Assessment and validation of glottic motion using cone-beam CT and real-time cine MRI

PURPOSE

This study aimed to assess the margin for the planning target volume (PTV) using the Van Herk formula. We then validated the proposed margin by real-time magnetic resonance imaging (MRI).

METHODS

An analysis of cone-beam computed tomography (CBCT) data from early glottic cancer patients was performed to evaluate organ motion. Deformed clinical target volumes (CTV) after rigid registration were acquired using the Velocity program (Varian Medical Systems, Palo Alto, CA, USA). Systematic (Σ) and random errors (σ) were evaluated. The margin for the PTV was defined as 2.5 Σ + 0.7 σ according to the Van Herk formula. To validate this margin, we accrued healthy volunteers. Sagittal real-time cine MRI was conducted using the ViewRay system (ViewRay Inc., Oakwood Village, OH, USA). Within the obtained sagittal images, the vocal cord was delineated. The movement of the vocal cord was summed up and considered as the internal target volume (ITV). We then assessed the degree of overlap between the ITV and the PTV (vocal cord plus margins) by calculating the volume overlap ratio, represented as (ITV∩PTV)/ITV.

RESULTS

CBCTs of 17 early glottic patients were analyzed. Σ and σ were 0.55 and 0.57 for left-right (LR), 0.70 and 0.60 for anterior-posterior (AP), and 1.84 and 1.04 for superior-inferior (SI), respectively. The calculated margin was 1.8 mm (LR), 2.2 mm (AP), and 5.3 mm (SI). Four healthy volunteers participated for validation. A margin of 3 mm (AP) and 5 mm (SI) was applied to the vocal cord as the PTV. The average volume overlap ratio between ITV and PTV was 0.92 (range 0.85-0.99) without swallowing and 0.77 (range 0.70-0.88) with swallowing.

CONCLUSION

By evaluating organ motion by using CBCT, the margin was 1.8 (LR), 2.2 (AP), and 5.3 mm (SI). The margin acquired using CBCT fitted well in real-time cine MRI. Given that swallowing during radiotherapy can result in a substantial displacement, it is crucial to consider strategies aimed at minimizing swallowing and related motion.

Applications of Artificial Intelligence, Machine Learning, and Deep Learning in Nutrition: A Systematic Review

In industry 4.0, where the automation and digitalization of entities and processes are fundamental, artificial intelligence (AI) is increasingly becoming a pivotal tool offering innovative solutions in various domains. In this context, nutrition, a critical aspect of public health, is no exception to the fields influenced by the integration of AI technology. This study aims to comprehensively investigate the current landscape of AI in nutrition, providing a deep understanding of the potential of AI, machine learning (ML), and deep learning (DL) in nutrition sciences and highlighting eventual challenges and futuristic directions. A hybrid approach from the systematic literature review (SLR) guidelines and the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines was adopted to systematically analyze the scientific literature from a search of major databases on artificial intelligence in nutrition sciences. A rigorous study selection was conducted using the most appropriate eligibility criteria, followed by a methodological quality assessment ensuring the robustness of the included studies. This review identifies several AI applications in nutrition, spanning smart and personalized nutrition, dietary assessment, food recognition and tracking, predictive modeling for disease prevention, and disease diagnosis and monitoring. The selected studies demonstrated the versatility of machine learning and deep learning techniques in handling complex relationships within nutritional datasets. This study provides a comprehensive overview of the current state of AI applications in nutrition sciences and identifies challenges and opportunities. With the rapid advancement in AI, its integration into nutrition holds significant promise to enhance individual nutritional outcomes and optimize dietary recommendations. Researchers, policymakers, and healthcare professionals can utilize this research to design future projects and support evidence-based decision-making in AI for nutrition and dietary guidance.

Improvement of performance for flexible film dosimeter by incorporating additive agents

OBJECTIVE

To evaluate the reduction in energy dependence and aging effect of the lithium salt of pentacosa-10,-12-diynoic acid (LiPCDA) films with additives including aluminum oxide (Al2O3), propyl gallate (PG), and disodium ethylenediaminetetracetate (EDTA).

APPROACH

LiPCDA films exhibited energy dependence on kilovoltage (kV) and megavoltage (MV) photon energies and experienced deterioration over time. Evaluations were conducted with added Al₂O₃ and antioxidants to mitigate these issues, and films were produced with and without Al₂O₃ to assess energy dependence. The films were irradiated at doses of 0, 3, 6, and 12 cGy at photon energies of 75 kV, 105 kV, 6 MV, 10 MV, and 15 MV. For the energy range of 75 kV to 15 MV, the mean and standard deviation (std) were calculated and compared for the values normalized to the net optical density (netOD) at 6 MV, corresponding to identical dose levels. To evaluate the aging effect, PG and disodium EDTA were incorporated into the films: sample C with 1% PG, sample D with 2% PG, sample E with 0.62% disodium EDTA added to sample D, and sample F with 1.23% disodium EDTA added to sample D.

MAIN RESULTS

Films containing Al2O3 demonstrated a maximum 15.8% increase in mean normalized values and a 15.1% reduction in std, reflecting a greater netOD reduction at kV than MV energies, which indicates less energy dependence in these films. When the OD of sample 1-4 depending on the addition of PG and disodium EDTA, was observed for 20 weeks, the transmission mode decreased by 8.7%, 8.3%, 29.3%, and 27.3%, respectively, while the reflection mode was 5.4. %, 3.0%, 37.0%, and 34.5%, respectively.

SIGNIFICANCE

Al2O3 effectively reduced the voltage and MV energy dependence. PG was more effective than disodium EDTA in preventing the deterioration of film performance owing to the aging effect.

Daraesoon (shoot of hardy kiwi) mitigates hyperglycemia in db/db mice by alleviating insulin resistance and inflammation

BACKGROUND/OBJECTIVES

Mitigating insulin resistance and hyperglycemia is associated with a decreased risk of diabetic complications. The effect of Daraesoon (shoot of hardy kiwi, Actinidia arguta) on hyperglycemia was investigated using a type 2 diabetes animal model.

MATERIALS/METHODS

Seven-week-old db/db mice were fed either an AIN-93G diet or a diet containing 0.4% of a 70% ethanol extract of Daraesoon, whereas db/+ mice were fed the AIN-93G diet for 7 weeks.

RESULTS

Consumption of Daraesoon significantly reduced serum glucose and blood glycated hemoglobin levels, along with homeostasis model assessment for insulin resistance in db/db mice. Conversely, Daraesoon elevated the serum adiponectin levels compared to the db/db control group. Furthermore, Daraesoon significantly decreased both serum and hepatic triglyceride levels, as well as serum total cholesterol levels. Additionally, consumption of Daraesoon resulted in decreased hepatic tumor necrosis factor-α and monocyte chemoattractant protein-1 expression.

CONCLUSIONS

These results suggest that hypoglycemic effect of Daraesoon is mediated through the improvement of insulin resistance and the downregulation of pro-inflammatory cytokine expression in db/db mice.

Gromwell ameliorates glucocorticoid-induced muscle atrophy through the regulation of Akt/mTOR pathway

BACKGROUND

Muscle atrophy is characterized by decreased muscle mass, function, and strength. Synthetic glucocorticoids, including dexamethasone (Dexa), are commonly used to treat autoimmune diseases. However, prolonged exposure of Dexa with high dose exerts severe side effects, including muscle atrophy. The purpose of this study was to investigate whether Gromwell root extract (GW) can prevent Dexa-induced muscle atrophy in C2C12 cells and mice and to characterize the composition of GW to identify bioactive compounds.

METHODS

For in vitro experiments, GW (0.5 and 1 µg/mL) or lithospermic acid (LA, 5 and 10 µM) was added to C2C12 myotubes on day 4 of differentiation and incubated for 24 h, along with 50 µM Dexa. For in vivo experiment, four-week-old male C57BL/6 mice were randomly divided into the four following groups (n = 7/group): Con group, Dexa group, GW0.1 group, and GW0.2 group. Mice were fed experimental diets of AIN-93 M with or without 0.1 or 0.2% GW for 4 weeks. Subsequently, muscle atrophy was induced by administering an intraperitoneal injection of Dexa at a dose of 15 mg/kg/day for 38 days, in conjunction with dietary intake.

RESULTS

In Dexa-induced myotube atrophy, treatment with GW increased myotube diameter, reduced the expression of muscle atrophy markers, and enhanced the expression of myosin heavy chain (MHC) isoforms in C2C12 cells. Supplementation with the GW improved muscle function and performance in mice with Dexa-induced muscle atrophy, evidenced in the grip strength and running tests. The GW group showed increased lean body mass, skeletal muscle mass, size, and myosin heavy chain isoform expression, along with reduced skeletal muscle atrophy markers in Dexa-injected mice. Supplementation with GW increased protein synthesis and decreased protein degradation through the Akt/mammalian target of rapamycin and glucocorticoid receptor/forkhead box O3 signaling pathways, respectively. We identified LA as a potential bioactive component of the GW. LA treatment increased myotube diameter and decreased the expression of muscle atrophy markers in Dexa-induced C2C12 cells.

CONCLUSIONS

These findings underscore the potential of the GW in preventing Dexa-induced skeletal muscle atrophy and highlight the contribution of LA to its effects.

Genome-Wide Identification and Comprehensive Analysis of the GASA Gene Family in Peanuts (Arachis hypogaea L.) under Abiotic Stress

Peanut (Arachis hypogaea L.) is a globally cultivated crop of significant economic and nutritional importance. The role of gibberellic-acid-stimulated Arabidopsis (GASA) family genes is well established in plant growth, development, and biotic and abiotic stress responses. However, there is a gap in understanding the function of GASA proteins in cultivated peanuts, particularly in response to abiotic stresses such as drought and salinity. Thus, we conducted comprehensive in silico analyses to identify and verify the existence of 40 GASA genes (termed AhGASA) in cultivated peanuts. Subsequently, we conducted biological experiments and performed expression analyses of selected AhGASA genes to elucidate their potential regulatory roles in response to drought and salinity. Phylogenetic analysis revealed that AhGASA genes could be categorized into four distinct subfamilies. Under normal growth conditions, selected AhGASA genes exhibited varying expressions in young peanut seedling leaves, stems, and roots tissues. Notably, our findings indicate that certain AhGASA genes were downregulated under drought stress but upregulated under salt stress. These results suggest that specific AhGASA genes are involved in the regulation of salt or drought stress. Further functional characterization of the upregulated genes under both drought and salt stress will be essential to confirm their regulatory roles in this context. Overall, our findings provide compelling evidence of the involvement of AhGASA genes in the mechanisms of stress tolerance in cultivated peanuts. This study enhances our understanding of the functions of AhGASA genes in response to abiotic stress and lays the groundwork for future investigations into the molecular characterization of AhGASA genes.

Development of a quasi-3D dosimeter using radiochromic plastic for patient-specific quality assurance

BACKGROUND

Patient-specific QA verification ensures patient safety and treatment by verifying radiation delivery and dose calculations in treatment plans for errors. However, a two-dimensional (2D) dose distribution is insufficient for detecting information on the three-dimensional (3D) dose delivered to the patient. In addition, 3D radiochromic plastic dosimeters (RPDs) such as PRESAGE® represent the volume effect in which the dosimeters have different sensitivities according to the size of the dosimeters. Therefore, to solve the volume effect, a Quasi-3D dosimetry system was proposed to perform patient-specific QA using predetermined-sized and multiple RPDs.

PURPOSE

For patient-specific quality assurance (QA) in radiation treatment, this study aims to assess a quasi-3D dosimetry system using an RPD.

METHODS

Gamma analysis was performed to verify the agreement between the measured and estimated dose distributions of intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT). We fabricated cylindrical RPDs and a quasi-3D dosimetry phantom. A practicability test for a pancreatic patient utilized a quasi-3D dosimetry device, an in-house RPD, and a quasi-3D phantom. The dose distribution of the VMAT design dictated the placement of nine RPDs. Moreover, a 2D diode array detector was used for 2D gamma analysis (MapCHECK2). The patient-specific QA was performed for IMRT, VMAT, and stereotactic ablative radiotherapy (SABR) in 20 prostate and head-and-neck patients. For each patient, six RPDs were positioned according to the dose distribution. VMAT SABR and IMRT/VMAT plans employed a 2%/2 mm gamma criterion, whereas IMRT/VMAT plans used a 3%/2 mm gamma criterion, a 10% threshold value, and a 90% passing rate tolerance. 3D gamma analysis was conducted using the 3D Slicer software.

RESULTS

The average gamma passing rates with 2%/2 mm and 3%/3 mm criteria for relative dose distribution were 91.6% ± 1.4% and 99.4% ± 0.7% for the 3D gamma analysis using the quasi-3D dosimetry system, respectively, and 97.5% and 99.3% for 2D gamma analysis using MapCHECK2, respectively. The 3D gamma analysis for patient-specific QA of 20 patients showed passing rates of over 90% with 2%/2 mm, 3%/2 mm, and 3%/3 mm criteria.

CONCLUSIONS

The quasi-3D dosimetry system was evaluated by performing patient-specific QAs with RPDs and quasi-3D phantom. The gamma indices for all RPDs showed more than 90% for 2%/2 mm, 3%/2 mm, and 3%/3 mm criteria. We verified the feasibility of a quasi-3D dosimetry system by performing the conventional patient-specific QA with the quasi-3D dosimeters.

Development of Novel Focal Irradiation Tool for High-Precision Irradiation Using Clinical Brachytherapy System

PURPOSE/OBJECTIVE(S)

Several small animals, including mice, are used to conduct research on state-of-the-art radiation therapy techniques or treatment-related toxicity. However, it is difficult to conduct the focal irradiation to a shallow depth on small animals, because irradiation using LINAC has limitations in energy and field size. The purpose of this paper was to develop a focal irradiation tool for high-precision irradiation and to evaluate beam characteristics.

MATERIALS/METHODS

We designed the collimator of 1 mm diameter consisting of tungsten material for high-precision irradiation applied to the clinical brachytherapy system and the percent depth dose and horizontal profile were measured. We compared the depth dose and horizontal profile with 4 mm diameter SRS cone for 6 MV in LINAC. We measured the PDD and horizontal profile using EBT3 film for high-precision irradiation of 1 mm diameter using Ir-192 source. In case of 4 mm diameter, the beam was measured using edge detector. In addition, all measurements were compared with the results of planning tool simulation.

RESULTS

In case of focal irradiation tool, the maximum dose showed at the surface for both measurement and simulation, and 26% and 32% doses at 1 mm depth, respectively. In addition, FWHM at a 1 mm depth showed that high-precision irradiation was possible with measurement and simulation results of 1.86 and 1.28 mm. In case of LINAC, the maximum dose was showed at a depth of 1 cm and 0.8 cm in the measurement and simulation, respectively. Even if the smallest cone is used, the FWHM at a dmax depth was 4.0 mm in both simulation and measurement.

CONCLUSION

We overcame the limitation for energy and field size through the focal irradiation tool for high-precision irradiation. The focal irradiation tool enables high dose delivery to the shallow depth. In addition, small FWHM reduced dose delivery to the periphery at a specific depth and enabled accurate dose delivery. These results mean that the focal irradiation tool can be useful in small animal experiments that require accurate doses near the shallow depth.

Extension of matRad with a modified microdosimetric kinetic model for carbon ion treatment planning: Comparison with Monte Carlo calculation

BACKGROUND

Treatment planning is essential for in silico particle therapy studies. matRad is an open-source research treatment planning system (TPS) based on the local effect model, which is a type of relative biological effectiveness (RBE) model.

PURPOSE

This study aims to implement a microdosimetric kinetic model (MKM) in matRad and develop an automation algorithm for Monte Carlo (MC) dose recalculation using the TOPAS code. In addition, we provide the developed MKM extension as open-source tool for users.

METHODS

Carbon beam data were generated using TOPAS MC pencil beam irradiation. We parameterized the TOPAS MC beam data with a double-Gaussian fit and modeled the integral depth doses and lateral spot profiles in the range of 100-430 MeV/u. To implement the MKM, the specific energy data table for Z = 1-6 and integrated depth-specific energy data were acquired based on the Kiefer-Chatterjee track structure and TOPAS MC simulation, respectively. Generic data were integrated into matRad, and treatment planning was performed based on these data. The optimized plan parameters were automatically converted into MC simulation input. Finally, the matRad TPS and TOPAS MC simulations were compared using the RBE-weighted dose calculation results. A comparison was made for three geometries: homogeneous water phantom, inhomogeneous phantom, and patient.

RESULTS

The RBE-weighted dose (DRBE ) distribution agreed with TOPAS MC within 1.8% for all target sizes for the homogeneous phantom. For the inhomogeneous phantom, the relative difference in the range of 80% of the prescription dose in the distal fall-off region (R80) between the matRad TPS and TOPAS MC was 0.6% (1.1 mm). DRBE between the TPS and the MC was within 4.0%. In the patient case, the difference in the dose-volume histogram parameters for the target volume between the TPS and the MC was less than 2.7%. The relative difference in R80 was 0.7% (1.2 mm).

CONCLUSIONS

The MKM was successfully implemented in matRad TPS, and the RBE-weighted dose was comparable to that of TOPAS MC. The MKM-implemented matRad was released as an open-source tool. Further investigations with MC simulations can be conducted using this tool, providing a good option for carbon ion research.

Lignan-Rich Sesame (Sesamum indicum L.) Cultivar Exhibits In Vitro Anti-Cholinesterase Activity, Anti-Neurotoxicity in Amyloid-β Induced SH-SY5Y Cells, and Produces an In Vivo Nootropic Effect in Scopolamine-Induced Memory Impaired Mice

Alzheimer's disease, a major cause of dementia, is characterized by impaired cholinergic function, increased oxidative stress, and amyloid cascade induction. Sesame lignans have attracted considerable attention owing to their beneficial effects on brain health. This study investigated the neuroprotective potential of lignan-rich sesame cultivars. Among the 10 sesame varieties studied, Milyang 74 (M74) extracts exhibited the highest total lignan content (17.71 mg/g) and in vitro acetylcholinesterase (AChE) inhibitory activity (66.17%, 0.4 mg/mL). M74 extracts were the most effective in improving cell viability and inhibiting reactive oxygen species (ROS) and malondialdehyde (MDA) generation in amyloid-β_25-35 fragment-treated SH-SY5Y cells. Thus, M74 was used to evaluate the nootropic effects of sesame extracts and oil on scopolamine (2 mg/kg)-induced memory impairment in mice compared to the control cultivar (Goenback). Pretreatment with the M74 extract (250 and 500 mg/kg) and oil (1 and 2 mL/kg) effectively improved memory disorder in mice (demonstrated by the passive avoidance test), inhibited AChE, and enhanced acetylcholine (Ach) levels. Moreover, immunohistochemistry and Western blot results showed that the M74 extract and oil reversed the scopolamine-induced increase in APP, BACE-1, and presenilin expression levels in the amyloid cascade and decreased BDNF and NGF expression levels in neuronal regeneration.

Evaluation of initial patient setup methods for breast cancer between surface-guided radiation therapy and laser alignment based on skin marking in the Halcyon system

BACKGROUND

This study was conducted to evaluate the efficiency and accuracy of the daily patient setup for breast cancer patients by applying surface-guided radiation therapy (SGRT) using the Halcyon system instead of conventional laser alignment based on the skin marking method.

METHODS AND MATERIALS

We retrospectively investigated 228 treatment fractions using two different initial patient setup methods. The accuracy of the residual rotational error of the SGRT system was evaluated by using an in-house breast phantom. The residual translational error was analyzed using the couch position difference in the vertical, longitudinal, and lateral directions between the reference computed tomography and daily kilo-voltage cone beam computed tomography acquired from the record and verification system. The residual rotational error (pitch, yaw, and roll) was also calculated using an auto rigid registration between the two images based on Velocity. The total setup time, which combined the initial setup time and imaging time, was analyzed to evaluate the efficiency of the daily patient setup for SGRT.

RESULTS

The average residual rotational errors using the in-house fabricated breast phantom for pitch, roll, and yaw were 0.14°, 0.13°, and 0.29°, respectively. The average differences in the couch positions for laser alignment based on the skin marking method were 2.7 ± 1.6 mm, 2.0 ± 1.2 mm, and 2.1 ± 1.0 mm for the vertical, longitudinal, and lateral directions, respectively. For SGRT, the average differences in the couch positions were 1.9 ± 1.2 mm, 2.9 ± 2.1 mm, and 1.9 ± 0.7 mm for the vertical, longitudinal, and lateral directions, respectively. The rotational errors for pitch, yaw, and roll without the surface-guided radiation therapy approach were 0.32 ± 0.30°, 0.51 ± 0.24°, and 0.29 ± 0.22°, respectively. For SGRT, the rotational errors were 0.30 ± 0.22°, 0.51 ± 0.26°, and 0.19 ± 0.13°, respectively. The average total setup times considering both the initial setup time and imaging time were 314 s and 331 s, respectively, with and without SGRT.

CONCLUSION

We demonstrated that using SGRT improves the accuracy and efficiency of initial patient setups in breast cancer patients using the Halcyon system, which has limitations in correcting the rotational offset.

An International Comparison Study Exploring the Influential Variables Affecting Students’ Reading Literacy and Life Satisfaction

The Program for International Student Assessment (PISA) aims to provide comparative data on 15-year-olds’ academic performance and well-being. The purpose of the current study is to explore and compare the variables that predict the reading literacy and life satisfaction of U.S. and South Korean students. The random forest algorithm, which is a machine learning approach, was applied to PISA 2018 data (4,677 U.S. students and 6,650 South Korean students) to explore and select the key variables among 305 variables that predict reading literacy and life satisfaction. In each random forest analysis, one for the U.S. and another for South Korea, 23 variables were derived as key variables in students’ reading literacy. In addition, 23 variables in the U.S. and 26 variables in South Korea were derived as important variables for students’ life satisfaction. The multilevel analysis revealed that various student-, teacher- or school-related key variables derived from the random forest were statistically related to either U.S. and/or South Korean students’ reading literacy and/or life satisfaction. The current study proposes to use a machine learning approach to examine international large-scale data for an international comparison. The implications of the current study and suggestions for future research are discussed.

Performance evaluation of a visual guidance patient-controlled respiratory gating system for respiratory-gated magnetic-resonance image-guided radiation therapy

The performance of a visual guidance patient-controlled (VG-PC) respiratory gating system for magnetic-resonance (MR) image-guided radiation therapy (MR-IGRT) was evaluated through a clinical trial of patients with either lung or liver cancer. Patients can voluntarily control their respiration utilizing the VG-PC respiratory gating system. The system enables patients to view near-real-time cine planar MR images projected inside the bore of MR-IGRT systems or an external screen. Twenty patients who had received stereotactic ablative radiotherapy (SABR) for lung or liver cancer were prospectively selected for this study. Before the first treatment, comprehensive instruction on the VG-PC respiratory gating system was provided to the patients. Respiratory-gated MR-IGRT was performed for each patient with it in the first fraction and then without it in the second fraction. For both the fractions, the total treatment time, beam-off time owing to the respiratory gating, and number of beam-off events were analyzed. The average total treatment time, beam-off time, and number of beam-off events with the system were 1507.3 s, 679.5 s, and 185, respectively, and those without the system were 2023.7 s (p < 0.001), 1195.0 s (p < 0.001), and 380 times (p < 0.001), respectively. The VG-PC respiratory gating system improved treatment efficiency through a reduction in the beam-off time, the number of beam-off events, and consequently the total treatment time when performing respiratory-gated MR-IGRT for lung and liver SABR.

First Report of Pseudomonas cichorii Causing Bacterial vein necrosis on Perilla plants [Perilla frutescens (L.) Britton.] in South Korea

Perilla (Perilla frutescens L.) is the second most important upland crop and the third largest edible oil crop in Korea (Shin and Kim 1994). During a disease survey in Busan, Korea in September 2021, symptoms of vein necrosis were observed in perilla plants, with incidences of approximately 30% and 50% in two fields. Symptoms of spots on the perilla appeared as leaf dryness and spots with water-soaked blotches largely concentrated on the mid-veins of leaves. The lesions were initiated with water-soaked spots on the leaf or stem and gradually turned black or brown. Necrosis was also observed in the stems. A bacterium was isolated on Luria-Bertani (LB) agar from diseased leaf tissues that were surface-disinfected with 70% ethyl alcohol for 3-5 min and then washed with sterile water three times. Three pieces of sterilized leaf tissue (size: 0.5 × 0.5 cm) were mixed with 500 µL sterile water for 30 min, and then the suspension was serially diluted and spread on LB agar. Subsequently, isolates were cultivated on LB agar and King's Medium B agar (KMB) (Schaad et al. 2001), and they were predominantly cream-colored and circular bacterial colonies with undulated margins. The bacterial colonies on KMB displayed fluorescence under 365 nm UV light. The isolates were analyzed with the GEN III MicroPlate (Biolog, Hayward, CA, USA), and all isolates were identified as Pseudomonas cichorii, a devastating plant bacterium that damages a wide range of host plants worldwide, including in South Korea (Hikichi et al. 2013; Ramkumar et al. 2015). To identify the species of the bacterial pathogen, genomic DNA of four isolates (BS4922, BS4167, BS4345, and BS4560) was extracted, and the 16S rRNA gene and hrcRST gene were amplified with universal primers, 27F/1492R and Hcr1/Hcr2, and sequencing was then done (Patel et al. 2019). In the BLAST analysis, the 16S rRNA sequences (GenBank OM060656, OM275434, OM275435, OM275436) showed a 100% and 99% similarity to P. cichorii strains MAFF 302698 (AB724286) and P. cichorii strain Pc-Gd-4 (KU923373), respectively. Further, hrcRST gene sequences (GenBank OM143596, OM268864, OM268865, and OM268866) showed high similarity (>99%) with P. cichorii strain P16-51 (MG518230). A pathogenicity test of the four isolates was performed on 3 - 4 weeks old perilla plants by creating wounds with a needle on the lower leaves and stems, and then the plants were inoculated by spraying inoculum (108 CFU/ml). The plants that served as the negative control were wounded and sprayed with unsterilized water. The inoculated perilla plants were placed in a greenhouse at 28 ± 2oC , 80-85% relative humidity, and a natural photoperiod. The inoculation site began to show symptoms of water-soaked brown lesions. Disease symptoms such as leaf dryness, water-soaked blotches on the mid-vein of leaves, and necrosis on plant stems were observed in the inoculated plants 7-10 days after inoculation, whereas the plants of the negative control group did not show any symptoms. The bacteria were re-isolated from the diseased tissues of the plants, and DNA sequence analysis identified them as P. cichorii. Additionally, all isolates induced hypersensitivity reactions in tobacco and tomato leaves within 24 h after inoculation. To our knowledge, this is the first report of P. cichorii infecting perilla in South Korea. The findings in this study will provide the basic information for the development of diagnostic tools and management measures against P. cichorii in perilla.

Development of an anthropomorphic multimodality pelvic phantom for quantitative evaluation of a deep-learning-based synthetic computed tomography generation technique

PURPOSE

The objective of this study was to fabricate an anthropomorphic multimodality pelvic phantom to evaluate a deep-learning-based synthetic computed tomography (CT) algorithm for magnetic resonance (MR)-only radiotherapy.

METHODS

Polyurethane-based and silicone-based materials with various silicone oil concentrations were scanned using 0.35 T MR and CT scanner to determine the tissue surrogate. Five tissue surrogates were determined by comparing the organ intensity with patient CT and MR images. Patient-specific organ modeling for three-dimensional printing was performed by manually delineating the structures of interest. The phantom was finally fabricated by casting materials for each structure. For the quantitative evaluation, the mean and standard deviations were measured within the regions of interest on the MR, simulation CT (CT_sim ), and synthetic CT (CT_syn ) images. Intensity-modulated radiation therapy plans were generated to assess the impact of different electron density assignments on plan quality using CT_sim and CT_syn . The dose calculation accuracy was investigated in terms of gamma analysis and dose-volume histogram parameters.

RESULTS

For the prostate site, the mean MR intensities for the patient and phantom were 78.1 ± 13.8 and 86.5 ± 19.3, respectively. The mean intensity of the synthetic image was 30.9 Hounsfield unit (HU), which was comparable to that of the real CT phantom image. The original and synthetic CT intensities of the fat tissue in the phantom were -105.8 ± 4.9 HU and -107.8 ± 7.8 HU, respectively. For the target volume, the difference in D_95% was 0.32 Gy using CT_syn with respect to CT_sim values. The V_65Gy values for the bladder in the plans using CT_sim and CT_syn were 0.31% and 0.15%, respectively.

CONCLUSION

This work demonstrated that the anthropomorphic phantom was physiologically and geometrically similar to the patient organs and was employed to quantitatively evaluate the deep-learning-based synthetic CT algorithm.

Scanning methodology for contact lens-type ocular in vivo dosimeter (CLOD) dosimetry applying a silicone material

PURPOSE

Contact lens-type ocular in vivo dosimeters (CLODs) were recently developed as the first in vivo dosimeter that can be worn directly on the eye to measure the dose delivered to the lens during radiotherapy. However, it has an inherent uncertainty because of its curved shape. Newton's ring effect inevitably occurs because the spacing between the glass window and the active layer is not constant. Furthermore, it involves a large uncertainty because the objective of the CLOD with such morphological characteristics is to measure the dose delivered to an out-of-field lens. In this study, we aimed to investigate the effects of various compensating materials on the sensitivity, accuracy, and uniformity of analysis using a curved CLOD. We developed a new scanning methodology that involves applying a compensating material to reduce the uncertainty caused by the air gap.

METHODS

Four compensating materials-Dragon Skin™ 10 (DS), a transparent silicon material, SORTA-Clear™ 40 (SC), optical grease (OG), and air (no compensating material)-were used in this study. The CLOD was scanned in the reflective mode and transmission mode using each compensating material. We then examined the sensitivity, accuracy, and scan uniformity to evaluate the scanning methodology using compensating materials.

RESULTS

The increase in sensitivity was the highest for OG compared to that for air in the reflective mode. On average, the sensitivity in the reflective mode was higher than that in the transmission mode by a factor of 2.5 for each dose. Among the four compensating materials, OG had the smallest uncertainty. Therefore, the best scan uniformity was achieved when OG was used.

CONCLUSIONS

Scanning methodology was proposed in which a compensating material is applied for a curved lens-type dosimeter. Our results show that OG is the most suitable compensating material to obtain the best accuracy of dose analysis. Following this methodology, the scan uncertainty of curved dosimeters significantly decreased.

Quantitative evaluation of radiodermatitis following whole-breast radiotherapy with various color space models: A feasibility study

Purpose

We analyzed skin images with various color space models to objectively assess radiodermatitis severity in patients receiving whole-breast radiotherapy.

Methods

Twenty female patients diagnosed with breast cancer were enrolled prospectively. All patients received whole-breast radiotherapy without boost irradiation. Skin images for both irradiated and unirradiated breasts were recorded in red-green-blue (RGB) color space using a mobile skin analysis device. For longitudinal analysis, the images were acquired before radiotherapy (RTbefore), approximately 7 days after the first fraction of radiotherapy (RT7days), RT14days, and approximately 10 days after radiotherapy completion (RTafter). Four color space models (RGB, hue-saturation-value (HSV), L*a*b*, and YCbCr models) were employed to calculate twelve color space parameters for each skin image. Skin dose measurements for irradiated breasts were performed using nanoDot optically stimulated luminescent dosimeters on the first fraction of radiotherapy. Subsequently, acute radiation dermatitis in each patient was assessed according to the Radiation Therapy Oncology Group scoring criteria at both RT14days and RTafter. Finally, several statistical analysis methods were applied to investigate the performance of the color space parameters to objectively assess the radiodermatitis.

Results

Owing to radiation-induced skin damage, R value of RGB model as well as S and V values of the HSV model for irradiated breasts increased significantly, while those for unirradiated breasts showed smaller increases. These parameters showed the longitudinal changes in color space parameters within each group and between groups over time with statistical significance. Strong correlations of the parameters for irradiated breasts at RT7days with skin doses and those at RTafter were observed with statistical significance.

Conclusion

The R value of RGB model as well as the S and V values of HSV model showed relatively better performance in evaluating the acute radiation dermatitis. These color space parameters could therefore serve as useful tools to assess radiodermatitis severity in a dose-dependent manner.

Comparison of treatment plans between static jaw and jaw tracking techniques in postmastectomy intensity-modulated radiation therapy

This study reports a dosimetric comparison between treatment plans using static jaw and jaw tracking techniques in intensity-modulated radiation therapy (IMRT) for postmastectomy radiation therapy (PMRT). Seventeen patients treated for left-sided breast cancer with implant-based reconstruction were subjected to IMRT plans. Another group of 22 patients treated for left-sided breast cancer without reconstruction was also subjected to IMRT plans. The plans were generated using the Eclipse treatment planning system with static jaw and jaw tracking techniques. The dose-volume histograms and dosimetric indices, such as mean dose (D_mean), V_{20 Gy}, V_{10 Gy}, and V_{5 Gy} (volumes receiving 20, 10, and 5 Gy at the least, respectively), and generalized equivalent uniform dose for organs at risk (OARs) were analyzed. A significant difference in the value of the dosimetric indices between the static jaw and jaw tracking plans was observed. For jaw tracking plans, the D_mean of the heart for the patients with implant-based reconstruction reduced from 11.6 ± 1.1 Gy to 10.0 ± 1.8 Gy, whereas the V_{5 Gy} reduced from 92.0 ± 4.5% to 85.1 ± 8.4%. The D_mean of the heart for patients without reconstruction reduced from 11.0 ± 2.3 Gy to 9.8 ± 2.6 Gy, whereas the V_{5 Gy} reduced from 81.4 ± 13.6% to 66.7 ± 17.4%. The dosimetric indices of OARs in the jaw tracking plans were significantly lower than those of the OARs in the static jaw plans. The jaw tracking technique was more effective for patients without reconstruction than for those with implant-based reconstruction.

Gold coated contact lens-type ocular in vivo dosimeter (CLOD) for monitoring of low dose in computed tomography: A Monte Carlo study

PURPOSE

This study reports a sensitivity enhancement of gold-coated contact lens-type ocular in vivo dosimeters (CLODs) for low-dose measurements in computed tomography (CT).

METHODS

Monte Carlo (MC) simulations were conducted to evaluate the dose enhancement from the gold (Au) layers on the CLODs. The human eye and CLODs were modeled, and the X-ray tube voltages were defined as 80, 120, and 140 kVp. The thickness of the Au layer attached to a CLOD ranged from 100 nm to 10 μm. The thickness of the active layer ranged from 20 to 140 μm. The dose ratio between the active layer of the Au-coated CLOD and a CLOD without a layer, i.e., the dose enhancement factor (DEF), was calculated.

RESULTS

The DEFs of the first 20-μm thick active layer of the 5-μm thick Au-coated CLOD were 18.4, 19.7, 20.2 at 80, 120, and 140 kVp, respectively. The DEFs decreased as the thickness of the active layer increased. The DEFs of 100-nm to 5-μm thick Au layers increased from 1.7 to 5.4 for 120-kVp X-ray tube voltage when the thickness of the active layer was 140 μm.

CONCLUSIONS

The MC results presented a higher sensitivity of Au-coated CLODs (∼20-times higher than that of CLODs without a gold layer). Au-coated CLODs can be applied to an evaluation of very low doses (a few cGy) delivered to patients during CT imaging.

Ameliorative Effect of Myricetin on Nonalcoholic Fatty Liver Disease in ob/ob Mice

Obesity, insulin resistance, and oxidative stress are important risk factors for nonalcoholic fatty liver disease (NAFLD). This study aimed at determining the beneficial effects of myricetin against NAFLD in ob/ob mice. C57BL/6-Lep^ob/ob mice (n = 21) were fed an AIN-93G diet (ob/ob control group) or diet containing 0.04% (low myricetin; LMTN group) or 0.08% (high myricetin; HMTN group) myricetin, and lean heterozygous littermates (lean control group, n = 7) were fed AIN-93G diet for 10 weeks. HMTN consumption significantly lowered serum glucose levels and homeostasis model assessment for insulin resistance values in ob/ob mice. In addition to reducing serum triglyceride (TG) and cholesterol levels, HMTN significantly decreased total hepatic lipid and TG levels partly through downregulation of carbohydrate response element-binding protein and sterol regulatory element-binding protein 1c expression. The reduction in the levels of hepatic thiobarbituric acid reactive substances by HMTN likely resulted from the elevation of nuclear factor erythroid-2-related factor 2 expression. Tumor necrosis factor-α and monocyte chemoattractant protein 1 expressions were reduced by LMTN and HMTN, and HMTN also decreased interleukin-6 expression. These results suggest that myricetin has beneficial effects against NAFLD by regulating the expression of transcription factors of hepatic lipid metabolism, the antioxidant system, and pro-inflammatory cytokines.

Dose calculation of 3D printing lead shield covered by biocompatible silicone for electron beam therapy

This study aims to calculate the dose delivered to the upstream surface of a biocompatible flexible absorber covering lead for electron beam treatment of skin and subcutaneous tumour lesions for head and neck. Silicone (Ecoflex™ 00-30, Smooth-On, Easton, PA, USA) was used to cover the lead to absorb backscattered electrons from lead. A 3D printer (Zortrax M300, Zortrax, Olsztyn, Poland) was used to fabricate the lead shield. Analytic calculation, simplified Monte Carlo (MC) simulation, and detailed MC simulation which includes a modeling of metal-oxide-semiconductor field-effect transistor (MOSFET) detector were performed to determine the electron backscatter factor (EBF) for 6 MeV and 9 MeV electron beams of a Varian iX Silhouette. MCNP6.2 was used to calculate the EBF and corresponding measurements were carried out by using MOSFET detectors. The EBF was experimentally measured by the ratio of dose at the upstream surface of the silicone to the same point without the presence of the lead shield. The results derived by all four methods agreed within 2.8% for 6 MeV and 3.4% for 9 MeV beams. In detailed MC simulations, for 6 MeV, dose to the surface of 7-mm-thick absorber was 103.7 [Formula: see text] 1.9% compared to dose maximum (D_max) without lead. For 9 MeV, the dose to the surface of the 10-mm-thick absorber was 104.1 [Formula: see text] 2.1% compared to D_max without lead. The simplified MC simulation was recommended for practical treatment planning due to its acceptable calculation accuracy and efficiency. The simplified MC simulation was completed within 20 min using parallel processing with 80 CPUs, while the detailed MC simulation required 40 h to be done. In this study, we outline the procedures to use the lead shield covered by silicone in clinical practice from fabrication to dose calculation.

Synthetic CT generation from weakly paired MR images using cycle-consistent GAN for MR-guided radiotherapy

Although MR-guided radiotherapy (MRgRT) is advancing rapidly, generating accurate synthetic CT (sCT) from MRI is still challenging. Previous approaches using deep neural networks require large dataset of precisely co-registered CT and MRI pairs that are difficult to obtain due to respiration and peristalsis. Here, we propose a method to generate sCT based on deep learning training with weakly paired CT and MR images acquired from an MRgRT system using a cycle-consistent GAN (CycleGAN) framework that allows the unpaired image-to-image translation in abdomen and thorax. Data from 90 cancer patients who underwent MRgRT were retrospectively used. CT images of the patients were aligned to the corresponding MR images using deformable registration, and the deformed CT (dCT) and MRI pairs were used for network training and testing. The 2.5D CycleGAN was constructed to generate sCT from the MRI input. To improve the sCT generation performance, a perceptual loss that explores the discrepancy between high-dimensional representations of images extracted from a well-trained classifier was incorporated into the CycleGAN. The CycleGAN with perceptual loss outperformed the U-net in terms of errors and similarities between sCT and dCT, and dose estimation for treatment planning of thorax, and abdomen. The sCT generated using CycleGAN produced virtually identical dose distribution maps and dose-volume histograms compared to dCT. CycleGAN with perceptual loss outperformed U-net in sCT generation when trained with weakly paired dCT-MRI for MRgRT. The proposed method will be useful to increase the treatment accuracy of MR-only or MR-guided adaptive radiotherapy.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13534-021-00195-8.

Effects of Fermented Beverage in Subjects with Metabolic Syndrome

This study investigated the effects of fermented beverage, kale/apple juice containing 5% vinegar in subjects with metabolic syndrome. Subjects were randomly assigned to receive 250 mL fermented beverage or water containing fructose, glucose, and sucrose twice daily for 10 weeks. Consumption of the fermented beverage significantly decreased plasma triglyceride, thiobarbituric acid reactive substances (TBARS), tumor necrosis factor (TNF)-α, and high sensitivity C-reactive protein (hs-CRP) levels compared to baseline values (P<0.05). Furthermore, consumption of the fermented beverage significantly decreased homeostasis model assessment for insulin resistance (HOMA-IR) values and atherogenic indexes compared with baseline values (P<0.05). In the control group, plasma triglyceride, TBARS, TNF-α, and hs-CRP levels, atherogenic indexes, and HOMA-IR values did not significantly differ pre-and post-treatment. The fermented beverage inhibited the activities of α-glucosidase and pancreatic lipase in vitro, therefore could be helpful in alleviating metabolic syndrome in subjects with metabolic syndrome.

Correlation between 3D scanner image and MRI for tracking volume changes in head and neck cancer patients

Introduction

We investigated the correlation between optical surface imaging using a three‐dimensional (3D) scanner and magnetic resonance imaging (MRI) for suggesting feasibility in the clinical process of tracking volume changes in head and neck patients during radiation treatment.

Methods

Ten patients were divided into two groups depending on the location of their tumor (i.e., right or left side). With weekly imaging data, the change in volume based on MRI was evaluated during the treatment course. Four volumes of interest (VOIs) were calculated on the 3D surface image of the facial and cervical areas using an optical 3D scanner, and the correlation between volumetric parameters were analyzed.

Results

The target volume changed significantly overall for both groups. The changes parotid volume reduced by up to 3.8% and 28.0% for groups A (right side) and B (left side), respectively. In Group A, VOI 1 on the facial area and VOI 3 on the cervical area decreased gradually during the treatment course by up to 3.3% and 10.7%, respectively. In Group B, only VOI 4 decreased gradually during the treatment course and reduced by up to 9.2%. In group A, the change in target volume correlated strongly with right‐side parotid, VOI 1, and VOI 3, respectively. The parotid also showed strong correlations with VOIs (P < 0.01). The weight loss was strongly correlated with either PTV or parotid without statistical significance (P > 0.05). In group B (left side), the change in target volume correlated strongly with each volumetric parameter, including weight loss. For individual patient, PTV showed more correlation with VOIs on the cervical area than VOIs on the facial area.

Conclusions

An optical 3D scanner can be applied to track changes in volume without radiation exposure during treatment and the optical surface image correlated with MRI.

Effects of pre-extraction intermittent PTH administration on extraction socket healing in bisphosphonate administered ovariectomized rats

The purpose of this study was to investigate the effect of administering intermittent parathyroid hormone (iPTH) before tooth extraction versus after tooth extraction on the risk of developing MRONJ in experimental animal model. Twenty-five ovariectomized rats received 6 weeks of bisphosphonate therapy. They were classified into 3 groups, based on the timing of the medication, as Control, Pre-PTH and Post-PTH groups. For Control group, normal saline was administered before and after tooth extraction. iPTH was administered during 4 weeks before tooth extraction for Pre-PTH group and after tooth extraction for Post-PTH group. The animals were euthanized 8 weeks after tooth extraction. Macroscopic, histological, micro-computed tomography (micro-CT), and histomorphometric examinations were conducted. The incidences of impaired healing were 11.11% both in Pre-PTH and Post-PTH groups, which was lower than the Control group (42.86%). Bone healing in the extraction socket, based on micro-CT and histomorphometry evaluations, was best in Post-PTH and worst in Control group. The Pre-PTH group showed moderate healing pattern. Despite of limitations in this study, the authors identified Pre-PTH group seems to have positive effect on extraction socket healing. With regard to timing, administering iPTH after tooth extraction was superior to applying it before tooth extraction.

Correlation of the gamma passing rates with the differences in the dose-volumetric parameters between the original VMAT plans and actual deliveries of the VMAT plans

Purpose

The aim of this study was to investigate the correlations of the gamma passing rates (GPR) with the dose-volumetric parameter changes between the original volumetric modulated arc therapy (VMAT) plans and the actual deliveries of the VMAT plans (DV errors). We compared the correlations of the TrueBeam STx system to those of a C-series linac.

Methods

A total of 20 patients with head and neck (H&N) cancer were retrospectively selected for this study. For each patient, two VMAT plans with the TrueBeam STx and Trilogy (C-series linac) systems were generated under similar modulation degrees. Both the global and local GPRs with various gamma criteria (3%/3 mm, 2%/2 mm, 2%/1 mm, 1%/2 mm, and 1%/1 mm) were acquired with the 2D dose distributions measured using the MapCHECK2 detector array. During VMAT deliveries, the linac log files of the multi-leaf collimator positions, gantry angles, and delivered monitor units were acquired. The DV errors were calculated with the 3D dose distributions reconstructed using the log files. Subsequently, Spearman’s rank correlation coefficients (r_s) and the corresponding p values were calculated between the GPRs and the DV errors.

Results

For the Trilogy system, the r_s values with p < 0.05 showed weak correlations between the GPRs and the DV errors (r_s<0.4) whereas for the TrueBeam STx system, moderate or strong correlations were observed (r_s≥0.4). The DV errors in the V_20Gy of the left parotid gland and those in the mean dose of the right parotid gland showed strong correlations (always with r_s > 0.6) with the GPRs with gamma criteria except 3%/3 mm. As the GPRs increased, the DV errors decreased.

Conclusion

The GPRs showed strong correlations with some of the DV errors for the VMAT plans for H&N cancer with the TrueBeam STx system.

Identification of anthocyanin compositions in black seed coated Korean adzuki bean (Vigna angularis) by NMR and UPLC-Q-Orbitrap-MS/MS and screening for their antioxidant properties using different solvent systems

The aim of the present research was to investigate the antioxidant properties and anthocyanin profiles in the black seed coated adzuki bean (Vigna angularis, Geomguseul cultivar). The acidic 60% methanol extract (40 μg/mL) contains the highest total phenolic and flavonoid contents (486 ± 3 mg GAE/100 g; 314 ± 10 mg CE/100 g) with potent antioxidant properties (trolox equivalent 1272 ± 26 and 662 ± 24 mg TE/100 g) against ABTS and DPPH radicals compared to other methanol-water ratios (20, 40, 80, and 100%). Ten anthocyanin components were identified in this extract including delphinidin-3,5-O-digalactoside (1), delphinidin-3,5-O-diglucoside (2), delphinidin-3-O-galactoside (3), delphinidin-3-O-glucoside (4), delphinidin-3-O-rutinoside (5), delphinidin-3-O-(p-coumaroyl)glucoside (6), cyanidin-3-O-glucoside (7), petunidin-3-O-galactoside (8), petunidin-3-O-glucoside (9) and petunidin-3-O-(p-coumaroyl)glucoside (10) via NMR spectroscopy and UPLC-Q-Orbitrap-MS/MS analysis. The key anthocyanins 3 and 4 of delphinidin type were isolated by reversed phase C-18 MPLC. Our results indicate that the anthocyanin profiles as well as the high phenolic and flavonoid contents are important factors determining the antioxidant effects of black adzuki bean.

Family Orientation and Achievement Goal Orientations Among the Children of Immigrant and Non-Immigrant Families

The current study examined the role of family orientations on the achievement motivations (i.e., achievement goal orientations and intrinsic motivation) of high school youths of different generational status (i.e., from immigrant or non-immigrant families) when their perception of their parents’ goals and classroom goal structures were tested simultaneously as predictors. A total of 331 high school students (ninth grade; ages 13–16, with 96% of the students in the ages of 14 or 15; 141 boys and 187 girls) from one high school in the United States participated in the study, completing a series of assessments with regard to their math classes. The findings show the complex role of the family contexts (parent goals and family orientations) on the adaptive mastery goals for children of immigrant families, going beyond previous studies that reported the relationships between family orientation and performance-approach or less adaptive performance-avoidance goals. This study still found that students’ family orientations strongly predicted their desire to win over their peers with certain levels of internal pressure in order to meet their parents’ expectations, aligned with previous literature. Through examining a context beyond the classroom context, studies should continue to examine the larger family and cultural context in understanding students with diverse backgrounds.

Flexible film dosimeter for in vivo dosimetry

PURPOSE

The aims of this study were to develop a flexible film dosimeter applicable to the irregular surface of a patient for in vivo dosimetry and to evaluate the device's dosimetric characteristics.

METHODS

A flexible film dosimeter with active layers consisting of radiochromic-sensitive films and flexible silicone materials was constructed. The dose-response, sensitivity, scanning orientation dependence, energy dependence, and dose rate dependence of the flexible film dosimeter were tested. Irradiated dosimeters were scanned 24 h post-irradiation, and the region of interest was 5 mm × 5 mm. Biological stability tests ensured the safety of application of the flexible film dosimeter for patients. A preliminary clinical study with the flexible film dosimeter was implemented on four patients.

RESULTS

The red channel demonstrated the highest sensitivity among all channels, and the response sensitivity of the dosimeter decreased with the applied dose, which were the same as the characteristics of GAFCHROMIC EBT3 radiochromic films. The flexible film dosimeter showed no significant energy dependence for photon beams of 6 MV, 6 MV flattening filter-free (FFF), 10 MV, and 15 MV. The flexible film dosimeter showed no substantial dose rate dependence with 6 or 6 MV FFF. In terms of biological stability, the flexible film dosimeter demonstrated no cytotoxicity, no irritation, and no skin sensitization. In the preliminary clinical study, the dose differences between the measurements with the flexible film dosimeter and calculations with the treatment planning system ranged from -0.1% to 1.2% for all patients.

CONCLUSIONS

The dosimeter developed in this study is a flexible film capable of attachment to a curved skin surface. The biological test results indicate the stability of the flexible film dosimeter. The preliminary clinical study showed that the flexible film dosimeter can be successfully applied as an in vivo dosimeter.

Monte Carlo simulation of a 2D dynamic multileaf collimator to improve the plan quality in radiotherapy plan: a proof-of-concept study

The leaf width of a multileaf collimator (MLC) determines the dose conformity to the target volume. The objective of this study was to investigate the feasibility of a two-dimensional dynamic MLC (2DDMLC) to improve the treatment plan quality with a fixed leaf width. The treatment head of the Clinac^™ linear accelerator with the Millennium 120^™ MLC was modelled with the Geant4 (for GEometry ANd Tracking) tollkit using the Monte Carlo (MC) method. The 2DDMLC produces a beam aperture by moving the MLC bank vertically to the leaf movement. Thus, the effect of the 2DDMLC motion on beam divergence and beam fluence resolution was evaluated by comparing the dose distributions between the conventional MLC motion and the 2DDMLC. Finally, the 2DDMLC was employed for dynamic conformal arc therapy for 13 brain cancer patients. The dose-volumetric parameters, including the dose delivered to 98% of the target volume (D _98%), percent volume given 20% of the prescribed dose (V _20%), and conformity index (CI) were compared with those of the conventional MLC. For the 6 MV beam of the MC model, the depth dose and lateral dose distribution differed by less than 2% between the simulation and measurement. The 2DDMLC did not significantly influence beam divergence and sharpened the beam. In clinical use, the dose delivered to the target was almost identical between the 2DDMLC and conventional MLC (D _98%  =  29.74 Gy versus 29.71 Gy, p   =  0.18). The CI was improved with the use of the 2DDMLC (CI  =  1.49 versus 1.47, p   =  0.14). Moreover, irradiation of normal tissue was reduced with the 2DDMLC compared with conventional MLC (V _20%  =  17.22% versus 17.45%, p   <  0.001). The 2DDMLC improved the dose conformity to the target volume and reduced the irradiation of the normal tissue compared with the conventional MLC.

Contact lens-type ocular in vivo dosimeter for radiotherapy

PURPOSE

This study aimed to (a) develop a contact lens-type ocular in vivo dosimeter (CLOD) that can be worn directly on the eye and (b) assess its dosimetric characteristics and biological stability for radiation therapy.

METHODS

The molder of a soft contact lens was directly used to create the dosimeter, which included a radiation-sensitive component - an active layer similar to a radiochromic film - to measure the delivered dose. A flatbed scanner with a reflection mode was used to measure the change in optical density due to irradiation. The sensitivity, energy, dose rate, and angular dependence were tested, and the uncertainty in determining the dose was calculated using error propagation analysis. Sequential biological stability tests, specifically, cytotoxicity and ocular irritation tests, were conducted to ensure the safe application of the CLOD to patients.

RESULTS

The dosimeter demonstrated high sensitivity in the low dose region, and the sensitivity linearly decreased with the dose. The responses obtained for the 10 and 15 MV photon beams were 1.7% and 1.9% higher compared to the 6 MV photon beam. A strong dose rate dependence was not obtained for the CLOD. Angular dependence was observed from 90° to 180° with a difference in response from 1% to 2%. The total uncertainty in error propagation analysis decreased as a function of the dose in the red channel. For a dose range of 0 to 50 cGy, the total uncertainties for 5, 10, and 50 cGy were 14.2%, 8.9%, and 5%, respectively. Quantitative evaluation using the MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) method presented no cytotoxicity. Further, no corneal opacity, iris reaction, or conjunctival inflammation was observed.

CONCLUSIONS

The CLOD is the first dosimeter that can be worn close to the eye. The results of cytotoxicity and irritation tests indicate that it is a stable medical device. The evaluation of dose characteristics in open field conditions shows that the CLOD can be applied to an in vivo dosimeter in radiotherapy.

Non-coplanar VMAT plans for lung SABR to reduce dose to the heart: a planning study

OBJECTIVE

This study aimed to compare the plan quality of non-coplanar partial arc (NPA) volumetric modulated arc therapy (VMAT) to that of coplanar partial arc (CPA) VMAT for stereotactic ablative radiotherapy (SABR) for lung cancer.

METHODS

A total of 20 patients treated for lung cancer with the SABR VMAT technique and whose lung tumors were close to the heart were retrospectively selected for this study. For the CPA VMAT, three coplanar half arcs were used while two coplanar half arcs and one noncoplanar arc rotating 315°-45° with couch rotations of 315° ± 5° were used for the NPA VMAT. For each patient, identical CT image sets and identical structures were used for both the CPA and NPA VMAT plans. Dose-volumetric parameters of each plan were analyzed.

RESULTS

For the planning target volume and both lungs, no statistically significant differences between the CPA and NPA VMAT plans were observed in general. For the heart, average values of D_0.1cc of the CPA and NPA VMAT plans were 29.42 ± 13.37 and 21.71 ± 9.20 Gy, respectively (p < 0.001). For whole body, the mean dose and the gradient index of the CPA VMAT plans were 1.2 ± 0.5 Gy and 4.356 ± 0.608 while those of the NPA VMAT plans were 1.1 ± 0.5 Gy and 4.111 ± 0.480, respectively (both with p < 0.001).

CONCLUSION

The NPA VMAT proposed in this study showed more favorable plan quality than the CPA VMAT plans for lung SABR with tumors located close to the heart.

ADVANCES IN KNOWLEDGE

For lung SABR, NPA VMAT can reduce doses to the heart as well as whole-body irradiation.

Characteristics of the Exradin W1 scintillator in the magnetic field

To investigate the angular dependency of the W1 scintillator with and without a magnetic field, the beam incidence angles to the detector varied from 0° to 360° at intervals of 30° when the detector was pointed in both the craniocaudal and right‐to‐left directions. The beam incidence angles also varied from 0° to 360° at intervals of 45° when the W1 scintillator was in the anterior‐to‐posterior direction. To investigate the field size dependency of the W1 scintillator with and without a magnetic field, the doses by an identical beam‐on time were measured at various square field sizes and the measured doses were normalized to the dose at the field of 10.5 cm × 10.5 cm (FS10.5). With and without a magnetic field, the deviations of the doses to the dose at the beam incident angle of 0° were always less than 1% regardless of the dosimeter positioning relative to the magnetic field direction. When the field sizes were equal to or less than FS10.5, the differences in the output factors with and without a magnetic field were less than 0.7%. However, those were larger than 1% at fields larger than FS10.5, and up to 3.1%. The W1 scintillator showed no angular dependency to the magnetic field. Differences larger than 1% in the output factors with and without a magnetic field were observed at field sizes larger than 10.5 cm × 10.5 cm.

Development of advanced skin dose evaluation technique using a tetrahedral-mesh phantom in external beam radiotherapy: a Monte Carlo simulation study

Incorrect prediction of skin dose in external beam radiotherapy (EBR) can have normal tissue complication such as acute skin desquamation and skin necrosis. The absorbed dose of skin should be evaluated within basal layer, placed between the epidermis and dermis layers. However, current treatment planning systems (TPS) cannot correctly define the skin layer because of the limitation of voxel resolution in computed tomography (CT). Recently, a new tetrahedral-mesh (TM) phantom was developed to evaluate radiation dose realistically. This study aims to develop a technique to evaluate realistic skin dose using the TM phantom in EBR. The TM phantom was modeled with thin skin layers, including the epidermis, basal layer, and dermis from CT images. Using the Geant4 toolkit, the simulation was performed to evaluate the skin dose according to the radiation treatment conditions. The skin dose was evaluated at a surface depth of 50 µm and 2000 µm. The difference in average skin dose between depths was up to 37%, depending on the thickness and region of the skin to be measured. The results indicate that the skin dose has been overestimated when the skin is evaluated using commercial TPS. Although it is not possible with traditional TPS, our skin dose evaluation technique can realistically express the absorbed dose at thin skin layers from a patient-specific phantom.

Retrospective study comparing MR-guided radiation therapy (MRgRT) setup strategies for prostate treatment: repositioning vs. replanning

BACKGROUND

This study compared adaptive replanning and repositioning corrections based on soft-tissue matching for prostate cancer by using the magnetic resonance-guided radiation therapy (MRgRT) system.

METHODS

A total of 19 patients with prostate cancer were selected retrospectively. Weekly magnetic resonance image (MRI) scans were acquired for 5 weeks for each patient to observe the anatomic changes during the treatment course. Initial intensity-modulated radiation therapy (IMRT) plans (iIMRT) were generated for each patient with 13 coplanar ⁶⁰Co beams on a ViewRay™ system. Two techniques were applied: patient repositioning and replanning. For patient repositioning, one plan was created: soft-tissue (prostate) matching (Soft). The dose distribution was calculated for each MRI with the beam delivery parameters from the initial IMRT plan. The replanning technique was used to generate the Adaptive plan, which was the reoptimized plan for the weekly MRI. The dose-volumetric parameters of the planning target volume (PTV), bladder, and rectum were calculated for all plans. During the treatment course, the PTV, bladder, and rectum were evaluated for changes in volume and the effect on dosimetric parameters. The differences between the dose-volumetric parameters of the plans were examined through the Wilcoxon test. The initial plan was used as a baseline to compare the differences.

RESULTS

The Adaptive plan showed better target coverage during the treatment period, but the change was not significant in the Soft plan. There were significant differences in D_98%, D_95%, and D_2% in PTV between the Soft and Adaptive plans (p < 0.05) except for D_mean. There was no significant change in D_max and D_mean as the treatment progressed with all plans. All indices for the Adaptive plan stayed the same compared to those of iIMRT during the treatment course. There were significant differences in D_15%, D_25%, D_35%, and D_50% in the bladder between the Soft and Adaptive plans. The Adaptive plan showed the worse dose sparing than the Soft plan for the bladder according to each dosimetric index. In contrast to the bladder, the Adaptive plan achieved better sparing than the Soft plan during the treatment course. The significant differences were only observed in D_15% and D_35% between the Soft and Adaptive plans (p < 0.05).

CONCLUSIONS

Patient repositioning based on the target volume (Soft plan) can relatively retain the target coverage for patients and the OARs remain at a clinically tolerance level during the treatment course. The Adaptive plan did not clinically improve for the dose delivered to OARs, it kept the dose delivered to the target volume constant. However, the Adaptive plan is beneficial when the organ positions and volumes change considerable during treatment.

A 3D-printed patient-specific applicator guide for use in high-dose-rate interstitial brachytherapy for tongue cancer: a phantom study

A patient-specific applicator guide system (PSAG) for tongue-cancer high-dose-rate (HDR) interstitial brachytherapy (ISBT) was developed by utilizing a 3D printing technique. An effectiveness of the 3D-printed PSAG (3D-PSAG) was evaluated for HDR ISBT. Six patients with tongue cancer were retrospectively selected for this study. For each patient, a total of three virtual clinical target volumes (CTV) requiring the insertion of four catheters (CTV4), six catheters (CTV6), and eight catheters (CTV8) were defined. For each CTV, treatment plans were generated to deliver 45 Gy in nine fractions. The 3D-PSAG was fabricated using a 3D-printer and the patient's CT-images. The resulting 3D-PSAG took the form of a shell conforming to the patient's contours with tubes for catheter insertion. For each CTV, catheters were inserted into the phantom with and without the 3D-PSAG. After that, CT-images of the phantom with the inserted catheters were acquired. Differences between the planned positions and those of the actually inserted catheters were evaluated from the CT-images. Given the actual catheter insertion positions, the dose distributions were reconstructed and analyzed. The maximum positional errors with and without the 3D-PSAG were 0.2 mm and 4.5 mm, respectively. For CTV6, the D _90% values of the original plan, the reconstructed plan with the 3D-PSAG, and the reconstructed plan without the 3D-PSAG, were 48.8  ±  1.7 Gy, 49.0  ±  2.9 Gy, and 45.6  ±  3.3 Gy, respectively. The D _1cc values for the mandible were 51.3  ±  9.2 Gy, 61.6  ±  8.3 Gy, and 81.1  ±  16.7 Gy, respectively. The dose homogeneities in the CTVs into which the catheters had been inserted with the 3D-PSAG were always superior to those into which the catheters had been inserted without the 3D-PSAG. The present phantom study demonstrated the feasibility of more accurate interstitial tongue brachytherapy while simplifying the treatment process by utilizing the 3D-PSAG.

Comparison of treatment plans between IMRT with MR-linac and VMAT for lung SABR

Background

The aim of this study was to compare the plan quality of magnetic-resonance image-based intensity modulated radiation therapy (MRI-based-IMRT) with the MRIdian Linac system to that of volumetric modulated arc therapy (VMAT) with the TrueBeam STx system for lung stereotactic ablative radiotherapy (SABR).

Methods

A total of 22 patients with tumors located in the lower lobe were retrospectively selected for the study. For each patient, both the MRI-based-IMRT and VMAT plans were generated using an identical CT image set and identical structures with the exception of the planning target volume (PTV). The PTVs of the MRI-based-IMRT were generated by adding an isotropic margin of 3 mm from the gross tumor volume, whereas those of VMAT were generated by adding an isotropic margin of 5 mm from the internal target volume. For both the MRI-based-IMRT and VMAT, the prescription doses to the PTVs were 60 Gy in four fractions.

Results

The average PTV volume of the MRI-based-IMRT was approximately 4-times smaller than that of VMAT (p <  0.001). The maximum dose to the bronchi for the MRI-based-IMRT was smaller than that for the VMAT (20.4 Gy versus 24.2 Gy, p <  0.001). In addition, V_40Gy of the rib for the MRI-based-IMRT was smaller than that for the VMAT (1.8 cm³ versus 7.7 cm³, p = 0.008). However, the maximum doses to the skin and spinal cord for the MRI-based-IMRT (33.0 Gy and 14.5 Gy, respectively) were larger than those for the VMAT (27.8 Gy and 11.0 Gy, respectively) showing p values of less than 0.02. For the ipsilateral lung, the mean dose, V_20Gy, V_10Gy, and V_5Gy for the MRI-based-IMRT were smaller than those for the VMAT (all with p <  0.05). For the contralateral lung, V_5Gy, V_10Gy, D_1500cc, and D_1000cc for the MRI-based-IMRT were larger than those for the VMAT (all with p <  0.05). The mean dose and V_50% of the whole body for the MRI-based-IMRT were smaller than those for the VMAT (0.9 Gy versus 1.2 Gy, and 78.7 cm³ versus 103.5 cm³, respectively, all at p <  0.001).

Conclusions

The MRI-based-IMRT using the MRIdian Linac system could reduce doses to bronchi, rib, ipsilateral lung, and whole body compared to VMAT for lung SABR when the tumor was located in the lower lobe.

Remote afterloading patient-specific brachytherapy with liquid radioisotope for irradiation of extensive scalp lesions: A Monte Carlo study

PURPOSE

The aim of this study is to propose a remote afterloading patient-specific brachytherapy technique for total scalp irradiation by utilizing liquid radioisotope as well as a three-dimensional (3D) printer and to find an optimal radioisotope for the suggested technique.

METHODS

We designed a brachytherapy device composed of liquid radioisotope tank, tube, patient-specific applicator, and a thin flexible pouch. The liquid radioisotope tank, tube, and the flexible pouch are interconnected one another to constitute a closed loop system. The pouch is located inside the solid patient-specific applicator; therefore, when the liquid radioisotope is injected into the pouch, the pouch is inflated and fills the space inside the applicator. The 3D-printed patient-specific applicator keeps the uniform thickness of the liquid radioisotope conforming patient's contour. To investigate an optimum condition for the suggested system, we performed Monte Carlo simulation with the GEANT4 simulation toolkit. To find the optimal radioisotope, percent depth doses (PDDs) of P-32, Sr-89, Y-90, and I-125 solutions were acquired in a rectangular parallelepiped phantom. For the selected radiation source, PDDs as well as dose rates in spherical phantoms with radii of 7.7 cm (infant head size) and 9.1 cm (adult head size) were acquired.

RESULTS

To deliver prescription doses at 4-mm depth regions (scalp region), 1-mm-thick Y-90 and 5-mm-thick I-125 in liquid form were found to be feasible for the suggested technique. For both spherical phantoms with radii of 7.7 and 9.1 cm, when delivering 2 Gy at the 4-mm depth region with the 1-mm-thick Y-90 and 5-mm-thick I-125 sources, 53.3 and 3.8 Gy were delivered at the surface regions, respectively (delivery time = 111.1 and 3.5 min with 1 GBq/ml solutions). The PDDs of Y-90 and I-125 became less than 1% at depths greater than 8 and 50 mm, respectively.

CONCLUSIONS

The remote afterloading patient-patient specific brachytherapy with I-125 or Y-90 in liquid form seems feasible for total scalp irradiation.

Effect of changes in monitor unit rate and energy on dose rate of total marrow irradiation based on Linac volumetric arc therapy

Background

This study set out to evaluate the effect of dose rate on normal tissues (the lung, in particular) and the variation in the treatment efficiency as determined by the monitor unit (MU) and energy applied in Linac-based volumetric arc therapy (VMAT) total marrow irradiation (TMI).

Methods

Linac-based VMAT plans were generated for the TMI for six patients. The planning target volume (PTV) was divided into six sub-volumes, each of which had their own isocenter. To examine the effect of the dose rate and energy, a range of MU rates (40, 60, 80, 100, 300, and 600 MU/min) were selected for 6, 10, and 15 MV. All the plans were verified by portal dosimetry.

Results

The dosimetric parameters for the target and normal tissue were consistent in terms of the energy and MU rate. The beam-on time was changed from 59.6 to 6 min for 40 and 600 MU/min. When 40 MU/min was set for the lung, the dose rate delivered to the lung was less than 6 cGy/min (that is, 90%), while the beam-on time was approximately 10 min. The percentage volume of the lung receiving 20 cGy/min was 1.47, 3.94, and 6.22% at 6, 10, and 15 MV, respectively. However, for 600 MU/min, the total lung volume received over 6 cGy/min regardless of the energy, and over 20 cGy/min for 10 and 15 MV (i.e., 54.4% for 6 MV).

Conclusions

In TMI treatment, reducing the dose rate administered to the lung can decrease the incidence of pulmonary toxicity. To reduce the probability of normal tissue complications, the selection of the lowest MU rate is recommended for fields including the lung. To minimize the total treatment time, the maximum MU rate can be applied to other fields.

Electronic supplementary material

The online version of this article (10.1186/s13014-019-1296-y) contains supplementary material, which is available to authorized users.

Impact of plan parameters and modulation indices on patient-specific QA results for standard and stereotactic VMAT

PURPOSE

To demonstrate the impact of modulation indices and plan parameters on the gamma passing rates (GPR) of patient-specific quality assurance of standard and stereotactic volumetric modulated arc therapy (VMAT) plans.

METHODS

A total of 758 patients' QA plans were utilized, including standard VMAT plans with Trilogy (n = 87, group A) and TreuBeam STx (n = 332, group B), and 339 stereotactic VMAT plans with TrueBeam STx (group C). Modulation indices were obtained considering the speed and acceleration of the multileaf collimator (MLC) (MI_s, MI_a), and MLC, gantry speed, and dose rate changes (MI_t). The mean aperture size (MA), monitor unit (MU), and amount of jaw tracking (%JT) were acquired. Gamma analysis was performed with 2 mm/2% and 1 mm/2% for the standard and stereotactic VMAT plans, respectively. Statistical analyses were performed to investigate the correlation between modulation index/plan parameters and GPR.

RESULTS

Spearman's rank correlation to GPRs with MI_s, MI_a, and MI_t, were -0.44, -0.45, and -0.46 for group A; -0.39, -0.37, and -0.38 for group B; and -0.04, -0.11, and -0.10 for group C, respectively. While MU and MA showed significant correlations in all groups, %JT showed a significant correlation only with stereotactic VMAT plans. The most influential parameter combinations were MU-MA (r_s = 0.50), MI_s-%JT (r_s = 0.43), and MU-%JT (r_s = 0.38) for groups A, B, and C, respectively.

CONCLUSIONS

MLC modulation mostly affected the GPR in the delivery of standard VMAT plans, while MU and %JT showed more importance in stereotactic VMAT plans.

Modulation indices and plan delivery accuracy of volumetric modulated arc therapy

PURPOSE

We evaluated the performance of various modulation indices (MI) for volumetric modulated arc therapy (VMAT) to predict plan delivery accuracy.

METHODS

The specific indices evaluated were MI quantifying the mechanical uncertainty (MI_t ), MI quantifying the mechanical and dose calculation uncertainties (MI_c ), MI for station parameter optimized radiation therapy (MI_SPORT ), modulation complexity score for VMAT (MCS_v ), leaf travel modulation complexity score (LTMCS), plan averaged beam area (PA), plan averaged beam irregularity (PI), plan averaged beam modulation (PM), and plan normalized monitor unit (PMU) to predict VMAT delivery accuracy. By utilizing 240 VMAT plans generated with the Trilogy and TrueBeam STx, Spearman's rank correlation coefficients (r) were calculated between the MIs and measures of conventional methods.

RESULTS

For the Trilogy system, MI_c showed the highest r values with gamma passing rates (GPRs) (r = -0.624 with P < 0.001 for MapCHECK2 and r = -0.655 with P < 0.001 for ArcCHECK). For TrueBeam STx, MI_c also showed the highest r values with GPRs (r = -0.625 with P < 0.001 for the MapCHECK2 and r = -0.561 with P < 0.001 for the ArcCHECK). The MI_t and MI_c showed the highest r values to the MLC position errors for the Trilogy and TrueBeam STx systems (r = 0.770 with P < 0.001 and r = 0.712 with P < 0.001, respectively). The PA showed the highest percent of r values (P < 0.05) to differences in the dose-volume parameters between original VMAT plans and actual deliveries for the Trilogy systems (30.9%). Both the MI_t and MI_c showed the highest percent of r values (P < 0.05) to differences in the dose-volume parameters between original VMAT plans and actual deliveries for the TrueBeam STx systems (31.8%).

CONCLUSION

To comprehensively review the results, the MI_c showed the best performance to predict the VMAT delivery accuracy.

Effect of low magnetic field on single-diode dosimetry for clinical use

PURPOSE

To evaluate the effect of a low magnetic field (B-field, 0.35 T) on QED™ for clinical use.

METHODS

Black and Blue QED were irradiated using tri-Co-60 magnetic resonance image-guided radiation therapy systems with and without the B-field. For both detectors, angular dependence of the beam orientation was evaluated by rotating the gantry and detector in parallel and perpendicular directions to the B-field. Angular dependence betweenthe directions of both QED and B-field was also measured. Response on the depth and output factor of both detectors was investigated for parallel and perpendicular setups, respectively.

RESULTS

When Black QED was placed on a surface, detector response decreased by 1.8% and 4.5% for parallel and perpendicular setups, respectively, owing to the B-field. The angular dependence of the beam orientation was not affected by B-field for both detectors. There was a significant angular dependence between Black QED and B-field direction and for the Black QED when the gantry was rotated. Owing to the B-field, the detector response at 90° decreased by 2.4%, response of Black QED on the depth was changed only on the surface, and output factor of Black QED was changed only on the surface. The response of Blue QED was not affected by the B-field for all examined situations.

CONCLUSIONS

Using Black QED on a surface in the same position as that in the calibration requires some correction to the B-field. Blue QED does not require correction as it is not affected by the B-field.

Hepatoprotective Effect of Fresh Grape Juice Prepared by a Low-Speed Masticating Juicer in db/db Mice

This study investigated the hepatoprotective effect of fresh grape juice prepared using a low-speed masticating (LSM) juicer or a high-speed centrifugal (HSC) juicer in mice. Six-week-old db/db mice were fed on an AIN-93G diet or a diet containing 1% freeze-dried LSM or HSC grape juice for 7 weeks. Treatment with LSM grape juice significantly decreased hepatic triglycerides, serum aspartate transaminase activities, and homeostasis model assessment for insulin resistance values, whereas HSC juice did not significantly influence these parameters. The LSM grape juice showed higher antioxidant and anti-inflammatory activities than HSC juice. The benefits of LSM grape juice are probably due to a much higher proanthocyanidin content than that of HSC juice. These results suggest that LSM grape juice can exert hepatoprotective effects in db/db mice, partly through improving insulin resistance and promoting antioxidant and inflammatory activities.

Autumn olive (Elaeagnus umbellata Thunb.) berry reduces fasting and postprandial glucose levels in mice

BACKGROUND/OBJECTIVES

Fasting and postprandial hyperglycemia should be controlled to avoid complications of diabetes mellitus. This study investigated the effects of autumn olive (Elaeagnus umbellata Thunb.) berry (AOB) on fasting and postprandial hyperglycemia in mice.

MATERIALS/METHODS

In vitro α-glucosidase inhibitory effect of AOB was determined. Maltose solution (2 g/kg) with and without AOB extract at 500 mg/kg or acarbose at 50 mg/kg was orally administered to normal mice after overnight fasting and glucose levels were measured. To study the effects of chronic consumption of AOB, db/db mice received the basal diet or a diet containing AOB extract at 0.4% or 0.8%, or acarbose at 0.04% for 7 weeks. Blood glycated hemoglobin and serum glucose and insulin levels were measured. Expression of adiponectin protein in epididymal white adipose tissue was determined by Western blotting.

RESULTS

In vitro inhibitory effect of AOB extract on α-glucosidase was 92% as strong as that of acarbose. The AOB extract (500 mg/kg) or acarbose (50 mg/kg) significantly suppressed the postprandial rise of blood glucose after maltose challenge and the area under the glycemic response curve in normal mice. The AOB extract at 0.4% or 0.8% of diet or acarbose at 0.04% of diet significantly lowered levels of serum glucose and blood glycated hemoglobin and homeostasis model assessment for insulin resistance values in db/db mice. The expression of adiponectin protein in adipose tissue was significantly elevated by the consumption of AOB at 0.8% of diet.

CONCLUSIONS

Autumn olive (E. umbellata Thunb.) berry may reduce postprandial hyperglycemia by inhibiting α-glucosidase in normal mice. Chronic consumption of AOB may alleviate fasting hyperglycemia in db/db mice partly by inhibiting α-glucosidase and upregulating adiponectin expression.

Development of a Geant4-based independent patient dose validation system with an elaborate multileaf collimator simulation model

Despite the improvements in the dose calculation models of the commercial treatment planning systems (TPS), their ability to accurately predict patient dose is still limited. One of the limitations is caused by the simplified model of the multileaf collimator (MLC). The aim of this study was to develop a Monte Carlo (MC) method‐based independent patient dose validation system with an elaborate MLC model for more accurate dose evaluation. Varian Clinac 2300 IX was simulated using Geant4 toolkits, after which MC commissioning with measurements was performed to validate the simulation model. A DICOM‐RT interface was developed to obtain the beam delivery conditions including the hundreds of MLC motions. Finally, the TPS dose distributions were compared with the MC dose distributions for water phantom cases and a patient case. Our results show that the TPS overestimated the absolute abutting leakage dose in the closed MLC field, with about 20% more of the maximum dose than that of the MC calculation. For water phantom cases, the dose distributions inside the target region were almost identical with the dose difference of less than 2%, while the dose near the edge of the target shows difference about 10% between Geant4 and TPS due to geometrical differences in MLC model. For the patient analysis, the Geant4 and TPS doses of all organs were matched well within 1.4% of the prescribed dose. However, for organs located in areas with high ratio of leaf pairs with distances less than 10 mm leaf pair (LP_(<10mm)), the maximum dose of TPS was overestimated by about 3% of the prescribed dose. These dose comparison results demonstrate that our system for calculating the patient dose is quite accurate. Furthermore, if the MLC sequences in treatment plan have a large ratio of LP_(short), more than 3% dose difference in normal tissue could be seen.

Assessment of the modulation degrees of intensity-modulated radiation therapy plans

Background

To evaluate the modulation indices (MIs) for predicting the plan delivery accuracies of intensity-modulated radiation therapy (IMRT) plans.

Methods

A total of 100 dynamic IMRT plans that used TrueBeam STx and 102 dynamic IMRT plans that used Trilogy were selected. For each plan, various MIs were calculated, which included the modulation complexity score (MCS), plan-averaged beam area (PA), plan-averaged beam irregularity (PI), plan-averaged beam modulation (PM), MI quantifying multi-leaf collimator (MLC) speeds (MI_s), MI quantifying MLC acceleration (MI_a), and MI quantifying MLC acceleration and segment aperture irregularity (MI_c,IMRT). To determine plan delivery accuracy, global gamma passing rates, MLC errors of log files, and dose-volumetric parameter differences between original and log file-reconstructed IMRT plans were obtained. To assess the ability of each MI for predicting plan delivery accuracy, Spearman’s rank correlation coefficients (r_s) between MIs and plan delivery accuracy measures were calculated.

Results

PI showed moderately strong correlations with gamma passing rates in MapCHECK2 measurements of both TrueBeam STx and Trilogy (r_s = − 0.591 with p <  0.001 and − 0.427 with p <  0.001 to with gamma criterion of 2%/2 mm, respectively). For ArcCHECK measurements, PI also showed moderately strong correlations with the gamma passing rates in the ArcCHECK measurements of TrueBeam STx and Trilogy (r_s = − 0.545 with p <  0.001 and r_s = − 0.581 with p <  0.001 with gamma criterion of 2%/2 mm, respectively). The PI showed the second strongest correlation with MLC errors in both TrueBeam STx and Trilogy (r_s = 0.861 with p <  0.001 and r_s = 0.767 with p <  0.001, respectively). In general, the PI showed moderately strong correlations with every plan delivery accuracy measure.

Conclusions

The PI showed moderately strong correlations with every plan delivery accuracy measure and therefore is a useful predictor of IMRT delivery accuracy.

Electronic supplementary material

The online version of this article (10.1186/s13014-018-1193-9) contains supplementary material, which is available to authorized users.

Development and dosimetric assessment of a patient-specific elastic skin applicator for high-dose-rate brachytherapy

PURPOSE

The purpose of this study was to develop a patient-specific elastic skin applicator and to evaluate its dosimetric characteristics for high-dose-rate (HDR) brachytherapy.

METHODS AND MATERIALS

We simulated the treatment of a nonmelanoma skin cancer on the nose. An elastic skin applicator was manufactured by pouring the Dragon Skin (Smooth-On Inc., Easton, PA) with a shore hardness of 10A into an applicator mold. The rigid skin applicator was printed using high-impact polystyrene with a shore hardness of 73D. HDR plans were generated using a Freiburg Flap (FF) applicator and patient-specific rigid and elastic applicators. For dosimetric assessment, dose-volumetric parameters for target volume and normal organs were evaluated. Global gamma evaluations were performed, comparing film measurements and treatment planning system calculations with various gamma criteria. The 10% low-dose threshold was applied.

RESULTS

The V_120% values of the target volume were 56.9%, 70.3%, and 70.2% for HDR plans using FF, rigid, and elastic applicators, respectively. The maximum doses of the right eyeball were 21.7 Gy, 20.5 Gy, and 20.5 Gy for the HDR plans using FF, rigid, and elastic applicators, respectively. The average gamma passing rates were 82.5% ± 1.5%, 91.6% ± 0.8%, and 94.8% ± 0.2% for FF, rigid, and elastic applicators, respectively, with 3%/3 mm criterion.

CONCLUSIONS

Patient-specific elastic skin applicator showed better adhesion to irregular or curved body surfaces, resulting in better agreement between planned and delivered dose distributions. The applicator suggested in this study can be effectively implemented clinically.

Reliability of the gamma index analysis as a verification method of volumetric modulated arc therapy plans

BACKGROUND

We investigate the gamma passing rate (GPR) consistency when applying different types of gamma analyses, linacs, and dosimeters for volumetric modulated arc therapy (VMAT).

METHODS

A total of 240 VMAT plans for various treatment sites, which were generated with Trilogy (140 plans) and TrueBeam STx (100 plans), were retrospectively selected. For each VMAT plan, planar dose distributions were measured with both MapCHECK2 and ArcCHECK dosimeters. During the planar dose distribution measurements, the actual multileaf collimator (MLC) positions, gantry angles, and delivered monitor units were recorded and compared to the values in the original VMAT plans to calculate mechanical errors. For each VMAT plan, both the global and local gamma analyses were performed with 3%/3 mm, 2%/2 mm, 2%/1 mm, 1%/2 mm, and 1%/1 mm. The Pearson correlation coefficients (r) were calculated 1) between the global and the local GPRs, 2) between GPRs with the MapCHECK2 and the ArcCHECK dosimeters, 3) and between GPRs and the mechanical errors during the VMAT delivery.

RESULTS

For the MapCHECK2 measurements, strong correlations between the global and local GPRs were observed only with 1%/2 mm and 1%/1 mm (r > 0.8 with p < 0.001), while weak or no correlations were observed for the ArcCHECK measurement. Between the MapCHECK2 and ArcCHECK measurements, the global GPRs showed no correlations (all with p > 0.05), while the local GPRs showed moderate correlations only with 2%/1 mm and 1%/1 mm for TrueBeam STx (r > 0.5 with p < 0.001). Both the global and local GPRs always showed weak or no correlations with the MLC positional errors except for the GPRs of MapCHECK2 with 1%/2 mm and 1%/1 mm for TrueBeam STx and the GPR of ArcCHECK with 1%/2 mm for Trilogy (r < - 0.5 with p < 0.001).

CONCLUSIONS

The GPRs varied according to the types of gamma analyses, dosimeters, and linacs. Therefore, each institution should carefully establish their own gamma analysis protocol by determining the type of gamma index analysis and the gamma criterion with their own linac and their own dosimeter.