Physical and Engineering Sciences in Medicine最新文献

Contrast-enhanced mammography is being increasingly implemented clinically, providing much improved contrast between tumour and background structures, particularly in dense breasts. Although CEM is similar to conventional mammography it differs via an additional exposure with high energy X-rays (≥ 40 kVp) and subsequent image subtraction. Because of its special operational aspects, the CEM aspect of a CEM unit needs to be uniquely characterised and evaluated. This study aims to verify the utility of a commercially available phantom set (BR3D model 020 and CESM model 022 phantoms (CIRS, Norfolk, Virginia, USA)) in performing key CEM performance tests (linearity of system response with iodine concentration and background subtraction) on two models of CEM units in a clinical setting. The tests were successfully performed, yielding results similar to previously published studies. Further, similarities and differences in the two systems from different vendors were highlighted, knowledge of which may potentially facilitate optimisation of the systems.

The volumetric reduction rate (VRR) was evaluated with consideration for six degrees-of-freedom (6DoF) patient setup errors based on a mathematical tumor model in single-isocenter volumetric modulated arc therapy (SI-VMAT) for brain metastases. Simulated gross tumor volumes (GTV) of 1.0 cm and dose distribution were created (27 Gy/3 fractions). The distance between the GTV center and isocenter (d) was set at 0-10 cm. The GTV was translated within 0-1.0 mm (Trans) and rotated within 0-1.0° (Rot) in the three axis directions using affine transformation. The tumor growth volume was calculated using a multicomponent mathematical model (MCTM), and lethal effects of irradiation and repair from damage during irradiation were calculated by a microdosimetric kinetic model (MKM) for non-small cell lung cancer (NSCLC) A549 and NCI-H460 (H460) cells. The VRRs were calculated 5 days after the end of irradiation using the physical dose to the GTV for varying d and 6DoF setup errors. The tolerance value of VRR, the GTV volume reduction rate, was set at 5%, based on the pre-irradiation GTV volume. With the exception of the only one A549 condition where (Trans, Rot) = (1.0 mm, 1.0°) was repeated for 3 fractions, all conditions met all the tolerance VRR values for A549 and H460 cells with varying d from 0 to 10 cm. Evaluation based on the mathematical tumor model suggested that if the 6DoF setup errors at each irradiation could be kept within 1.0 mm and 1.0°, there would be little effect on tumor volume regardless of the distance from the isocenter in SI-VMAT.

The gamma probe is a commonly used detector for localizing sentinel lymph nodes after the injection of radiopharmaceuticals. In recent years, studies have focused on improving the features of gamma probes to achieve more consistent localization of the radiotracer uptake. As part of this effort, a novel gamma probe prototype based on an active shielding was developed, and its characteristics, including sensitivity, resolution and shielding effectiveness, were determined. The prototype integrates trapezoidal-shaped bismuth germanate (BGO) array coupled with a silicon photomultiplier (SiPM) array, accompanied by dedicated electronics and software for stand alone usage. We conducted a thorough characterization, validating experimental observations through Monte Carlo simulations using the GEANT4 simulation package. In scattering environment, with a probe-source distance of 30 mm, the experimental results show that the detector sensitivity is $120\pm 5$ cps/MBq, and the spatial and angular resolutions, in terms of full width at half maximum (FWHM), are $44.8\pm 1.3$ mm and $87.3\pm 1.5^{\circ }$ , respectively. The shielding effectiveness of the probe was determined to be greater than 95 $\%$ . The prototype with active shielding was found to have comparable performance to conventional gamma probes.

A novel phantom for measuring the 10% and 50% values of the modulation transfer function (MTF) for computed tomography scanners (CT) was investigated. The phantom was constructed by drilling rows of holes of different sizes and frequencies into a small block of polymethyl methacrylate (PMMA). The MTF at a given frequency was determined from the ratio of the range of Hounsfield units within the rows of holes at different frequencies, and the difference in Hounsfield units between air and PMMA. A MTF curve was plotted from measurements at different frequencies and the 10% and 50% MTF values were obtained from a cubic spline interpolation. The MTF results obtained with the drilled hole phantom method were compared to a conventional method - using a thin wire and Spice-CT ImageJ Plugin- and with identical acquisition and reconstruction parameters. The drilled hole phantom measured the 50% MTF with reasonable accuracy but underestimated the 10% MTF by 8.2% on average. MTF measurements were reproducible for repeated image acquisitions and with different users analysing the images, and the phantom was able to accurately measure the change in MTF when measured on images using different reconstruction kernels. The tool may find application as a cheap, easy to use method for routine QC testing of CT scanners.

Increasingly, interventional thoracic workflows utilize cone-beam CT (CBCT) to improve navigational and diagnostic yield. Here, we investigate the feasibility of implementing free-breathing 4D respiratory CBCT for motion mitigated imaging in patients unable to perform a breath-hold or without suspending mechanical ventilation during thoracic interventions. Circular 4D respiratory CBCT imaging trajectories were implemented on a clinical robotic CBCT system using additional real-time control hardware. The circular trajectories consisted of 1 × 360° circle at 0° tilt with fixed gantry velocities of 2°/s, 10°/s, and 20°/s. The imaging target was an in-house developed anthropomorphic breathing thorax phantom with deformable lungs and 3D-printed imaging targets. The phantom was programmed to reproduce 3 patient-measured breathing traces. Following image acquisition, projections were retrospectively binned into ten respiratory phases and reconstructed using filtered back projection, model-based, and iterative motion compensated algorithms. A conventional circular acquisition on the system of the free-breathing phantom was used as comparator. Edge Response Width (ERW) of the imaging target boundaries and Contrast-to-Noise Ratio (CNR) were used for image quality quantification. All acquisitions across all traces considered displayed visual evidence of motion blurring, and this was reflected in the quantitative measurements. Additionally, all the 4D respiratory acquisitions displayed a lower contrast compared to the conventional acquisitions for all three traces considered. Overall, the current implementation of 4D respiratory CBCT explored in this study with various gantry velocities combined with motion compensated algorithms improved image sharpness for the slower gantry rotations considered (2°/s and 10°/s) compared to conventional acquisitions over a variety of patient traces.

The aim of this study was to evaluate the point doses using a distribution of the size-specific dose estimate (SSDE) from axial CT images of in-house phantoms having diameters from 8 to 40 cm. In-house phantoms made of polyester-resin (PESR) mixed with methyl ethyl ketone peroxide (MEKP) were used. The phantoms were built with different diameter sizes of 8, 16, 24, 32, and 40 cm. The phantoms were scanned by Siemens a SOMATOM Perspective-128 slice CT scanner with constant input parameters. The point doses were interpolated from the central SSDE (SSDEc) and the peripheral SSDE (SSDEp). The SSDEc and SSDEp were calculated from the SSDE with h- and k-factors. The point doses were compared to the direct measurements using the nanoDot™ optically-stimulated luminescence dosimeter (OSLD) in dedicated holes on the phantoms. It was found that the point dose decreases as the phantom diameter increased. The doses obtained using two approaches differed by 11% on average. The highest difference was 40% and the lowest difference was < 1%. It was found that dose based on the SSDE concept tended to be higher compared to the measured dose by OSLD. Point dose estimation using the concept of SSDE distribution can be considered an alternative for accurate and simple estimation. This approach still requires improvements to increase its accuracy and its application to estimate the organ dose needs further investigation.

The treatment, planning, simulation, and setup of radiotherapy patients contain many processes subject to errors involving both staff and equipment. Cone-beam-CT (CBCT) provides a final check of patient positioning and corrections based on this can be made prior to treatment delivery. Statistical Process Control (SPC) techniques are used in various industries for quality management and error mitigation. The utility of SPC techniques to monitor process and equipment changes in our Head and Neck patient treatments was assessed by application to CBCT results from a quality-focused longitudinal study. Individuals and moving range (XmR) as well as exponentially-weighted moving average (EWMA) techniques were explored. The SPC techniques were sensitive to process changes and trends over the 12 years of data collected. A reduction in the random component of patient setup errors needing correction was observed. Systematic components of error remained more stable. An uptick in both datasets was observed correlating with the COVID-19 pandemic. Process control limits for use in prospective process monitoring were established. Challenges that arose from using SPC techniques in a retrospective study are outlined.

In the realm of high-intensity focused ultrasound (HIFU) therapy, the precise prediction of lesion size during treatment planning remains a challenge, primarily due to the difficulty in quantitatively assessing energy deposition at the target site and the acoustic properties of the tissue through which the ultrasound wave propagates. This study investigates the hypothesis that the echo amplitude originating from the focus is indicative of acoustic attenuation and is directly related to the resultant lesion size. Echoes from multi-layered tissues, specifically porcine tenderloin and bovine livers, with varying fat thickness from 0 mm to 35 mm were collected using a focused ultrasound (FUS) transducer operated at a low power output and short duration. Subsequent to HIFU treatment under clinical conditions, the resulting lesion areas in the ex vivo tissues were meticulously quantified. A novel treatment strategy that prioritizes treatment spots based on descending echo amplitudes was proposed and compared with the conventional raster scan approach. Our findings reveal a consistent trend of decreasing echo amplitudes and HIFU-induced lesion areas with the increasing fat thickness. For porcine tenderloin, the values decreased from 2541.7 ± 641.9 mV and 94.4 ± 17.9 mm² to 385(342.5) mV and 24.9 ± 18.7 mm², and for bovine liver, from 1406(1202.5) mV and 94.4 ± 17.9 mm² to 502.1 ± 225.7 mV and 9.4 ± 6.3 mm², respectively, as the fat thickness increases from 0 mm to 35 mm. Significant correlations were identified between preoperative echo amplitudes and the HIFU-induced lesion areas (R = 0.833 and 0.784 for the porcine tenderloin and bovine liver, respectively). These correlations underscore the potential for an accurate and dependable prediction of treatment outcomes. Employing the proposed treatment strategy, the ex vivo experiment yielded larger lesion areas in bovine liver at a penetration depth of 8 cm compared to the conventional approach (58.84 ± 17.16 mm² vs. 44.28 ± 15.37 mm², p < 0.05). The preoperative echo amplitude from the FUS transducer is shown to be a reflective measure of acoustic attenuation within the wave propagation window and is closely correlated with the induced lesion areas. The proposed treatment strategy demonstrated enhanced efficiency in ex vivo settings, affirming the feasibility and accuracy of predicting HIFU-induced lesion size based on echo amplitude.

Particle (proton, carbon ion, or others) radiotherapy for ocular tumors is highly dependent on precise dose distribution, and any misalignment can result in severe complications. The proposed eye positioning and tracking system (EPTS) was designed to non-invasively position eyeballs and is reproducible enough to ensure accurate dose distribution by guiding gaze direction and tracking eye motion. Eye positioning was performed by guiding the gaze direction with separately controlled light sources. Eye tracking was performed by a robotic arm with cameras and a mirror. The cameras attached to its end received images through mirror reflection. To maintain a light weight, certain materials, such as carbon fiber, were utilized where possible. The robotic arm was controlled by a robot operating system. The robotic arm, turntables, and light source were actively and remotely controlled in real time. The videos captured by the cameras could be annotated, saved, and loaded into software. The available range of gaze guidance is 360° (azimuth). Weighing a total of 18.55 kg, the EPTS could be installed or uninstalled in 10 s. The structure, motion, and electromagnetic compatibility were verified via experiments. The EPTS shows some potential due to its non-invasive wide-range flexible eye positioning and tracking, light weight, non-collision with other equipment, and compatibility with CT imaging and dose delivery. The EPTS can also be remotely controlled in real time and offers sufficient reproducibility. This system is expected to have a positive impact on ocular particle radiotherapy.

Immunotherapy is a rapidly evolving field, with many models attempting to describe its impact on the immune system, especially when paired with radiotherapy. Tumor response to this combination involves a complex spatiotemporal dynamic which makes either clinical or pre-clinical in vivo investigation across the resulting extensive solution space extremely difficult. In this review, several in silico models of the interaction between radiotherapy, immunotherapy, and the patient's immune system are examined. The study included only mathematical models published in English that investigated the effects of radiotherapy on the immune system, or the effect of immuno-radiotherapy with immune checkpoint inhibitors. The findings indicate that treatment efficacy was predicted to improve when both radiotherapy and immunotherapy were administered, compared to radiotherapy or immunotherapy alone. However, the models do not agree on the optimal schedule and fractionation of radiotherapy and immunotherapy. This corresponds to relevant clinical trials, which report an improved treatment efficacy with combination therapy, however, the optimal scheduling varies between clinical trials. This discrepancy between the models can be attributed to the variation in model approach and the specific cancer types modeled, making the determination of the optimum general treatment schedule and model challenging. Further research needs to be conducted with similar data sets to evaluate the best model and treatment schedule for a specific cancer type and stage.