Rapid and sensitive parallel on-site detection of antibiotics and resistance genes in aquatic environments using evanescent wave dual-color fluorescence fiber-embedded optofluidic nanochip.

Environmental antibiotics and antibiotic resistance genes (ARGs) pose considerable threat to humans and animals; thus, the rapid and sensitive parallel detection of these pollutants from a single sample is urgently required. However, traditional multiplexed analytic technologies detect only one type of target (e.g., small molecules or nucleic acids) per assay. To address this issue, Evanescent wave Dual-color fluorescence Fiber-embedded Optofluidic Nanochip (EDFON) was fabricated by integrating a fiber-embedded optofluidic nanochip with evanescent wave dual-color fluorescence technology. The EDFON was used for the parallel quantitative detection of sulfamerazine (SMR) and MCR-1 with high sensitivity and specificity by combining a heterogeneous immunoassay with a homogenous hybridization chain reaction based on time-resolved effects. LODs of 0.032 µg/L and 35 pM was obtained for SMR and MCR-1, respectively, within 20 min. To our best knowledge, the EDFON is the first device for the simultaneous detection of two type of targets in each test, which is highly valuable to prevent the global threats of antibiotics and ARGs. Comparison with liquid chromatography-mass spectrometry showed a strong linear relationship (R2 = 0.998) for SMR pollution in the Qinghe River, with spiked SMR and MCR-1 negative surface and wastewater samples showing recovery rates of 91.8-113.4%. These results demonstrate the excellent accuracy and reliability of the EDFON, with features such as multi-analyte detection, field-deployment, and minimal-equipment, rendering it revolutionary for environmental monitoring, food safety, and medical diagnostics.

Efficacy and safety analysis of hypofractionated and conventional fractionated radiotherapy in postoperative breast cancer patients.

OBJECTIVES: In this meta-analysis, we conducted a comparative analysis of the safety and efficacy of hypofractionated and conventional fractionated radiotherapy in individuals who had undergone surgery for breast cancer. METHODS: This study involved a systematic and independent review of relevant research articles published in reputable databases such as PubMed, Embase, Cochrane Library, and Web of Science. Two investigators conducted the review, which included studies published up to January 3, 2023. The quality of the eligible studies was evaluated and data were extracted using Review Manager software 5.4 (RevMan 5.4) to calculate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: The analysis comprised 35 studies and encompassed a collective sample of 18,246 individuals diagnosed with breast cancer. We did not find a statistically significant disparity in efficacy between conventional fractionated (CF) radiotherapy and hypofractionated (HF) radiotherapy regarding local recurrence (LR; OR = 0.91, 95% CI: 0.76-1.09, P = 0.30), disease-free survival (DFS; OR = 1.20, 95% CI: 1.01-1.42, P = 0.03), and overall survival (OS; OR = 1.08, 95% CI: 0.93-1.26, P = 0.28). Concerning safety, there was no significant difference between the HF and CF regimens in terms of breast pain, breast atrophy, lymphedema, pneumonia, pulmonary fibrosis, telangiectasia, and cardiotoxicity. However, the HF regimen resulted in lower skin toxicity (OR = 0.43, 95% CI: 0.33-0.55, P < 0.01) and improved patient fatigue outcomes (OR = 0.73, 95% CI: 0.60 - 0.88, P < 0.01). CONCLUSIONS: Although there is no substantial difference in LR, DFS, OS, or many other side effects between the HF and CF regimens, the HF regimen reduces skin toxicity and relieves patient fatigue. If these two issues need to be addressed in clinical situations, the HF regimen may be a superior alternative to conventional radiotherapy in postoperative breast cancer patients.

Research of correlation between personality traits and hormones with the nature of pulmonary nodules.

Background: Rising rates of lung cancer screening have contributed to an increase in pulmonary nodule diagnosis rates. Studies have shown that psychosocial factors and hormones have an impact on the development of the oncological diseases. Therefore, we conducted this study to explore the potential relationship between pulmonary nodules pathology and patient personality traits and hormone levels. Methods: This study enrolled 245 individuals who had first been diagnosed with pulmonary nodules in Tangdu Hospital and admitted for surgery. The personality profile of these patients was analyzed on admission using the C-Type Behavioral Scale and hormone levels were measured in preoperative serum samples. Associations between nodule pathology, personality scores, and hormone levels， were then assessed through Statistical methods analysis. Results: Behavioral scale analyses revealed significant differences four items, including depression, anger outward, optimism, and social support (P< 0.05). Specifically, patients with higher depression scores were more likely to harbor malignant pulmonary nodules, as were patients with lower levels of anger outward, social support, and optimism. Univariate analyses indicated that nodule pathology was associated with significant differences in nodule imaging density, CT value, testosterone levels, and T4 levels(P< 0.05), and logistic regression analyses revealed pulmonary nodule imaging density and T4 levels to be significant differences of nodule pathology. Conclusion: The results showed a significant association between nodules pathology and the personality characteristics of the patients (depression, anger outward, optimism, social support), the patients' T4 levels and the imaging density of the nodules.

Cardiorespiratory dose comparison among six radiotherapy regimens for patients with left-sided breast cancer.

There is uncertainty regarding the benefits and drawbacks of various radiation protocols for the treatment of left-sided breast cancer. To address this issue, we conducted a Bayesian network analysis. First, we searched several electronic databases for eligible literature. Next, we pooled the data from twelve studies concerning three-dimensional conformal radiation therapy (3D-CRT), intensity modulated radiation therapy (IMRT), and volumetric modulated arc therapy (VMAT), combined with either deep inspiratory breath-holding (DIBH) or free-breathing (FB) modalities. The integrated cardiac and pulmonary dosimetric indexes for all included treatments were compared using Bayesian networks. A direct meta-analysis indicated that for the two methods of 3D-CRT and IMRT, DIBH technology was more effective than FB in reducing the radiation dose to the heart and lungs. Additionally, according to the network results, DIBH was superior to FB in all six treatment options, regardless of whether the plan was 3D-CRT, IMRT, or VMAT. Besides, the combined data indicated that the FB-3D-CRT regimen had the weakest dosimetric advantage of all the treatments. Excluding FB-3D-CRT, each of the other five treatments had its own specific benefits. This is the first Bayesian study of several radiotherapy regimens for breast cancer patients on the left side, and the findings can be used to select appropriate radiotherapy programs for breast cancer patients.

A method for selecting reference beam model of VMAT plans with three 6MV beam-matched linear accelerators during radiation oncology.

Our objective was to provide a method for selecting reference beam model and evaluating the dosimetric accuracy of volumetric modulated arc therapy (VMAT) plans delivered on three Elekta beam-matched linacs during radiation oncology. Beam data was measured on three beam-matched linacs including Synergy1, Synergy2 and VersaHD. For eighteen lung and esophagus cases, fifty-four plans were generated using VMAT technique with three linac beam models respectively for point dose measurement and three-dimensional dose measurement. Each VMAT plan was executed sequentially on three linacs respectively. Measurement results were compared with treatment planning system (TPS) calculation results for all VMAT plans. Among three beam-matched linacs, discrepancy in beam output factor, percentage depth dose at 5 cm, 10 cm, 20 cm depth and MLC leaf offset are all within 1% except 20 × 20 cm2 and 30 × 30 cm2 field sizes, and discrepancy in beam profile is all within 2%. With comparison between measurement result and TPS calculation result, the absolute dose deviations are within the range of ± 3%, and the gamma passing rates are all over 95% for all VMAT plans, which are within the tolerance of clinical acceptability. Compared with all plans delivered on Synegy1 and VersaHD, the point dose discrepancy between measured results and TPS calculated results for plans delivered on Synergy2 is smallest, and the gamma passing rate between measured results and TPS calculated results for plans delivered on Synergy2 is highest. The beam-matched linacs demonstrate good agreement between measurement result and TPS calculation result for VMAT plans. The method can be used for selecting reference beam model for VMAT plans.

PD-L1 exosomes electrochemical sensor based on coordination of AgNCs and Zr4+: Multivalent peptide enhancing target capture efficiency and antifouling performance.

Programmed death ligand 1 (PD-L1) exosomes are important biomarkers of immune activation in the initial stages of treatment and can predict clinical responses to PD-1 blockade in various cancer patients. However, traditional PD-L1 exosome bioassays face challenges such as high interface fouling in complex detection environments, limited detection specificity, and poor clinical serum applicability. Inspired by the multi-branched structure of trees, a biomimetic tree-like multifunctional antifouling peptide (TMAP)-assisted electrochemical sensor was developed for high-sensitivity exosomes detection. Multivalent interaction of TMAP significantly enhances the binding affinity of PD-L1 exosomes, thanks to the designed branch antifouling sequence, TMAPs antifouling performance is further improved. The addition of Zr4+ forms coordination bonds with the exosome's lipid bilayer phosphate groups to achieve highly selective and stable binding without interference from protein activity. The specific coordination between AgNCs and Zr4+ contributes to a dramatic change in the electrochemical signals, and lowing detection limit. The designed electrochemical sensor exhibited excellent selectivity and a wide dynamic response within the PD-L1 exosome concentration range from 78 to 7.8 × 107 particles/mL. Overall, the multivalent binding ability of TMAP and the signal amplification characteristics of AgNCs have a certain driving role in achieving clinical detection of exosomes.

Current strategies of plasmonic nanoparticles assisted surface-enhanced Raman scattering toward biosensor studies.

With the progressive nanofabrication technology, plasmonic nanoparticles (PNPs) have been increasingly deployed in the field of biosensing. PNPs have favorable biocompatibility, conductivity, and tunable optical properties. In addition, the localized surface plasmon resonance (LSPR) of PNPs plays a vital role in surface-enhanced Raman scattering (SERS). PNPs-based SERS biosensing enables wide-ranging applications for sensitive detection and high spatial and temporal resolution imaging. Numerous reviews of PNPs in the field of SERS biosensing highlight the fabrication or applications in one or more fields. However, the specific strategies for the SERS biosensor construction had not been summarized systematically. Thus, this work offers a comprehensive overview of SERS enhancement strategies based on PNPs, with a focus on SERS label-free detection along with label detection sensing construction, as well as its challenges and future trends.

Raspberry-Like Gold Nanoparticles Based On Nanoclusters Anchored on Cyclodextrin-Functionalized Nanoparticles: Synthesis and Ultrasensitive Electrochemical Detection of Chromium(VI) Ions.

A facile synthetic strategy is devised to construct raspberry like gold nanoparticles (RbNPs) formed by gold nanoclusters wrapped around ß-cyclodextrin functionalized gold nanoparticles (CD-AuNPs@AuNCs). An efficient and sensitive electrochemical sensor for the detection of Cr(VI) has been developed based on RbNPs. The sensing platform exhibits an excellent wide linear range (100 pg mL-1 to 10 µg mL-1 ), extremely low detection limit (40.91 fg mL-1 i. e. 0.79 pM), which may pave a new way to fabricate other ultrasensitive electrochemical sensors based on the designed RbNPs.

Effects of probiotic supplementation on related side effects after chemoradiotherapy in cancer patients.

Objectives: Chemotherapy and radiotherapy generally cause serious adverse side effects in cancer patients, thereby affecting subsequent treatment. Numerous studies have shown that taking probiotics is an option for preventing and treating these side effects. In this investigation, a meta-analysis of the effects of oral probiotics on side effects brought on by radiotherapy, chemotherapy, or chemoradiotherapy treatment will be carried out. Methods: Two researchers independently and carefully reviewed all pertinent studies that were published before June 30, 2022 and were accessible on PubMed, Embase, Cochrane Library, and the Web of Science. Moreover, the Cochrane Collaboration's Tool was used to evaluate the risk of bias. Utilizing Review Manager software version 5.4, data were retrieved from eligible studies to evaluate their merits and determine odds ratios (OR) and 95% confidence intervals (CIs) (RevMan 5.4). Results: 2 097 patients from 16 randomized controlled trials were extracted, and standard meta-analysis methods were used to examine the data. Compared with the placebo groups, oral probiotics significantly reduced the side effects caused by radiotherapy and chemotherapy on various types of cancer, such as head and neck cancer, pelvic and abdominal cancer, breast cancer, lung cancer, etc. (OR: 0.31, 95% CI: 0.20 - 0.48; P < 0.005). Further analysis found that the incidence of diarrhea in patients with pelvic and abdominal cancers (OR: 0.32, 95% CI: 0.16 - 0.65; P < 0.005) and the frequency of oral mucositis in patients with head and neck tumors were also significantly lower (OR: 0.28, 95% CI: 0.18 - 0.43; P < 0.005) after the oral administration of probiotics. This suggests that probiotics have a positive influence on the treatment of side effects after chemoradiotherapy. Additionally, a funnel plot revealed that there was no significant publication bias in this study. Conclusions: Probiotics may help to reduce the occurrence of cancer therapy-related side effects, especially oral mucositis in head and neck tumors and diarrhea in patients with pelvic and abdominal tumors. However, given the small number of clinical trials involved, additional randomized, double-blind, multicentric trials in a larger population are required. This paper may assist researchers in improving trial design in the selection of probiotic strains and selecting appropriate patients who may benefit from probiotic treatments.

Nanozyme-based cascade SPR signal amplification for immunosensing of nitrated alpha-synuclein.

A self-assembled nanozyme of iron porphyrin mediated supramolecular modified gold nanoparticles (FpA) was fabricated to determine nitrated alpha-synuclein as the Tyr 39 residue (nT39 α-Syn) of a potential biomarker for early diagnosis of Parkinson's disease (PD). Mechanically, localized surface plasmon resonance (LSPR) and the mass effect caused by catalytic deposition of the nanozyme contributed to a cascade signal amplification strategy. The sensor allowed a signal amplification and selective nT39 α-Syn bioanalysis with a 1.34-fold enhancement by cascade amplified SPR signal and double specific recognition. The detection limit was 1.78 ng/mL in the detection range of 7-240 ng/mL. Benefiting from the excellent immunosensor, this method can distinguish healthy people and PD patients using actual samples. Overall, this strategy provides a nanozyme-based biosensing platform for the early diagnosis of PD and can be applied to detect other protein biomarkers, such as PD-L1.

The clinical evaluation of atlas-based auto-segmentation for automatic contouring during cervical cancer radiotherapy.

Purpose: Our purpose was to investigate the influence of atlas library size and CT cross-slice number on the accuracy and efficiency of the atlas-based auto-segmentation (ABAS) method for the automatic contouring of clinical treatment volume (CTV) and organs at risk (OARs) during cervical cancer radiotherapy. Methods: Of 140 cervical cancer patients, contours from 20, 40, 60, 80, 100, and 120 patients were selected incrementally to create six atlas library groups in ABAS. Another 20 tested patients were automatically contoured with the ABAS method and manually contoured by the same professional oncologist. Contours included CTV, bladder, rectum, femoral head-L, femoral head-R, and spinal cord. The CT cross-slice numbers of the 20 tested patients included 61, 65, 72, 75, 81, and 84. The index of dice similarity coefficients (DSCs) and Hausdorff distance (HD) were used to assess the consistency between ABAS automatic contouring and manual contouring. The randomized block analysis of variance and paired t-test were used for statistical analysis. Results: The mean DSC values of "CTV, bladder, femoral head, and spinal cord" were all larger than 0.8. The femoral head and spinal cord showed a high degree of agreement between ABAS automatic contouring and manual contouring, with a mean DC >0.80 and HD <1 cm in all atlas library groups. A post-hoc least significant difference comparison indicated that no significant difference had been found between different atlas library sizes with DSC and HD values. For ABAS efficiency, the atlas library size had no effect on the time of ABAS automatic contouring. The time of automatic contouring increased slightly with the increase in CT cross-slice numbers, which were 99.9, 106.8, 114.0, 120.6, 127.9, and 134.8 s with CT cross-slices of 61, 65, 72, 75, 81, and 84, respectively. Conclusion: A total of 20 atlas library sizes and a minimum CT cross-slice number including CTV and OARs are enough for ensuring the accuracy and efficiency of ABAS automatic contouring during cervical cancer radiotherapy.

Immobilization for Lipase: Enhanced Activity and Stability by Flexible Combination and Solid Support.

In this study, an enhanced activity and stability method for immobilizing porcine pancreatic lipase (PPL) was developed based on ZIF-8 encapsulated supramolecular-modified gold nanoparticle complexes (pSC4-AuNPs@ZIF-8). Supramolecular calix[4]arene (pSC4) can recognize the amino group of PPL through non-covalent force, and this flexible binding method protected the structure of PPL during the immobilization process. Due to the hydrophilic of pSC4-AuNPs and hydrophobic of ZIF-8, PPL can maintain a "lid open" conformation, which can enhance the stability of PPL structure and reduce PPL activity loss. ZIF-8 was used to immobilize PPL to avoid the difficult recovery of free PPL. Compared with the native form of PPL, it exhibited 70.6% maintained activity with terrific pH and temperature stability, and had good performance in thermal stability, time stability, and reusability. In addition, three immobilized PPL methods were designed to further clarify the influence of synthetic methods and additives on the activity and stability of PPL. Importantly, the loading rate of pSC4-AuNPs@ZIF-8@PPL was up to 51.2% among these immobilized PPL systems. Therefore, pSC4-AuNPs@ZIF-8 may serve as a versatile and promising immobilization system for enzymes.

Comparison of Deep Inspiration Breath Hold Versus Free Breathing in Radiotherapy for Left Sided Breast Cancer.

Objectives: Modern breast cancer techniques, such as the deep inspiration breath-hold (DIBH) technique has been applied for left-sided breast cancer. Whether the DIBH regimen is the optimal solution for left-sided breast cancer remains unclear. This meta-analysis aims to elucidate the differences of DIBH and free-breathing (FB) for patients receiving radiotherapy for left-sided breast cancer and provide a practical reference for clinical practice. Methods: Relevant research available on PubMed, Embase, Cochrane Library, and the Web of Science published before November 30, 2021 was independently and systematically examined by two investigators. Data were extracted from eligible studies for assessing their qualities and calculating the standardized mean difference (SMD) and 95% confidence intervals (CIs) using Review Manager software 5.4 (RevMan 5.4). Results: Forty-one studies with a total of 3599 left-sided breast cancer patients were included in the meta-analysis. Compared with FB, DIBH reduced heart dose (D mean, D max, V30, V10, V5), left anterior descending branch (LAD) dose (D mean, D max), ipsilateral lung dose (D mean, V20, V10, V5), and heart volume significantly. Lung volume increased greatly, and a statistically significant difference. For contralateral breast mean dose, DIBH has no obvious advantage over FB. The funnel plot suggested this study has no significant publication bias. Conclusions: Although DIBH has no obvious advantage over FB in contralateral breast mean dose, it can significantly reduce heart dose, LAD dose, ipsilateral lung dose, and heart volume. Conversely, it can remarkably increase the ipsilateral lung volume. This study suggests that soon DIBH could be more widely utilized in clinical practice because of its excellent dosimetric performance.

How to ensure uninterrupted treatment of radiotherapy patients during delta variants of SARS-CoV-2 virus epidemic: the latest experience from Xi'an, China.

This letter is some reflections on the articles by Lee et al. that have been published in MEDICAL ONCOLOGY. In this article, the experience of transferring, screening, and uninterrupted treatment of cancer patients in our radiotherapy center during Delta Variants of SARS-CoV-2 virus epidemic in Xi'an, China is presented in the form of a flowchart. By taking effective control measures, the radiotherapy center has not only effectively prevented the spread of the virus, but also ensured uninterrupted treatment for all patients. Therefore, we quickly share our center's experience so that more radiotherapy patients can benefit.

Aptamer-Assisted Protein Orientation on Silver Magnetic Nanoparticles: Application to Sensitive Leukocyte Cell-Derived Chemotaxin 2 Surface Plasmon Resonance Sensors.

Leukocyte cell-derived chemotaxin 2 (LECT2) has been proved to be a potential biomarker for the diagnosis of liver fibrosis. In this work, a sensitive surface plasmon resonance (SPR) assay for LECT2 analysis was developed. Tyrosine kinase with immune globulin-like and epidermal growth factor-like domains 1 (Tie1) is an orphan receptor of LECT2 with a C-terminal Fc tag, which is far away from the LECT2 binding sites. The Fc aptamer was intentionally used to capture the Tie1 through its Fc tag, connecting with Fe3O4-coated silver magnetic nanoparticles (Ag@MNPs) and ensuring the LECT2 binding site to be outward. Attributed to the orientation nature of the captured protein, Ag@MNPs were able to enhance the SPR signal. A sensitive LECT2 sensor was successfully fabricated with a detection limit of 10.93 pg/mL. The results showed that the immobilization method improved the binding efficiency of Tie1 protein. This strategy could be extended to attach antibodies or recombinant Fc label proteins to Fc aptamer-based nanoparticles.

Comparison of therapeutic efficacy and toxicity of docetaxel, cisplatin, and fluorouracil (TPF)-based induction chemotherapy plus concurrent chemoradiotherapy and chemoradiotherapy alone in locally advanced nasopharyngeal carcinoma.

PURPOSE: In recent years, docetaxel, cisplatin, and fluorouracil (TPF)-based induction chemotherapy plus concurrent chemoradiotherapy (CCRT) has been commonly applied for locally advanced nasopharyngeal carcinoma (LA-NPC). However, whether TPF+CCRT regimen is the best choice for LA-NPC remains unclear. This meta-analysis aims to elucidate and compare the efficacy and toxicity of TPF+CCRT versus CCRT alone for LA-NPC. METHODS: Two investigators independently and systematically searched relevant studies available on PubMed, Embase, Cochrane Library, and Web of Science published before January 7, 2021. Data were extracted from eligible studies for assessing their qualities, and calculating pooled hazard ratios (HR), odds ratio (OR) and 95% confidence intervals (CI) using Review Manager software 5.3 (RevMan 5.3). RESULTS: Five studies involving 759 LA-NPC patients were analyzed in the meta-analysis. Compared to CCRT alone, TPF-based IC plus CCRT significantly improved overall survival (OS) (HR = 0.53, 95% CI: 0.35-0.81, P = .003), progression-free survival (PFS) (HR = 0.63, 95% CI: 0.46-0.86, P = .004), distant metastasis-free survival (DMFS) (HR = 0.58, 95% CI: 0.39-0.86, P = .008), and locoregional failure-free survival (LRFFS) (HR 0.62, 95% CI: 0.43-0.90, P = .01). In addition, TPF-based IC plus CCRT mainly increased risks of grade 3/4 acute hematological toxicity and non-hematological toxicities like leukopenia (OR = 1.84, 95% CI: 0.42-8.03, P = .42), neutropenia (OR = 1.78, 95% CI: 0.23-13.82, P = .58), thrombocytopenia (OR = 1.76, 95% CI: 0.53-5.81, P = .35), febrile neutropenia (OR = 2.76, 95% CI: 0.07-101.89, P = .58), vomiting (OR = 18.94, 95% CI: 0.99-362.02, P = .05) and dry mouth (OR = 2.23, 95% CI: 0.22-22.57, P = .50), which were uncomplicated and manageable. CONCLUSIONS: TPF + CCRT is superb than CCRT alone for the management of LA-NPC. However, TPF+CCRT increases the incidences of grade 3/4 acute hematological toxicity and some non-hematological toxicities.

Using 4DCBCT simulation and guidance to evaluate inter-fractional tumor variance during SABR for lung tumor within the lower lobe.

Inter-fractional tumor variance would lead to insufficient dosage or overdose in tumor region during lung cancer radiotherapy. However, previous works have not considered influence of inter-fractional tumor amplitude variance at treatment position due to lack of effective evaluation method during radiotherapy, especially for lung tumor within the lower lobe. Our objective was to investigate inter-fractional tumor baseline shift and amplitude variance due to respiratory motion with 4DCBCT simulation and guidance during stereotactic ablative body radiotherapy (SABR) for lung tumor. Subject included 19 patients with lung tumor within the lower lobe. 4DCBCT-simulated images at treatment position were acquired sequentially to determine internal tumor volume (ITV) and reference tumor motion at simulation process. Compared with reference tumor motion, 95 4DCBCT-guided images were acquired during each treatment to evaluate inter-fractional tumor baseline shift and amplitude variance, which were - 0.0 ± 1.3 mm and - 0.2 ± 1.4 mm in left-right(LR) direction, 0.9 ± 2.3 mm and 0.4 ± 2.9 mm in superior-inferior (SI) direction, 0.1 ± 1.5 mm and - 0.4 ± 2.0 mm in anterior-posterior (AP) direction. ITV margin were 3.5 mm, 7.5 mm and 5.3 mm in LR, SI and AP directions with van Herk's (Int J Radiat Oncol Biol Phys 52(5):1407-1422, 2002) formula. 4DCBCT simulation and guidance is a reliable method to evaluate inter-fractional tumor variance during SABR for lung tumor within the lower lobe. ITV margin of 3.5 mm, 7.5 mm and 5.3 mm in LR, SI and AP directions would ensure greater tumor coverage during SABR for lung tumor within the lower lobe.