Three-Dimensional Dosimetry by Optical-CT and Radiochromic Gel Dosimeter of a Multiple Isocenter Craniospinal Radiation Therapy Procedure

Craniospinal irradiation (CSI) is a complex radiation technique employed to treat patients with primitive neuroectodermal tumors such as medulloblastoma or germinative brain tumors with the risk of leptomeningeal spread. In adults, this technique poses a technically challenging planning process because of the complex shape and length of the target volume. Thus, it requires multiple fields and different isocenters to guarantee the primary-tumor dose delivery. Recently, some authors have proposed the use IMRT technique for this planning with the possibility of overlapping adjacent fields. The high-dose delivery complexity demands three-dimensional dosimetry (3DD) to verify this irradiation procedure and motivated this study. We used an optical CT and a radiochromic Fricke-xylenol-orange gel with the addition of formaldehyde (FXO-f) to evaluate the doses delivered at the field junction region of this treatment. We found 96.91% as the mean passing rate using the gamma analysis with 3%/2 mm criteria at the junction region. However, the concentration of fail points in a determined region called attention to this evaluation, indicating the advantages of employing a 3DD technique in complex dose-distribution verifications.

14-weeks combined exercise epigenetically modulated 118 genes of menopausal women with prediabetes

BACKGROUND

Pre-diabetes precedes Diabetes Mellitus (DM) disease and is a critical period for hyperglycemia treatment, especially for menopausal women, considering all metabolic alterations due to hormonal changes. Recently, the literature has demonstrated the role of physical exercise in epigenetic reprogramming to modulate the gene expression patterns of metabolic conditions, such as hyperglycemia, and prevent DM development. In the present study, we hypothesized that physical exercise training could modify the epigenetic patterns of women with poor glycemic control.

METHODS

48 post-menopause women aged 60.3 ± 4.5 years were divided according to their fasting blood glucose levels into two groups: Prediabetes Group, PG (n=24), and Normal Glucose Group, NGG (n=24). All participants performed 14 weeks of physical exercise three times a week. The Infinium Methylation EPIC BeadChip measured the participants' Different Methylated Regions (DMRs).

RESULTS

Before the intervention, the PG group had 12 DMRs compared to NGG. After the intervention, five DMRs remained different. Interestingly, when comparing the PG group before and after training, 118 DMRs were found. The enrichment analysis revealed that the genes were related to different biological functions such as energy metabolism, cell differentiation, and tumor suppression.

CONCLUSION

Physical exercise is a relevant alternative in treating hyperglycemia and preventing DM in post-menopause women with poor glycemic control.

Patient-specific IMRT QA verification using machine learning and gamma radiomics

Gamma function is the standard methodology for comparing dose distributions. It is calculated in dedicated software, and its results verification is not performed. Thus we developed an automatic tool for patient-specific QA results verification through high accuracy machine learning (ML) models based on the radiomics characteristics extraction from gamma images. We used 158 patient-specific QA tests and extracted 105 radiomics features from each gamma image. Three random forest models were developed (ML I, ML II, and ML III). ML I and ML II verified the gamma image approval using criteria of 2%/2mm/15% threshold and 3%/3mm/15% threshold, respectively. ML III verified if the gamma analyzes software recommended protocol was followed to detect if the TPS grid modification step was done. The models were based on the most important features selected using the mean decreased impurity, and their performances were evaluated. ML I included 25 features. Its accuracy was 0.85 using the test set and 0.84 using dataset B. ML II included 10 features, and its accuracy with the test set was 0.98; the same value was achieved using the never seen data (dataset B). The First-order 10th percentile feature was identified as a feature strongly related to the approved classification. ML III selected 23 features with an accuracy of 0.99 for test set and 0.98 for dataset B. An automatic workflow example for gamma analyses QA results verification could be proposed combining the models to detect grid inconsistencies on software evaluation, followed by the test approval classification.

The risk of induced cancer and ischemic heart disease following low dose lung irradiation for COVID-19: estimation based on a virtual case

Background

Recently, low dose radiotherapy delivered to the whole lung has been proposed as treatment for the pneumonia due to COVID-19. Although there is biological plausibility for its use, the evidence supporting its effectiveness is scarce, and the risks associated with it may be significant. Thus, based on a virtual case simulation, we estimated the risks of radiation-induced cancer (RIC) and cardiac disease.

Methods

Lifetime attributable risks (LAR) of RIC were calculated for the lung, liver, esophagus, and breast of female patients. The cardiovascular risk of exposure-induced death (REID) due to ischemic heart disease was also calculated. The doses received by the organs involved in the treatment were obtained from a simulation of conformal radiotherapy (RT) treatment, delivering a dose of 0.5 Gy–1.5 Gy to the lungs. We considered a LAR and REID <1% as acceptable, 1–2% cautionary, and >2% unacceptable.

Results

The lung was at the highest risk for RIC (absolute LAR below 5200 cases/100,000 and 2250 cases/100,000 for women and men, respectively). For women, the breast had the second-highest LAR, especially for young women. The liver and esophagus had LARs below 700/100,000 for both sexes, with a higher incidence of esophageal cancer in women and liver cancer in men. Regarding the LAR cutoff, we observed an unacceptable or cautionary LAR for lung cancer in all women and men <60 years with an RT dose >1 Gy. LAR for lung cancer with an RT dose of 1 Gy was cautionary for women >60 years of age and men <40 years of age. No LAR estimation was unacceptable for the RT dose ≤0.7 Gy in all groups irrespective of sex or age at exposure. Only 0.5 Gy had an acceptable REID.

Conclusions

A RT dose ≤0.5 Gy provides an acceptable LAR estimate (≤1%) for RIC and REID, irrespective of sex and age. The current ongoing trials should initially use doses ≤0.5 Gy to maintain the risks at an acceptable level and include only patients who fail or do not have any other treatment option.

Comparison between shear wave dispersion magneto motive ultrasound and transient elastography for measuring tissue-mimicking phantom viscoelasticity

Several methods have been developed over the last several years to analyze the mechanical properties of soft tissue. Elastography, for example, was proposed to evaluate soft tissue stiffness in an attempt to reduce the need for invasive procedures, such as breast biopsies; however, its qualitative nature and the fact that it is operator-dependent have proven to be limitations of the technique. Quantitative shearwave- based techniques have been proposed to obtain information about tissue stiffness independent of the operator. This paper describes shear wave dispersion magnetomotive ultrasound (SDMMUS), a new shear-wave-based method in which a viscoelastic medium labeled with iron oxide nanoparticles is displaced by an external tone burst magnetic field. As in magnetomotive ultrasound (MMUS), SDMMUS uses ultrasound to detect internal mechanical vibrations induced by the interaction between a magnetic field and magnetic nanoparticles. These vibrations generated shear waves that were evaluated to estimate the viscoelastic properties of tissue-mimicking phantoms. These phantoms were manufactured with different concentrations of gelatin and labeled with iron oxide nanoparticles. The elasticity and viscosity obtained with SDMMUS agreed well with the results obtained by traditional ultrasound-based transient elastography.

Versatile magnetometer assembly for characterizing magnetic properties of nanoparticles

We constructed a versatile magnetometer assembly for characterizing iron oxide nanoparticles. The magnetometer can be operated at room temperature or inside a cryocooler at temperatures as low as 6 K. The magnetometer's sensor can be easily exchanged and different detection electronics can be used. We tested the assembly with a non-cryogenic commercial Hall sensor and a benchtop multimeter in a four-wire resistance measurement scheme. A magnetic moment sensitivity of 8.5 × 10(-8) Am(2) was obtained with this configuration. To illustrate the capability of the assembly, we synthesized iron oxide nanoparticles coated with different amounts of a triblock copolymer, Pluronic F-127, and characterized their magnetic properties. We determined that the polymer coating does not affect the magnetization of the particles at room temperature and demonstrates that it is possible to estimate the average size of coating layers from measurements of the magnetic field of the sample.

A hybrid transducer to magnetically and ultrasonically evaluate magnetic fluids

Ultrasound, magnetic fields, and optical techniques have been explored for clinical diagnosis and therapy. However, these techniques have limitations. In this study, we constructed and characterized a transducer to magnetically and ultrasonically investigate samples labeled with magnetic particles. The transducer is a hybrid system consisting of an ac biosusceptometer (ACB) and an ultrasonic transducer. The basic operation principle consisted of measuring the magnetization and microvibrations of ferromagnetic particles (37 and 70 μm) mixed in yogurt and excited by an external alternating magnetic field generated by the ACB's excitation coils. The vibration of the ferromagnetic particles was measured in phantoms using a Doppler ultrasonic transducer; we verified the sensitivity to detecting the vibrations at low concentrations of ferromagnetic material (~1%). The responses of the susceptometer and Doppler ultrasound linearly depended on the voltage level applied to the magnetizing coils at low ferromagnetic particle concentrations (⩽ 5%). We also conducted a repeatability test on the prototype, which indicated a deviation of 0.94% and 0.25% in the Doppler and susceptometric measurements, respectively. We can conclude that the hybrid transducer technique has potential clinical applications.

Hybrid system for magnetic and acoustic measurement

In order to improve the spatial resolution of Biosusceptometry of Alternate Current (BAC), we are suggesting the coupling of a Doppler ultrasonic transducer with the BAC system. The Doppler transducer obtains information from the vibration of ferromagnetic particles immersed in a visco-elastic medium when it is excited by an alternating magnetic field. In this case, the same magnetic particles used as contrast for susceptometric measurement also will work as contrast for the Doppler measurement. In this work, we present the characterization of the hybrid system for susceptometric and acoustic measurements simultaneously. It was observed that the susceptometric and Doppler ultrasound signal have the same profile and maximum amplitude for frequency of magnetizing field about 200 Hz. When using ferrite particles as magnetic contrast mixed with yogurt as based material, the susceptometric and Doppler measurement have sensitivity for concentration of particles as low as 1%. The sensitivity of the Doppler is dependent of the gradient of magnetic field over the sample. In this work, the magnetic field 5 cm far from the face of the transducer was 70 microT/volts.

Detection of reentry currents in atrial flutter by magnetocardiography

We discuss the use of magnetocardiography to detect reentry currents in cardiac flutter and fibrillation. The magnetic field produced by induced atrial flutter was measured in isolated rabbit hearts. A moving dipole model is proposed to treat the experimental data and to locate the reentry path.

Magnetic localisation of a current dipole implanted in dogs

In order to evaluate the difficulty in localising a current dipole due to volume conductor current contributions to the magnetocardiogram, accuracy of depth localisation of a commercial coaxial pacemaker cable, used as a current dipole, was studied in two experimental situations: immersed in a prismatic container with NaCl solution and introduced into the lower oesophagus of dogs. Isofield contour maps were obtained by interpolation of the magnetic field measured over a plane and perpendicular to it with a third-order gradiometer coupled to a SQUID. The dipole can be accurately localised in the prismatic container. The observation of an isofield map that is symmetric about the maximum-minimum axis when the dogs are in the dorsal decubitus position with the dipole in the cephalocaudal direction implies that internal inhomogeneities in the dog's volume conductor produce no appreciable effect on the magnetic field. Nevertheless, a large distortion of the magnetic field lines is observed and can be explained by calculations using models that take into account the external boundary of the volume conductor.