Diagnostic findings in sinonasal aspergillosis in dogs in the United Kingdom: 475 cases (2011-2021).

OBJECTIVES: To describe the diagnostic tests used and their comparative performance in dogs diagnosed with sinonasal aspergillosis in the United Kingdom. A secondary objective was to describe the signalment, clinical findings and common clinicopathologic abnormalities in sinonasal aspergillosis. MATERIALS AND METHODS: A multi-centre retrospective survey was performed involving 23 referral centres in the United Kingdom to identify dogs diagnosed with sinonasal aspergillosis from January 2011 to December 2021. Dogs were included if fungal plaques were seen during rhinoscopy or if ancillary testing (via histopathology, culture, cytology, serology or PCR) was positive and other differential diagnoses were excluded. RESULTS: A total of 662 cases were entered into the database across the 23 referral centres. Four hundred and seventy-five cases met the study inclusion criteria. Of these, 419 dogs had fungal plaques and compatible clinical signs. Fungal plaques were not seen in 56 dogs with turbinate destruction that had compatible clinical signs and a positive ancillary test result. Ancillary diagnostics were performed in 312 of 419 (74%) dogs with observed fungal plaques permitting calculation of sensitivity of cytology as 67%, fungal culture 59%, histopathology 47% and PCR 71%. CLINICAL SIGNIFICANCE: The sensitivities of ancillary diagnostics in this study were lower than previously reported challenging the clinical utility of such tests in sinonasal aspergillosis. Treatment and management decisions should be based on a combination of diagnostics including imaging findings, visual inspection, and ancillary testing, rather than ancillary tests alone.

MicroRT-small animal conformal irradiator.

A novel small animal conformal radiation therapy system has been designed and prototyped: MicroRT. The microRT system integrates multimodality imaging, radiation treatment planning, and conformal radiation therapy that utilizes a clinical 192Ir isotope high dose rate source as the radiation source (teletherapy). A multiparameter dose calculation algorithm based on Monte Carlo dose distribution simulations is used to efficiently and accurately calculate doses for treatment planning purposes. A series of precisely machined tungsten collimators mounted onto a cylindrical collimator assembly is used to provide the radiation beam portals. The current design allows a source-to-target distance range of 1-8 cm at four beam angles: 0 degrees (beam oriented down), 90 degrees, 180 degrees, and 270 degrees. The animal is anesthetized and placed in an immobilization device with built-in fiducial markers and scanned using a computed tomography, magnetic resonance, or positron emission tomography scanner prior to irradiation. Treatment plans using up to four beam orientations are created utilizing a custom treatment planning system-microRTP. A three-axis computer-controlled stage that supports and accurately positions the animals is programmed to place the animal relative to the radiation beams according to the microRTP plan. The microRT system positioning accuracy was found to be submillimeter. The radiation source is guided through one of four catheter channels and placed in line with the tungsten collimators to deliver the conformal radiation treatment. The microRT hardware specifications, the accuracy of the treatment planning and positioning systems, and some typical procedures for radiobiological experiments that can be performed with the microRT device are presented.

[Disseminated intravascular coagulation in systemic lupus erythematosus]. / Coagulación intravascular diseminada en el lupus eritematoso sistémico.

A patient with systemic lupus erythematosus (SLE) who developed disseminated intravascular coagulation during the beginning of SLE is presented. No other cause responsible for the producing of DIC was found. After treatment with corticoids, and cyclophosphamide the DIC was rapidly settled. This case supports the need for a complete blood test in patients with SLE who show coagulation alterations.

Characterization of speckle in lung images acquired with a benchtop in-line x-ray phase-contrast system.

We investigate the manifestation of speckle in propagation-based x-ray phase-contrast imaging of mouse lungs in situ by use of a benchtop imager. The key contributions of the work are the demonstration that lung speckle can be observed by use of a benchtop imaging system employing a polychromatic tube-source and a systematic experimental investigation of how the texture of the speckle pattern depends on the parameters of the imaging system. Our analyses consists of image texture characterization based on the statistical properties of pixel intensity values.

SU-E-J-05: Validation of an Iterative Tomosynthesis Algorithm for Low Dose on Board Cone Beam CT Patient Localization.

PURPOSE: Cone beam CT (CBCT) is a well established technique to localize patients using bone and soft tissue anatomy. Current protocols are limited to one weekly CBCT due to the considerable imaging dose delivered to the patient. The purpose of this project is to develop and validate a low dose CBCT algorithm to reduce dose and imaging time of current 3D imaging localization procedures using a novel iterative tomosynthesis algorithm to allow daily CBCT for patient positioning and target localization. METHODS: The algorithm is based on the combination of a tomosynthesis filtered back propagation (TFBP) acquisition geometry algorithm and a maximum likelihood expectation maximization (MLEM) iterative reconstruction. Circular or arc acquisition trajectory, projection number, and angular projection position are optimized according to the anatomical treatment site and region of interest. The TFBP method provides the first 3D image estimate, and the MLEM improves its quality. In this study, we focused on head and neck treatment localization imaging. RESULTS: We studied the performance of our tomosynthesis algorithm imaging resolution on an anthropomorphic head and neck phantom to determine image quality as a function of dose reduction techniques. Reconstructed anatomy shows that a 1/8 dose reduction provides similar image quality and resolution as current CBCT protocols. Seven iterations show an optimal compromise between image quality and reconstruction time. Tomosynthesis images provide digitally reconstructed radiographs with similar resolution and contrast as full CBCT. We verified that the iterative process eliminates phantom images originated by the acquired sparse angular data projections. CONCLUSIONS: We developed and validated an iterative algorithm for low dose cone beam CT based on circular or arc tomosynthesis geometries and iterative reconstruction techniques. The algorithm combines the strengths of both techniques to provide a novel low dose method to image patient anatomy for patient positioning and target localization.

WE-G-217BCD-07: Implementation and Evaluation of Helical On-Board CBCT and Exact Image Reconstruction.

PURPOSE: Longitudinal coverage of CBCT, which is 17 cm for head scan and 15.5 cm for body scan, is not enough to cover the entire PTV for over 90% of head/neck and gastrointestinal/genitourinary/gynecologic patients if lymph nodes are involved. Helical CBCT, which was accomplished using external beam LINAC in its research mode, is one promising way to extend the CBCT longitudinal coverage. Aim of this study is to compare Katsevich's exact algorithm with traditional FDK algorithm for helical CBCT image reconstruction. METHODS: CBCT projection raw data were acquired on a TrueBeam LINAC machine (Varian Medical Systems) in the research mode in helical trajectories that encompass a 360 degree rotation, 25 cm pitch, 100 kVp, 80 mA, and 25 ms, with a Catphan 600. Reconstruction was done with Katsevich's exact and FDK approximate algorithms. Scatter correction, beam-hardening correction, and non-uniform gantry angle correction, are performed on projection data to reduce artifacts and noise. Image qualities (CT number accuracy, uniformity, SNR) were evaluated and compared between the reconstruction algorithms. RESULTS: Images reconstructed by Katsevich's algorithm show better qualities, compared to ones by FDK algorithm and HU numbers have higher uniformity and accuracy. The HU-density calibration curve closely conforms to the manufacturer recommended values. The level of noise computed as the standard deviation in the phantom uniform region is 28.07 for the Katsevich algorithm, compared to 44.64 for the FDK algorithm. CONCLUSIONS: Katsevich's exact reconstruction algorithm provided better image qualities than FDK for helical CBCT scans. This result will very useful for our ongoing investigation of helical CBCT, which would lead to improvement of CBCT longitudinal coverage of PTV and would be essential for future image-guided adaptive radiation therapy applications. Varian Research Agreement with Washington University in St. Louis.

SU-E-T-159: Sensitivity of in Line Real Time Scintillating Fiber Detectors for External Beam Treatment Verification and Patient Safety.

PURPOSE: We studied the sensitivity of a novel transmission fiber scintillator array designed and built for in line treatment verification. The purpose of this project is to assess the capability of the fiber detector array technology to detect treatment errors in real time without false positives to enhance patient safety. METHODS: We developed a linear scintillator array detector using radiation hard scintillating fibers and high speed parallel signal conditioning and data acquisition to monitor external beam treatment fluence in real time. The detector captures and resolves the time and amplitude of each linac pulse at each MLC segment. The detector has 60 fibers aligned to each MLC leaf and two output channels per fiber. The data is captured by a high speed parallel digitizer to determine the IMRT beam output delivered to a patient in real time. We evaluated the detector peak pulse linearity according to dose rate, MLC positioning, and beam energy. We analyzed the detector sensitivity, signal to noise ratio, and pulse distribution statistics to determine beam output and fluence in real time. RESULTS: We analyzed the response of the detector to 6 MV and 10 MV photon beams. The statistical analysis of the detected linac pulses indicates that a minimum of 20 pulses are required to evaluate MLC positioning and fluence with 3 mm and 3% resolution, respectively. During testing, no false positives were detected. Linearity with respect to output rate, MLC or jaw opening, and fluence is within 2%. CONCLUSIONS: Measured sensitivity and signal to noise ratio of a real time linear fiber array detector show that delivered beam fluence can be monitored every 55 msec, with no observed false positives during treatment to provide in vivo real time patient safety and beam monitoring.

Osmotic concentration of the gastric juice of dogs.

1. The freezing point of the gastric juice, produced by histamine stimulation in anaesthetized dogs, of the arterial plasma and of the plasma obtained from a gastric vein were measured.2. The osmolality of the blood that passes through the gastric mucosa increases during secretion of acid juice.3. The amount of water that should be removed from the arterial plasma to obtain a solution isosmolal to the gastric venous plasma is equivalent to the amount of water required to dilute the secreted H(+). From this result it is concluded that the increase of osmolality of the venous plasma is a consequence of the clearance of water free of solute by the gastric mucosa.4. The gastric juice was hyposmotic to the venous plasma in twenty out of thirty dogs, being isosmotic to that plasma in seven dogs. Even in the last group of animals, the gastric secretion might be considered as slightly hypotonic to the venous blood that passes through the secretory part of the mucosa.5. Considerations based on available data suggest that the ;primary' acid juice is usually hyposmotic to the extracellular fluid in the vicinity of the oxyntic cells.