we have stabilized the QDs achieving surface modification and observed an effect on size reduction. Photoluminescence spectra of the QDs, TEM images and a preliminary micro-FTIR investigation of functionalised QDs will be presented in this paper.

Sonochemical preparation of high surface area MgAl2O4 spinel

High surface area MgAl(2)O(4) has been synthesised by a sonochemical method. Two kinds of precursors were used, alkoxides and nitrates/acetates and in both cases nanostructured MgAl(2)O(4) was obtained. The effect of the addition of a surfactant during the sonication, cetyl trimethyl ammonium bromide, was also investigated. In the case of alkoxides precursors the as-made product is a mixture of hydroxides of aluminium and magnesium, while with nitrates/acetates a gel is obtained after sonication, containing the metal hydroxides and ammonium nitrate. Heating at 500 degrees C transforms the as-made products into MgAl(2)O(4) spinel phase. The surface area is up to 267 m(2)/g after treatment at 500 degrees C and 138 m(2)/g at 800 degrees C.

Single bubble sonochemistry: decomposition of alkyl bromide and the isomerization reaction of maleic acid

Single bubble cavitation offers an unique opportunity to evaluate the effect of bubble activity in promoting chemical reactions. In this paper we study the isomerization reaction of maleic acid into fumaric acid using an aqueous solution of maleic acid saturated with CH2Br2. The Br* radicals are generated at the bubble surface and a whitish thread forms. For comparison, the same reaction was conducted in a sonochemical bath. A possible scheme of the reactions activated at bubble surface after the decomposition of organic brominated substances is proposed.

Moving single bubble sonoluminescence in phosphoric acid and sulphuric acid solutions

The phenomenon of sonoluminescence still presents some unsolved aspects. Recently [Y.T. Didenko, K. Suslick, Molecular Emission during Single Bubble Sonoluminescence, Nature 407 (2000) 877-879.], it was found that a single cavitating air bubble in polar aprotic liquids (including formamide and adiponitrile) can produce very strong sonoluminescence while undergoing macroscopic translation movements in the resonator, a condition known as moving single bubble sonoluminescing (MSBSL). Here we describe some experiments conducted in aqueous solutions of phosphoric and sulphuric acid. In these liquid media, it is possible to reproduce MSBSL and luminescence is emitted even if a trapped bubble is subjected to a strong shape instability, named in the literature "jittering phase". When a moving and luminescing bubble was present and the acoustic pressure gradually increased, we observed the generation of a discrete lattice of trapped bubbles. The bubbles in the lattice emit very intense light flashes and can change their position while maintaining the overall spatial distribution in time. Some preliminary results, obtained from Mie-scattering and measurements of relative light intensity, are reported.

Evidence for liquid phase reactions during single bubble acoustic cavitation

We extended the recent experiment by Lepoint et al. [Sonochemistry and Sonoluminescence, NATO ASI Series, Series C 524, Kluwer Academic Publishers, Dordrecht/Boston/London, 1999, p. 285], involving a so-called single bubble sonochemistry process, to a three-phase system. We have found experimental evidence that a single cavitating bubble can activate the oxidation of I- ions after the injection of a CCl4 liquid drop in the bubble trapping apparatus. The solvent drop (CCl4 is almost water insoluble) is pushed towards the bubble position and forms a thin film on the bubble surface. When the acoustic pressure drive is increased above 100 kPa, the three-phase system gives rise to a dark filament, indicating the complexation reaction between starch (added to the water phase) and I2. I2 species is the product of surface reactions involving bubble-induced decomposition of CCl4. Further increase of the acoustic drive causes the thin CCl4 film to separate from the bubble and stops I2 production. The study of the chemical activity of this three-phase system could give new advances on dynamics of the bubble collapse.

Evaluation of methods for opto-electronic body surface sensing applied to patient position control in breast radiation therapy

The accuracy gap between the high levels of accuracy in radiotherapy planning and the uncertain set-up of each therapy fraction represents a crucial factor in the optimisation of radiation treatment. This occurs because the conventional means of patient alignment and immobilisation do not guarantee accurate implementation of the therapy plan in the actual irradiation treatment. A patient repositioning technique is proposed, based on opto-electronic motion capture and on methods of registration of body surfaces described by a limited dataset. The validation of the method was related to breast cancer radiotherapy and was based on simulated and experimental repositioning procedures involving a phantom and two subjects. With respect to previous work, the surface registration procedure was, in this case, implemented as a constrained non-linear least-square problem (constraints were given by the position of a couple of passive markers placed on the sternum), and three different algorithms were compared in terms of accuracy in misalignment detection and of computational cost. The simulation and experimental activities identified the best performing algorithm, which systematically limited the repositioning errors to below clinically acceptable thresholds (5 mm), with residual surface mismatches lower than 2 mm.

[Opto-electronic techniques and 3D body surface reconstruction for the control of patient positioning in the radiotherapy of breast cancer]

PURPOSE

In radiotherapy clinical practice, the currently existing gap between the high degree of accuracy in treatment planning and, the possibility of conforming the high-energy radiation beams on the one hand, and the uncertain set-up of each irradiation session on the other is a decisive factor for optimizing radiation treatment. Indeed there is wide experimental evidence that the current methods used for patient alignment and immobilization do not guarantee the necessary precision in delivering therapy with respect to the specifications of the treatment plan. The main reason for this is the lack of control systems that may be applied systematically to provide quantitative real-time feedback on the quality of patient repositioning and immobility during radiation emission.

MATERIAL AND METHODS

Opto-electronic techniques and body surface registration methods were sygergisically used for the automatic three-dimensional verification and correction of patient position at the therapy unit. The method is based on radiotherapy applications of real-time opto-electronic human motion analysis using passive markers to control patient repositioning and to acquire and describe body surfaces in three dimensions. The quantitative detection of the localization error relies on the real-time detection of the position of an hybrid set of control points, namely physical passive markers and laser light markers, and their immediate comparison with a reference data set. The data set consists of the reference positions of the passive markers and a three-dimensional model of the body surface. The method was experimentally tested at the Radiotherapy Division of the European Institute of Oncology to control the repositioning of a phantom and of a volunteer, with reference to the clinical realignment procedure applied for breast cancer radiotherapy.

RESULTS

The results confirm that the technique represents a valuable method to detect and automatically correct localization errors in the irradiation set-up. The use of the information provided by the laser markers allows one to reduce the potential inaccuracies in the manual relocation of the passive markers on the subject's skin and guarantees that position control is based on a redundant set of data describing the three-dimensional localization and configuration of the irradiated body surface portion. The experimental results show that the initial displacements of the controlled body area were systematically reduced to median values below 1 millimeter and 1.2 millimeters for the phantom and the volunteer, respectively.

CONCLUSIONS

The synergistic use of opto-electronic technologies and stereophotogrammetric techniques associated to surface registration methods proved to provide an accurate description of the spatial transformation between the reference position and the actual position of the controlled body area. This allowed us to define an effective procedure to correct the patients position and recover the quality of the irradiation set-up, in agreement with the clinical requirements. The reported results confirm that the dynamic sensing of the body surface by opto-electronic technologies is a particularly promising technique that allows to systematically achieve swift and accurate patient alignment, thus ensuring that the treatment plan specifications are reproduced in the reality of each irradiation session.