Testing of an enhanced leaf model for improved dose calculation in a commercial treatment planning system.

BACKGROUND: With the ever-increasing complexity of dynamic radiotherapy treatments, dose calculation algorithms are challenged to accurately calculate the dose resulting from small, on- and off-axis multileaf collimator (MLC) aperture movements. Although the currently available Eclipse (Varian Medical Systems, Palo Alto) dose calculation algorithms still use a simplified, binary MLC model, a more advanced and detailed modeling of the MLC could be beneficial for the dose calculation precision of high-end treatments. PURPOSE: To improve the modeling of the MLC in the dose calculation algorithms of the Eclipse treatment planning system, an enhanced MLC attenuation model was constructed through ray tracing through the actual leaf designs for the most commonly used Varian MLC types. The enhanced leaf model (ELM) thus includes the rounded leaf tip shape, the drive screw cutout, and the leaf body thickness. The purpose of this work is to test out this new model and explore possible improvements compared to the previous model. METHODS: Dose calculations were performed in a research Eclipse environment equipped with the original and enhanced MLC model. Measurements were performed on TrueBeam and on Halcyon dual MLC treatment units. Dedicated static and dynamic MLC test plans were designed to challenge the dose calculation and highlight differences between both models while keeping the experimental setup simple in order to minimize measurement uncertainties. Measurements were performed with single ion chambers, 2D ion chamber arrays and film. RESULTS: The improved MLC model considerably improves the accuracy of the dose calculation for the test fields used in this study. For the TrueBeam MLC, improvements are most prominent for off-axis dose delivery through narrow (static or dynamic) MLC gaps. For 3 mm narrow sweeping gap deliveries at 12 cm off-axis, the advanced model agrees within 2% with the measurement, in contrast to the 12% deviation observed with the original MLC model. For the Halcyon MLC, improvements are especially prominent when the leaves of both MLC stacks are aligned, regardless of their position in the field. Sweeping gap measurements improve from a 7%-10% deviation with the original model to within 2% with the new model. CONCLUSIONS: Although test fields designed in this study emphasize the flaws in the original MLC dose calculation model, the enhanced MLC model resolves all of the observed discrepancies, showing excellent on- and off-axis agreements with all of the performed measurements.

Disease burden caused by respiratory syncytial virus compared with influenza among adults: a retrospective cohort study from Eastern Finland in 2017-2018.

OBJECTIVES: Respiratory syncytial virus (RSV) is one of the most important causes of lower respiratory tract illnesses. In this study, we examined the number and severity of RSV infections among adult patients. The underlying diseases and background information of patients with RSV were examined and compared with the patients with influenza. DESIGN: Retrospective cohort study. SETTING: Patients receiving tertiary care services in Kuopio University Hospital (KUH) district in Eastern Finland. PARTICIPANTS: 725 patients (152 with RSV infection and 573 with influenza) treated in KUH between November 2017 and May 2018. PRIMARY AND SECONDARY OUTCOME MEASURES: Hospitalisation and mortality. RESULTS: Compared with influenza, RSV caused a more serious disease in terms of hospitalisation (84.2% vs 66.0%, p<0.001), incidence of pneumonia (37.5% vs 23.2%, p<0.001), need for antibiotics (67.1% vs 47.3%, p<0.001) and supplemental oxygen (50.7% vs 31.2%, p<0.001). The all-cause mortality during hospitalisation and 30 days after discharge was higher among the RSV-infected patients (8.6% vs 3.5%, p=0.010). Solid malignancies (23.1% vs 5.0%, p=0.042) and chronic kidney disease (30.8% vs 5.8%, p=0.011) were more common among the RSV-infected non-survivors compared with survivors. RSV was an independent risk factor for hospitalisation (adjusted OR (aOR) 2.035; 95% CI 1.17 to 3.55) and mortality (aOR 2.288; 95% CI 1.09 to 4.81) compared with influenza. CONCLUSIONS: Among all the screened patients, those with RSV infection were older and had more underlying conditions than patients with influenza. They had increased likelihood of hospitalisation and mortality when compared with influenza. Solid malignancies and chronic kidney disease seemed to be independent risk factors for death among RSV-infected patients. During RSV and influenza epidemics, it is important to test patients with respiratory symptoms for RSV and influenza to prevent the spread of the infections among elderly and chronically ill patients.

Experience in commissioning the halcyon linac.

PURPOSE: This manuscript describes the experience of two institutions in commissioning the new HalcyonTM platform. Its purpose is to: (a) validate the pre-defined beam data, (b) compare relevant commissioning data acquired independently by two separate institutions, and (c) report on any significant differences in commissioning between the Halcyon linear accelerator and other medical linear accelerators. METHODS: Extensive beam measurements, testing of mechanical and imaging systems, including the multi-leaf collimator (MLC), were performed at the two institutions independently. The results were compared with published recommendations as well. When changes in standard practice were necessitated by the design of the new system, the efficacy of such changes was evaluated as compared to published approaches (guidelines or vendor documentation). RESULTS: Given the proper choice of detectors, good agreement was found between the respective experimental data and the treatment planning system calculations, and between independent measurements by the two institutions. MLC testing, MV imaging, and mechanical system showed unique characteristics that are different from the traditional C-arm linacs. Although the same methodologies and physics equipment can generally be used for commissioning the Halcyon, some adaptation of previous practices and development of new methods were also necessary. CONCLUSIONS: We have shown that the vendor pre-loaded data agree well with the independent measured ones during the commission process. This verifies that a data validation instead of a full-data commissioning process may be a more efficient approach for the Halcyon. Measurement results could be used as a reference for future Halcyon users.

Persistent Legionella pneumophila colonization of a hospital water supply: efficacy of control methods and a molecular epidemiological analysis.

After a nosocomial outbreak caused by Legionella pneumophila serogroup 5, the hospital water distribution system, which was found to be colonized by L. pneumophila serogroups 5 and 6, was decontaminated by the superheat and flush method and by installing an additional heat-shock unit in one of the hot water circuits. This unit exposed the recirculated water to a temperature of 80 degrees C. The efficacy of the decontamination measures was evaluated by monitoring the temperatures and legionella concentrations at different parts of the hot water distribution system. The genetic diversity of the colonizing legionella flora was examined using two genotyping methods: amplified fragment length polymorphism analysis (AFLP) and random amplified polymorphic DNA (RAPD) analysis. Selected serogroup 6 strains were also analyzed by sequence-based typing (SBT). The results indicated that long-term eradication of serogroup 5 strains was never achieved. Only one serogroup 6 strain was never isolated after the superheat and flush. In all, according to genetic fingerprints, the diversity of Legionella strains in a hospital water system remains stable over the years regardless of the use of recommended disinfection procedures.

Evaluation of multiplex polymerase chain reaction and microarray-based assay for rapid herpesvirus diagnostics.

Rapid diagnosis is critical to minimize morbidity and mortality associated with infections of the central nervous system (CNS). In this study, we evaluated the performance of a multiplex polymerase chain reaction (PCR) and microarray-based method, Prove-it™ Herpes, in a routine clinical laboratory setting for the diagnostics of 7 herpesviruses in viral CNS infections. Cerebrospinal fluid samples (n = 495), which had arrived for diagnostics in the 5 participating laboratories, were analyzed for herpesvirus DNA both by the current PCR-based method of the laboratory and by the microarray assay. The sensitivity and specificity for the microarray assay were 93% and 99%, respectively. The microarray assay was considered as a rapid and robust diagnostic platform that was easily implemented into the laboratory workflow. The broad herpesvirus coverage and the small sample volume required by the assay could benefit the diagnostics and thus the treatment of life-threatening infections of the CNS, especially among immunocompromised patients.

Mycobacterium avium with the bird type IS1245 RFLP profile is commonly found in wild and domestic animals, but rarely in humans.

Cervical lymphadenitis is the main manifestation of Mycobacterium avium infection in immunocompetent children. Exposure to birds has been discussed as a source of infection. To clarify from where children acquire the infection, M. avium isolates from different origins were analysed with restriction fragment length polymorphism (RFLP) on insertion sequence IS1245, and compared by computer cluster correlation analysis. This molecular epidemiological tool has previously revealed a distinction between multiband profiles found mainly in strains from humans, and a 3-band/bird type profile in strains isolated mainly from birds. 32 isolates from children were compared with 28 isolates from adults and 45 isolates from animals. We found that 67% of the animal isolates had the bird type profile, also found in 1 sputum isolate from an adult. Strains from children showed only multiband profiles that did not differ significantly from profiles of isolates from adults. All but 2 bird isolates showed the bird type profile. Neither of the remaining 2, which had multiband profiles, clustered with the isolates from children. Our results indicate that the true reservoir of M. avium is unknown. Thus the question of whether or not M. avium can be incriminated as a zoonotic disease remains unanswered.