Good Timing Matters: The Spatially Fractionated High Dose Rate Boost Should Come First

Monoplanar microbeam irradiation (MBI) and pencilbeam irradiation (PBI) are two new concepts of high dose rate radiotherapy, combined with spatial dose fractionation at the micrometre range. In a small animal model, we have explored the concept of integrating MBI or PBI as a simultaneously integrated boost (SIB), either at the beginning or at the end of a conventional, low-dose rate schedule of 5x4 Gy broad beam (BB) whole brain radiotherapy (WBRT). MBI was administered as array of 50 µm wide, quasi-parallel microbeams. For PBI, the target was covered with an array of 50 µm × 50 µm pencilbeams. In both techniques, the centre-to-centre distance was 400 µm. To assure that the entire brain received a dose of at least 4 Gy in all irradiated animals, the peak doses were calculated based on the daily BB fraction to approximate the valley dose. The results of our study have shown that the sequence of the BB irradiation fractions and the microbeam SIB is important to limit the risk of acute adverse effects, including epileptic seizures and death. The microbeam SIB should be integrated early rather than late in the irradiation schedule.

Non-conventional Ultra-High Dose Rate (FLASH) Microbeam Radiotherapy Provides Superior Normal Tissue Sparing in Rat Lung Compared to Non-conventional Ultra-High Dose Rate (FLASH) Radiotherapy

Conventional radiotherapy is a widely used non-invasive form of treatment for many types of cancer. However, due to a low threshold in the lung for radiation-induced normal tissue damage, it is of less utility in treating lung cancer. For this reason, surgery is the preferred treatment for lung cancer, which has the detriment of being highly invasive. Non-conventional ultra-high dose rate (FLASH) radiotherapy is currently of great interest in the radiotherapy community due to demonstrations of reduced normal tissue toxicity in lung and other anatomy. This study investigates the effects of FLASH microbeam radiotherapy, which in addition to ultra-high dose rate incorporates a spatial segmentation of the radiation field, on the normal lung tissue of rats. With a focus on fibrotic damage, this work demonstrates that FLASH microbeam radiotherapy provides an order of magnitude increase in normal tissue radio-resistance compared to FLASH radiotherapy. This result suggests FLASH microbeam radiotherapy holds promise for much improved non-invasive control of lung cancer.

Multiscale pink-beam microCT imaging at the ESRF-ID17 biomedical beamline

Recent trends in hard X-ray micro-computed tomography (microCT) aim at increasing both spatial and temporal resolutions. These challenges require intense photon beams. Filtered synchrotron radiation beams, also referred to as `pink beams', which are emitted by wigglers or bending magnets, meet this need, owing to their broad energy range. In this work, the new microCT station installed at the biomedical beamline ID17 of the European Synchrotron is described and an overview of the preliminary results obtained for different biomedical-imaging applications is given. This new instrument expands the capabilities of the beamline towards sub-micrometre voxel size scale and simultaneous multi-resolution imaging. The current setup allows the acquisition of tomographic datasets more than one order of magnitude faster than with a monochromatic beam configuration.

Survival of rats bearing advanced intracerebral F 98 tumors after glutathione depletion and microbeam radiation therapy: conclusions from a pilot project

Background

Resistance to radiotherapy is frequently encountered in patients with glioblastoma multiforme. It is caused at least partially by the high glutathione content in the tumour tissue. Therefore, the administration of the glutathione synthesis inhibitor Buthionine-SR-Sulfoximine (BSO) should increase survival time.

Methods

BSO was tested in combination with an experimental synchrotron-based treatment, microbeam radiation therapy (MRT), characterized by spatially and periodically alternating microscopic dose distribution. One hundred thousand F98 glioma cells were injected into the right cerebral hemisphere of adult male Fischer rats to generate an orthotopic small animal model of a highly malignant brain tumour in a very advanced stage. Therapy was scheduled for day 13 after tumour cell implantation. At this time, 12.5% of the animals had already died from their disease.

The surviving 24 tumour-bearing animals were randomly distributed in three experimental groups: subjected to MRT alone (Group A), to MRT plus BSO (Group B) and tumour-bearing untreated controls (Group C). Thus, half of the irradiated animals received an injection of 100 μM BSO into the tumour two hours before radiotherapy.

Additional tumour-free animals, mirroring the treatment of the tumour-bearing animals, were included in the experiment. MRT was administered in bi-directional mode with arrays of quasi-parallel beams crossing at the tumour location. The width of the microbeams was ≈28 μm with a center-to-center distance of ≈400 μm, a peak dose of 350 Gy, and a valley dose of 9 Gy in the normal tissue and 18 Gy at the tumour location; thus, the peak to valley dose ratio (PVDR) was 31.

Results

After tumour-cell implantation, otherwise untreated rats had a mean survival time of 15 days. Twenty days after implantation, 62.5% of the animals receiving MRT alone (group A) and 75% of the rats given MRT + BSO (group B) were still alive. Thirty days after implantation, survival was 12.5% in Group A and 62.5% in Group B. There were no survivors on or beyond day 35 in Group A, but 25% were still alive in Group B. Thus, rats which underwent MRT with adjuvant BSO injection experienced the largest survival gain.

Conclusions

In this pilot project using an orthotopic small animal model of advanced malignant brain tumour, the injection of the glutathione inhibitor BSO with MRT significantly increased mean survival time.

Synchrotron-generated microbeams induce hippocampal transections in rats

Synchrotron-generated microplanar beams (microbeams) provide the most stereo-selective irradiation modality known today. This novel irradiation modality has been shown to control seizures originating from eloquent cortex causing no neurological deficit in experimental animals. To test the hypothesis that application of microbeams in the hippocampus, the most common source of refractory seizures, is safe and does not induce severe side effects, we used microbeams to induce transections to the hippocampus of healthy rats. An array of parallel microbeams carrying an incident dose of 600 Gy was delivered to the rat hippocampus. Immunohistochemistry of phosphorylated γ-H2AX showed cell death along the microbeam irradiation paths in rats 48 hours after irradiation. No evident behavioral or neurological deficits were observed during the 3-month period of observation. MR imaging showed no signs of radio-induced edema or radionecrosis 3 months after irradiation. Histological analysis showed a very well preserved hippocampal cytoarchitecture and confirmed the presence of clear-cut microscopic transections across the hippocampus. These data support the use of synchrotron-generated microbeams as a novel tool to slice the hippocampus of living rats in a minimally invasive way, providing (i) a novel experimental model to study hippocampal function and (ii) a new treatment tool for patients affected by refractory epilepsy induced by mesial temporal sclerosis.

Rat sensorimotor cortex tolerance to parallel transections induced by synchrotron-generated X-ray microbeams

Microbeam radiation therapy is a novel preclinical technique, which uses synchrotron-generated X-rays for the treatment of brain tumours and drug-resistant epilepsies. In order to safely translate this approach to humans, a more in-depth knowledge of the long-term radiobiology of microbeams in healthy tissues is required. We report here the result of the characterization of the rat sensorimotor cortex tolerance to microradiosurgical parallel transections. Healthy adult male Wistar rats underwent irradiation with arrays of parallel microbeams. Beam thickness, spacing and incident dose were 100 or 600 µm, 400 or 1200 µm and 360 or 150 Gy, respectively. Motor performance was carried over a 3-month period. Three months after irradiation rats were sacrificed to evaluate the effects of irradiation on brain tissues by histology and immunohistochemistry. Microbeam irradiation of sensorimotor cortex did not affect weight gain and motor performance. No gross signs of paralysis or paresis were also observed. The cortical architecture was not altered, despite the presence of cell death along the irradiation path. Reactive gliosis was evident in the microbeam path of rats irradiated with 150 Gy, whereas no increase was observed in rats irradiated with 360 Gy.

X-Tream quality assurance in synchrotron X-ray microbeam radiation therapy

Microbeam radiation therapy (MRT) is a novel irradiation technique for brain tumours treatment currently under development at the European Synchrotron Radiation Facility in Grenoble, France. The technique is based on the spatial fractionation of a highly brilliant synchrotron X-ray beam into an array of microbeams using a multi-slit collimator (MSC). After promising pre-clinical results, veterinary trials have recently commenced requiring the need for dedicated quality assurance (QA) procedures. The quality of MRT treatment demands reproducible and precise spatial fractionation of the incoming synchrotron beam. The intensity profile of the microbeams must also be quickly and quantitatively characterized prior to each treatment for comparison with that used for input to the dose-planning calculations. The Centre for Medical Radiation Physics (University of Wollongong, Australia) has developed an X-ray treatment monitoring system (X-Tream) which incorporates a high-spatial-resolution silicon strip detector (SSD) specifically designed for MRT. In-air measurements of the horizontal profile of the intrinsic microbeam X-ray field in order to determine the relative intensity of each microbeam are presented, and the alignment of the MSC is also assessed. The results show that the SSD is able to resolve individual microbeams which therefore provides invaluable QA of the horizontal field size and microbeam number and shape. They also demonstrate that the SSD used in the X-Tream system is very sensitive to any small misalignment of the MSC. In order to allow as rapid QA as possible, a fast alignment procedure of the SSD based on X-ray imaging with a low-intensity low-energy beam has been developed and is presented in this publication.

In-line phase-contrast breast tomosynthesis: a phantom feasibility study at a synchrotron radiation facility

The major objective is to adopt, apply and test developed in-house algorithms for volumetric breast reconstructions from projection images, obtained in in-line phase-contrast mode. Four angular sets, each consisting of 17 projection images obtained from four physical phantoms, were acquired at beamline ID17, European Synchroton Radiation Facility, Grenoble, France. The tomosynthesis arc was  ±32°. The physical phantoms differed in complexity of texture and introduced features of interest. Three of the used phantoms were in-house developed, and made of epoxy resin, polymethyl-methacrylate and paraffin wax, while the fourth phantom was the CIRS BR3D. The projection images had a pixel size of 47 µm  ×  47 µm. Tomosynthesis images were reconstructed with standard shift-and-add (SAA) and filtered backprojection (FBP) algorithms. It was found that the edge enhancement observed in planar x-ray images is preserved in tomosynthesis images from both phantoms with homogeneous and highly heterogeneous backgrounds. In case of BR3D, it was found that features not visible in the planar case were well outlined in the tomosynthesis slices. In addition, the edge enhancement index calculated for features of interest was found to be much higher in tomosynthesis images reconstructed with FBP than in planar images and tomosynthesis images reconstructed with SAA. The comparison between images reconstructed by the two reconstruction algorithms shows an advantage for the FBP method in terms of better edge enhancement. Phase-contrast breast tomosynthesis realized in in-line mode benefits the detection of suspicious areas in mammography images by adding the edge enhancement effect to the reconstructed slices.

The High Radiosensitizing Efficiency of a Trace of Gadolinium-Based Nanoparticles in Tumors

We recently developed the synthesis of ultrasmall gadolinium-based nanoparticles (GBN), (hydrodynamic diameter <5 nm) characterized by a safe behavior after intravenous injection (renal clearance, preferential accumulation in tumors). Owing to the presence of gadolinium ions, GBN can be used as contrast agents for magnetic resonance imaging (MRI) and as radiosensitizers. The attempt to determine the most opportune delay between the intravenous injection of GBN and the irradiation showed that a very low content of radiosensitizing nanoparticles in the tumor area is sufficient (0.1 μg/g of particles, i.e. 15 ppb of gadolinium) for an important increase of the therapeutic effect of irradiation. Such a promising and unexpected result is assigned to a suited distribution of GBN within the tumor, as revealed by the X-ray fluorescence (XRF) maps.

Minor changes in the macrocyclic ligands but major consequences on the efficiency of gold nanoparticles designed for radiosensitization

Many studies have been devoted to adapting the design of gold nanoparticles to efficiently exploit their promising capability to enhance the effects of radiotherapy. In particular, the addition of magnetic resonance imaging modality constitutes an attractive strategy for enhancing the selectivity of radiotherapy since it allows the determination of the most suited delay between the injection of nanoparticles and irradiation. This requires the functionalization of the gold core by an organic shell composed of thiolated gadolinium chelates. The risk of nephrogenic systemic fibrosis induced by the release of gadolinium ions should encourage the use of macrocyclic chelators which form highly stable and inert complexes with gadolinium ions. In this context, three types of gold nanoparticles (Au@DTDOTA, Au@TADOTA and Au@TADOTAGA) combining MRI, nuclear imaging and radiosensitization have been developed with different macrocyclic ligands anchored onto the gold cores. Despite similarities in size and organic shell composition, the distribution of gadolinium chelate-coated gold nanoparticles (Au@TADOTA-Gd and Au@TADOTAGA-Gd) in the tumor zone is clearly different. As a result, the intravenous injection of Au@TADOTAGA-Gd prior to the irradiation of 9L gliosarcoma bearing rats leads to the highest increase in lifespan whereas the radiophysical effects of Au@TADOTAGA-Gd and Au@TADOTA-Gd are very similar.

Energy spectra considerations for synchrotron radiotherapy trials on the ID17 bio-medical beamline at the European Synchrotron Radiation Facility

The aim of this study was to validate the kilovoltage X-ray energy spectrum on the ID17 beamline at the European Synchrotron Radiation Facility (ESRF). The purpose of such validation was to provide an accurate energy spectrum as the input to a computerized treatment planning system, which will be used in synchrotron microbeam radiotherapy trials at the ESRF. Calculated and measured energy spectra on ID17 have been reported previously but recent additions and safety modifications to the beamline for veterinary trials warranted a fresh investigation. The authors used an established methodology to compare X-ray attenuation measurements in copper sheets (referred to as half value layer measurements in the radiotherapy field) with the predictions of a theoretical model. A cylindrical ionization chamber in air was used to record the relative attenuation of the X-ray beam intensity by increasing thicknesses of high-purity copper sheets. The authors measured the half value layers in copper for two beamline configurations, which corresponded to differing spectral conditions. The authors obtained good agreement between the measured and predicted half value layers for the two beamline configurations. The measured first half value layer was 1.754 ± 0.035 mm Cu and 1.962 ± 0.039 mm Cu for the two spectral conditions, compared with theoretical predictions of 1.763 ± 0.039 mm Cu and 1.984 ± 0.044 mm Cu, respectively. The calculated mean energies for the two conditions were 105 keV and 110 keV and there was not a substantial difference in the calculated percentage depth dose curves in water between the different spectral conditions. The authors observed a difference between their calculated energy spectra and the spectra previously reported by other authors, particularly at energies greater than 100 keV. The validation of the beam spectrum by the copper half value layer measurements means the authors can provide an accurate spectrum as an input to a treatment planning system for the forthcoming veterinary trials of microbeam radiotherapy to spontaneous tumours in cats and dogs.

Simultaneous submicrometric 3D imaging of the micro-vascular network and the neuronal system in a mouse spinal cord

Faults in vascular (VN) and neuronal networks of spinal cord are responsible for serious neurodegenerative pathologies. Because of inadequate investigation tools, the lacking knowledge of the complete fine structure of VN and neuronal system represents a crucial problem. Conventional 2D imaging yields incomplete spatial coverage leading to possible data misinterpretation, whereas standard 3D computed tomography imaging achieves insufficient resolution and contrast. We show that X-ray high-resolution phase-contrast tomography allows the simultaneous visualization of three-dimensional VN and neuronal systems of ex-vivo mouse spinal cord at scales spanning from millimeters to hundreds of nanometers, with nor contrast agent nor sectioning and neither destructive sample-preparation. We image both the 3D distribution of micro-capillary network and the micrometric nerve fibers, axon-bundles and neuron soma. Our approach is very suitable for pre-clinical investigation of neurodegenerative pathologies and spinal-cord-injuries, in particular to resolve the entangled relationship between VN and neuronal system.

Synchrotron-based photon activation therapy effect on cisplatin pre-treated human glioma stem cells

BACKGROUND

Glioblastoma multiforme (GBM) is one of the deadliest cancers characterized by very limited sensitivity to chemo- and/or radiotherapy. The presence of GBM stem-like cells in the tumor might be relevant for GBM treatment resistance.

AIM

To provide a proof-of-concept of the efficacy of photon activation therapy (PAT) using monochromatic synchrotron radiation (SR), in killing GBM stem cells pre-treated with cisplatin.

MATERIALS AND METHODS

Irradiation was performed using a 1-8 Gy dose range and energies just above or below the platinum K-shell edge (78.39 keV) or with a conventional X-ray source. Cells were exposed to drug concentrations allowing 90% cell survival, mimicking the unfavourable tissue distribution generally achieved in GMB patients.

RESULTS

a significant enhancement in cell lethality was observed using SR compared to conventional X-ray irradiation.

CONCLUSION

PAT deserved to be further explored in in vivo models based on GBM stem-like cells.

Synergistic effect of cisplatin and synchrotron irradiation on F98 gliomas growing in nude mice

Among brain tumors, glioblastoma multiforme appears as one of the most aggressive forms of cancer with poor prognosis and no curative treatment available. Recently, a new kind of radio-chemotherapy has been developed using synchrotron irradiation for the photoactivation of molecules with high-Z elements such as cisplatin (PAT-Plat). This protocol showed a cure of 33% of rats bearing the F98 glioma but the efficiency of the treatment was only measured in terms of overall survival. Here, characterization of the effects of the PAT-Plat on tumor volume and tumor blood perfusion are proposed. Changes in these parameters may predict the overall survival. Firstly, changes in tumor growth of the F98 glioma implanted in the hindlimb of nude mice after the PAT-Plat treatment and its different modalities have been characterized. Secondly, the effects of the treatment on tumor blood perfusion have been observed by intravital two-photon microscopy. Cisplatin alone had no detectable effect on the tumor volume. A reduction of tumor growth was measured after a 15 Gy synchrotron irradiation, but the whole therapy (15 Gy irradiation + cisplatin) showed the largest decrease in tumor growth, indicating a synergistic effect of both synchrotron irradiation and cisplatin treatment. A high number of unperfused vessels (52%) were observed in the peritumoral area in comparison with untreated controls. In the PAT-Plat protocol the transient tumor growth reduction may be due to synergistic interactions of tumor-cell-killing effects and reduction of the tumor blood perfusion.

The effect of Photon Activation Therapy on cisplatin pre-treated human tumour cell lines: comparison with conventional X-ray irradiation

Cisplatin is an antineoplastic drug widely used for the treatment of several solid tumours. However, the side effects related to cisplatin-based anticancer therapy often outweigh the benefits. Therefore, the identification of new anticancer strategies able to offer a better toxicity profile while maintaining the same level of efficacy as platinum-based treatments would be highly desirable. We assessed the efficacy of synchrotron radiation in triggering the Auger effect in human A549 non-small cell lung cancer and IGROV-1 ovarian cancer cells pre-treated with cisplatin. Cisplatin was chosen as the carrier of platinum atoms in the cells because of its alkylating-like activity and the irradiation was done with monochromatic beams above and below the platinum K-shell edge (78.39 keV). On cisplatin-treated cells, at concentrations allowing 80 percent of cell survival with respect to controls, no differences were observed in cell viability when they were irradiated either above or below the K-shell edge of platinum, suggesting that cisplatin toxicity can mask the enhancement of cell death induced by the irradiation. At lower cisplatin concentrations allowing 95-90 percent of cell survival, an enhancement in cellular death with respect to conventional irradiation conditions was clearly observed in all cancer types when cells were irradiated with beams either above or below the platinum K-shell edge. Our results lend additional support to the suggestion that the Photon Activation Therapy in combination with cisplatin treatment should be further explored in relevant in vivo models of glioma and non-glioma cancer models.

Pencilbeam irradiation technique for whole brain radiotherapy: technical and biological challenges in a small animal model

We have conducted the first in-vivo experiments in pencilbeam irradiation, a new synchrotron radiation technique based on the principle of microbeam irradiation, a concept of spatially fractionated high-dose irradiation. In an animal model of adult C57 BL/6J mice we have determined technical and physiological limitations with the present technical setup of the technique. Fifty-eight animals were distributed in eleven experimental groups, ten groups receiving whole brain radiotherapy with arrays of 50 µm wide beams. We have tested peak doses ranging between 172 Gy and 2,298 Gy at 3 mm depth. Animals in five groups received whole brain radiotherapy with a center-to-center (ctc) distance of 200 µm and a peak-to-valley ratio (PVDR) of ∼ 100, in the other five groups the ctc was 400 µm (PVDR ∼ 400). Motor and memory abilities were assessed during a six months observation period following irradiation. The lower dose limit, determined by the technical equipment, was at 172 Gy. The LD50 was about 1,164 Gy for a ctc of 200 µm and higher than 2,298 Gy for a ctc of 400 µm. Age-dependent loss in motor and memory performance was seen in all groups. Better overall performance (close to that of healthy controls) was seen in the groups irradiated with a ctc of 400 µm.

Dual energy CT at the synchrotron: a piglet model for neurovascular research

BACKGROUND

Although the quality of imaging techniques available for neurovascular angiography in the hospital environment has significantly improved over the last decades, the equipment used for clinical work is not always suited for neurovascular research in animal models. We have previously investigated the suitability of synchrotron-based K-edge digital subtraction angiography (KEDSA) after intravenous injection of iodinated contrast agent for neurovascular angiography in radiography mode in both rabbit and pig models. We now have used the KEDSA technique for the acquisition of three-dimensional images and dual energy CT.

MATERIALS AND METHODS

All experiments were conducted at the biomedical beamline ID 17 of the European Synchrotron Radiation Facility (ESRF). A solid state germanium (Ge) detector was used for the acquisition of image pairs at 33.0 and 33.3 keV. Three-dimensional images were reconstructed from an image series containing 60 single images taken throughout a full rotation of 360°. CT images were reconstructed from two half-acquisitions with 720 projections each.

RESULTS

The small detector field of view was a limiting factor in our experiments. Nevertheless, we were able to show that dual energy CT using the KEDSA technique available at ID 17 is suitable for neurovascular research in animal models.

Life sciences: microorganisms in the space environment

Preliminary results of the Spacelab 1 experiment on the response of Bacillus subtilis spores to conditions of free space are presented. Exposure to the vacuum of space on the Spacelab pallet reduced viability counts about 50 percent and increased mutation frequencies by a factor of about 10. Interpretation of apparent differences in the photobiological and photochemical data between flight and ground simulation experiments will require more statistical analyses and data from actual fluence measurements.

Short-term effects of synchrotron irradiation on vasculature and tissue in healthy mouse brain

The purpose of this study is to measure the effects of a tomographic synchrotron irradiation on healthy mouse brain. The cerebral cortexes of healthy nude mice were irradiated with a monochromatic synchrotron beam of 79 keV at a dose of 15 Gy in accordance with a protocol of photoactivation of cisplatin previously tested in our laboratory. Forty-eight hours, one week and one month after irradiation, the blood brain barrier (BBB) permeability was measured in the irradiated area with intravital multiphoton microscopy using fluorescent dyes with molecular weights of 4 and 70 kDa. Vascular parameters and gliosis were also assessed using quantitative immunohistochemistry. No extravasation of the fluorescent dyes was observed in the irradiated area at any measurement time (48 h, 1 week, 1 month). It appears that the BBB remains impermeable to molecules with a molecular weight of 4 kDa and above. The vascular density and vascular surface were unaffected by irradiation and no gliosis was induced. These findings suggest that a 15 Gy/79 keV synchrotron irradiation does not induce important damage on brain vasculature and tissue on the short term following irradiation.

New technology enables high precision multislit collimators for microbeam radiation therapy

During the past decade microbeam radiation therapy has evolved from preclinical studies to a stage in which clinical trials can be planned, using spatially fractionated, highly collimated and high intensity beams like those generated at the x-ray ID17 beamline of the European Synchrotron Radiation Facility. The production of such microbeams typically between 25 and 100 microm full width at half maximum (FWHM) values and 100-400 microm center-to-center (c-t-c) spacings requires a multislit collimator either with fixed or adjustable microbeam width. The mechanical regularity of such devices is the most important property required to produce an array of identical microbeams. That ensures treatment reproducibility and reliable use of Monte Carlo-based treatment planning systems. New high precision wire cutting techniques allow the fabrication of these collimators made of tungsten carbide. We present a variable slit width collimator as well as a single slit device with a fixed setting of 50 microm FWHM and 400 microm c-t-c, both able to cover irradiation fields of 50 mm width, deemed to meet clinical requirements. Important improvements have reduced the standard deviation of 5.5 microm to less than 1 microm for a nominal FWHM value of 25 microm. The specifications of both devices, the methods used to measure these characteristics, and the results are presented.

Synchrotron-based intra-venous K-edge digital subtraction angiography in a pig model: a feasibility study

BACKGROUND

K-edge digital subtraction angiography (KEDSA) combined with the tunability of synchrotron beam yields an imaging technique that is highly sensitive to low concentrations of contrast agents. Thus, contrast agent can be administered intravenously, obviating the need for insertion of a guided catheter to deliver a bolus of contrast agent close to the target tissue. With the high-resolution detectors used at synchrotron facilities, images can be acquired at high spatial resolution. Thus, the KEDSA appears particularly suited for studies of neurovascular pathology in animal models, where the vascular diameters are significantly smaller than in human patients.

MATERIALS AND METHODS

This feasibility study was designed to test the suitability of KEDSA after intravenous injection of iodine-based contrast agent for use in a pig model. Four adult male pigs were used for our experiments. Neurovascular angiographic images were acquired using KEDSA with a solid state Germanium (Ge) detector at the European Synchrotron Radiation Facility (ESRF) in Grenoble, France.

RESULTS

After intravenous injection of 0.9 ml/kg iodinated contrast agent (Xenetix), the peak iodine concentrations in the internal carotid and middle cerebral arteries reached 35 mg/ml. KEDSA images in radiography mode allowed the visualization of intracranial arteries of less than 1.5mm diameter.

Energy calibration of a high-resolution inelastic x-ray scattering spectrometer

The energy scale of a triple-axis x-ray spectrometer with meV energy resolution based on perfect silicon crystal optics is calibrated, utilizing the most recent determination of the silicon lattice parameter and its thermal expansion coefficient and recording the dispersion of longitudinal acoustic and optical phonons in a diamond single crystal and the molecular vibration mode in liquid nitrogen. Comparison of the x-ray results with previous inelastic neutron and Raman scattering results as well as with ab initio phonon dispersion calculations yields an overall agreement better than 2%.

Technology solutions for better outcomes: integrated information management in key to productivity increases in medicine

The challenges to healthcare systems around the world are primarily impacted by two topics: demographic factors and progress in medicine. An ageing population inherently needs more medical services which add financial burdens, in particular, to public healthcare. Since the level of medical education is growing at the same time, we are observing an increased demand for sophisticated (in general expensive) medicine. Drastic changes in financing seem unavoidable. Multiple diagnoses, repeated examinations, trial-and-error, overcapacities and other signs of missing economical considerations are reinforced by reimbursement systems. In a world where, in principle, all information is available everywhere, more than a patient's history should be accessible. Other industries have knowledge management systems in place that make state-of-the-art expertise available everywhere. Intelligent patient databases could consist of learning cycles that (i) enable the individual to benefit from structured knowledge, in addition to personal experience of the physician, and (ii) use the knowledge generated from the individual to extend the database. The novel area of molecular medicine fits perfectly well into these scenarios. Only attached to an IT backbone can the flood of information be managed in a beneficial way. Efficiency improvements in healthcare address the needs of all parties in the system: patients, providers, and payers. The opportunities, however, can only materialize if everyone is prepared to change. IT will set the standards for the biggest challenge in healthcare: The paradigm shift in medicine.

Phonon modes at the 2H-NbSe2 surface observed by grazing incidence inelastic x-ray scattering

We have determined the dispersion of acoustic and optical surface phonon modes 2H-NbSe2 at the by inelastic x-ray scattering under grazing incidence conditions. Already, at room temperature, an anomaly is observed close to the charge density wave -vector position located at about one-third along the Gamma-M direction of the Brillouin zone. Our results indicate that the anomaly for the surface mode occurs at a lower energy than that measured in bulk sensitive geometry in the same experiment, showing evidence of a modified behavior in the uppermost layers. We demonstrate that inelastic x-ray scattering in grazing incidence conditions provides a unique tool to selectively study either surface or bulk lattice dynamics in a single experiment.

New irradiation geometry for microbeam radiation therapy

Microbeam radiation therapy (MRT) has the potential to treat infantile brain tumours when other kinds of radiotherapy would be excessively toxic to the developing normal brain. MRT uses extraordinarily high doses of x-rays but provides unusual resistance to radioneurotoxicity, presumably from the migration of endothelial cells from 'valleys' into 'peaks', i.e., into directly irradiated microslices of tissues. We present a novel irradiation geometry which results in a tolerable valley dose for the normal tissue and a decreased peak-to-valley dose ratio (PVDR) in the tumour area by applying an innovative cross-firing technique. We propose an MRT technique to orthogonally crossfire two arrays of parallel, nonintersecting, mutually interspersed microbeams that produces tumouricidal doses with small PVDRs where the arrays meet and tolerable radiation doses to normal tissues between the microbeams proximal and distal to the tumour in the paths of the arrays.

Elasticity of cobalt at high pressure studied by inelastic x-ray scattering

The five independent elastic moduli of single-crystalline hcp cobalt were determined by inelastic x-ray scattering to 39 GPa and compared to ultrasonic measurements and first principles calculations. In general the agreement is good, in particular, for the evolution of the longitudinal sound velocity in the a-c plane. This confirms the calculations, suggesting that a similar evolution is valid for hcp iron, the main constituent of the Earth's inner core, up to the highest investigated pressure. Our results represent an important benchmark to further refine ab initio calculations.

Sliding-induced decoupling and charge transfer between the coexisting Q1 and Q2 charge density waves in NbSe3

Using high-resolution x-ray scattering in the presence of an applied current, we report evidence for a dynamical decoupling between the two NbSe3 charge-density waves (CDWs), Q1 (T(C1)=145 K) and Q2 (T(C2)=59 K), coexisting below T(C2). Simultaneous and oppositely directed shifts of the relevant CDW superlattice spots develop above a threshold current which we identify as the depinning threshold I(C1) for the more strongly pinned upper CDW Q1 (I(C1) approximately 10I(C2)). In contrast with shifts induced by current conversion processes, the present effect is not current polarized and is not limited to the current-contact regions. We propose a model which explains this instability through a sliding-induced charge transfer between the two electronic reservoirs corresponding to the Q1 and Q2 CDWs.

Phonon dispersion in graphite

We measured the dispersion of the graphite optical phonons in the in-plane Brillouin zone by inelastic x-ray scattering. The longitudinal and transverse optical branches cross along the Gamma-K as well as the Gamma-M direction. The dispersion of the optical phonons was, in general, stronger than expected from the literature. At the K point the transverse optical mode has a minimum and is only approximately 70 cm(-1) higher in frequency than the longitudinal mode. We show that first-principles calculations describe very well the vibrational properties of graphene once the long-range character of the dynamical matrix is taken into account.

Motional ordering of a charge-density wave in the sliding state

We have used high-resolution x-ray scattering, in the presence of an applied direct current, for studying the correlation lengths in the sliding charge-density wave (CDW) state. Transport properties were simultaneously measured in situ during the experiment. We find that, while the transverse correlation is reduced when the CDW moves, the CDW becomes more ordered in the direction of motion. This is the first report of a motional ordering process in a periodic system other than a vortex lattice.

Sound velocities in iron to 110 gigapascals

The dispersion of longitudinal acoustic phonons was measured by inelastic x-ray scattering in the hexagonal closed-packed (hcp) structure of iron from 19 to 110 gigapascals. Phonon dispersion curves were recorded on polycrystalline iron compressed in a diamond anvil cell, revealing an increase of the longitudinal wave velocity (VP) from 7000 to 8800 meters per second. We show that hcp iron follows a Birch law for VP, which is used to extrapolate velocities to inner core conditions. Extrapolated longitudinal acoustic wave velocities compared with seismic data suggest an inner core that is 4 to 5% lighter than hcp iron.

In vitro delineation of human brain-stem anatomy using a small resonator: correlation with macroscopic and histological findings

Our purpose was to investigate the potential of an experimental animal coil using a commercial MRI unit to delineate the anatomical structure of the human brain stem. Three formaldehyde-fixed brain-stem specimens were examined by MRI and sectioned perpendicular to their longitudinal axis. The images were compared with gross anatomy and myelin-stained histological sections. Fibre tracts and nuclei which were not evident on examination of the unstained specimen were readily identified by MRI. Due to its inherent grey/white matter contrast, MRI with a high-resolution coil delineates anatomical structures in a way comparable to the myelin-stained histological sections. However, pigmented structures, readily visible on examination of the unstained specimen were discernible on neither MRI nor on myelin-stained sections. The excellent anatomical detail and grey/white matter contrast provided by these images could make MRI a useful adjunct to the pathologist investigating brain disease.

[Theoretical principles and technical realization of high resolution nuclear magnetic resonance tomography with the example of a dedicated coil system]

The theory of high-resolution magnetic resonance imaging (MRI) and the physical properties of a dedicated coil system with its clinical application are reviewed. To evaluate the spatial resolution of the system, a phantom sample was depicted by a transverse T1-weighted sequence (time of repetition 500 ms, time of echo 25 ms, 256 x 256 matrix, 3 acquisitions, field of view 25 mm2). Relative signal intensity decrease was less using the 5-cm coil, as signal intensity field distribution depends on coil diameter. The phantom appeared as an attainable resolution of 100-microns pixel width using the 2.5-cm coil. For the 5-cm coil the pixel width was 200 microns, not accomplishing clear resolution of the phantom. Coil head choice depends on the anatomic depth of the target organ. Work-up of the skin and musculoskeletal lesions is the main indication for high-resolution MRI using surface coils.

Applications of specialized coils for high-resolution MRI on a whole-body scanner

To investigate the application of a mini-coil surface system for high-resolution MRI, 60 volunteers were examined in a 1.5-T whole-body scanner. Two replaceable probe heads were available: a circular 2.5-cm coil and a quadratic 5-cm coil, both of which were placed directly on the skin. The skin layers, Achilles tendon and finger joints were examined with the 2.5-cm coil and a FOV of 25 X 25 mm2. A matrix of 256 pixels resulted in a pixel size of 0.098 X 0.098 mm2. For imaging of the carpal tunnel, the 5-cm coil was used in transverse orientation. The FOV was 50 X 50 mm2 so that a matrix of 256 X 256 pixels led to a pixel size of 0.195 X 0.195 mm2. The resulting spatial resolution permitted visualization of the epidermis, dermis and subcutis, resulting in clear definition of anatomical detail of the musculoskeletal system. MRI measurement of skin-layer thickness did not correlate with histometric data (p < 0.05). This discrepancy was due in part to shrinkage of the tumor specimen on histologic preparation. Other causes include the motion artifacts and the limited accuracy of determining thickness on the MRI display unit.

[MRT of the eye: the normal anatomy and detection of the smallest lesions with a high-resolution surface coil]

PURPOSE

A new, high-resolution surface coil for MRI of the eye was evaluated with regard to practicability, image quality and sensitivity for small lesions.

MATERIAL AND METHODS

48 patients in whom a space-occupying lesion of the eye or orbit was suspected were examined (1.5 T tomograph, 5 cm surface coil, T1- and T2-weighted spin-echo sequences, the former before and after i.v. gadolinium DTPA).

RESULTS

45/48 patients tolerated MR with the high-resolution surface coil. No adverse effects were experienced by the patients. In 11/48 patients a space occupying lesion of the eye was detected (melanoma, 5; metastases, 2; haemorrhage, 1; malformation, hamartoma and scarring after melanoma, one each). The smallest detectable lesion had a thickness of < 1 mm.

CONCLUSION

First experiences with the high-resolution surface coil indicate that this device is suited for detection of very small lesions of the eye.

Prototype breast coil for MR-guided needle localization

OBJECTIVE

Evaluation of breast lesions detected by MR alone is a problem: Preoperative MR-guided localization is difficult, since the breast is not accessible by a needle within the breast coil. Magnetic resonance-guided core biopsy and needle aspiration are impossible. Together with Siemens Erlangen, a prototype localization breast coil has been developed and tested.

MATERIALS AND METHODS

The device consists of a circular polarized coil, which contains two plates for mediolateral breast compression. They are perforated with numerous holes and thus allow access to the breast from both sides. By means of bushings, which fit into the holes, sterile needle insertion in a horizontal path is possible.

RESULTS

So far, precise needle insertion has been possible in 10 of 11 lesions, allowing exact needle insertion into 5 invasive carcinomas (1 MR-detected), 1 MR-detected additional focus, 2 in situ carcinomas (1 MR-detected), and 3 benign lesions.

CONCLUSION

Our studies show that MR-guided needle localization is possible.

[Indications for the application of a high resolution coil in MR tomography]

This is the first study with high spatial resolution Magnetic Resonance Imaging (MRI), performed with a high resolution coil in a clinical whole-body system. Measurements were recorded with a slice thickness of 2 mm. A 256 x 256 matrix and a 2.5 cm field of view were used resulting in a pixel size of 0.01 mm2. MR images of the skin, hand, wrist, knee and ankle of 14 healthy volunteers, of three anatomic pathology tissue specimens and of three formalin-fixed specimens were obtained. Normal anatomy was identified and compared with the three gross anatomic pathology sections. The skin, hands, wrists and ankles of 30 patients were examined and a variety of pathological lesions were detected, including cutaneous neoplasms and ulceration, acute and chronic tendon lesions and pathologic features of the bone and wrist. Based on the excellent imaging of anatomic detail and superior contrast resolution, high resolution MRI proved an important complement for preoperative diagnosis.

A new holder and surface MRI coil for the examination of the newborn infant hip

A special holder was developed for examination of the infant hip joint using MRI. This holder allows the infant hip joint to be examined both in a neutral position and in various defined functional positions. A special integrated surface coil, also developed for this purpose, provides the high spatial resolution required for assessment of the fine joint structures. Thirty infants were examined and the new device has proved useful in advanced hip dysplasia, therapy-resistant subluxation and luxation, and for operative therapy planning (reconstruction of the acetabular roof, redirectional osteotomies). Interpretation errors due to misprojection can be eliminated to a large extent since the holder allows standardized and reproducible positioning.

MR imaging of experimental meningeal melanomatosis in nude rats

MR imaging of the rat brain has become an increasingly frequently used method in experimental neuroradiology. On a generally available 1.5 T whole body tomograph, supplemented with an individually made small coil and a special SE sequence we obtained fairly fine images of the structures of the rat brain. With gadolinium-DTPA, we were able to visualize posterior fossa and cervical leptomeningeal growth of intrathecally injected B16 melanoma in nude rats. Using MRI to follow experimental leptomeningeal metastasis, may provide a new means for diagnostic evaluation and preclinical testing of treatment modalities.

Switched array coils

Switched array coils (SACs) are a useful tool in local coil imaging since they allow in a user-friendly manner one to make the best choice in the trade-off between field of view and signal-to-noise ratio. This is done by selecting the current path within a conductor array equipped with suitable switches. Since the switching can be controlled by the system, this allows changing of the coil dimensions within multislice sequences. Thus image quality can be improved due to smaller coil dimensions for a given slice and a larger area can be covered by electronically shifting this sensitive area. The principle can be applied to surface--as well as volume--coil designs.

[A simplified technic in high-resolution MR tomography of the shoulder: ZEPRA (Zoom of Eccentric Positioned Regions by active Aliasing)]

A fairly easy method for high-resolution MR imaging of the shoulder is described. The combination of a defined arrangement of the gradients with a small-volume Helmholtz coil provides the possibility of a high zoom of structures apart from the magnet's centre. The maximal achievable zoom factor depends on the ratio of FOV/sensitive coil volume. The ZEPRA method acts by phase-encoded aliasing only. With this technique all interesting soft tissue of the shoulder may readily be visualized in every direction and with every type of sequence.