Novel adaptive beam-dependent margins for additional OAR sparing.

Margins are employed in radiotherapy treatment planning to mitigate the dosimetric effects of geometric uncertainties for the clinical target volume (CTV). Unfortunately, whilst the use of margins can increase the probability that sufficient dose is delivered to the CTV, it can also result in delivering high dose of radiation to surrounding organs at risk (OARs). We expand on our previous work on beam-dependent margins and propose a novel adaptive margin concept, where margins are moulded away from selected OARs for better OAR-high-dose sparing, whilst maintaining similar dose coverage probability to the CTV. This, however, comes at a cost of a larger irradiation volume, and thus can negatively impact other structures. We investigate the impact of the adaptive margin concept when applied to prostate radiotherapy treatments, and compare treatment plans generated using our beam-dependent margins without adaptation, with adaption from the rectum and with adaptation from both the rectum and bladder. Five prostate patients were used in this planning study. All plans achieved similar dose coverage probability, and were able to ensure at least 90% population coverage with the target receiving at least 95% of the prescribed dose to [Formula: see text]. We observed overall better high-dose sparing to OARs that were considered when using the adapted beam-dependent PTVs, with the degree of sparing dependent on both the number of OARs under consideration as well as the relative position between the CTV and the OARs.

A novel probabilistic approach to generating PTV with partial voxel contributions.

Radiotherapy treatment planning for use with high-energy photon beams currently employs a binary approach in defining the planning target volume (PTV). We propose a margin concept that takes the beam directions into account, generating beam-dependent PTVs (bdPTVs) on a beam-by-beam basis. The resulting degree of overlaps between the bdPTVs are used within the optimisation process; the optimiser effectively considers the same voxel to be both target and organ at risk (OAR) with fractional contributions. We investigate the impact of this novel approach when applied to prostate radiotherapy treatments, and compare treatment plans generated using beam dependent margins to conventional margins. Five prostate patients were used in this planning study, and plans using beam dependent margins improved the sparing of high doses to target-surrounding OARs, though a trade-off in delivering additional low dose to the OARs can be observed. Plans using beam dependent margins are observed to have a slightly reduced target coverage. Nevertheless, all plans are able to satisfy 90% population coverage with the target receiving at least 95% of the prescribed dose to [Formula: see text].

A randomized double-blind controlled calcium supplementation trial, and bone and height acquisition in children.

There is limited information relating Ca intake to bone and height acquisition among Oriental children who consume little or even no milk. The present controlled study investigated the acquisition of bone mass and height of Chinese children with an initial Ca intake of approximately 567 mg/d who were supplemented to about 800 mg/d. Eighty-four 7-year-old Hong Kong Chinese children underwent an 18-month randomized, double-blind, controlled Ca-supplementation trial. The children were randomized to receive either 300 mg elemental Ca or a placebo tablet daily. Bone mass of the distal one-third radius was measured by single-photon absorptiometry, lumbar spine and femoral neck were determined using dual-energy X-ray absorptiometry. Measurements were repeated 6-monthly. Baseline serum 25-hydroxycholecalciferol concentration and physical activity were also assessed. Baseline Ca intakes of the study group and controls were respectively 571 (SD 326) and 563 (SD 337) mg/d. There were no significant differences in baseline serum 25-hydroxycholecalciferol concentration (P = 0.71) and physical activity (P = 0.36) between the study and control groups. After 18 months the study group had significantly greater increases in lumbar-spinal bone mineral content (20.9 v. 16.34%; P = 0.035), lumbar-spinal area (11.16 v. 8.71%; P = 0.049), and a moderately greater increment in areal bone mineral density of the radius (7.74 v. 6.00%; P = 0.081) when compared with the controls. The results confirm a positive effect of Ca on bone mass of the spine and radius but no effects on femoral-neck and height increase. A longer trial is warranted to confirm a positive Ca effect during childhood that may modify future peak bone mass.

True fractional calcium absorption in Chinese children measured with stable isotopes (42Ca and 44Ca).

True fractional Ca absorption (TFCA) was compared in children with different habitual Ca intakes using a double-label stable-isotope technique. Chinese children aged 7 years from Hongkong (n22) and Jiangmen (n12) participated in the study. An oral administration of 8 mg 44Ca in 100 g chocolate milk was given shortly after an intravenous injection of 0.75 mg 42Ca. Ca isotopic ratios were determined in urine samples collected 24 h later using thermal-ionization mass spectrometry. There was no significant difference in TFCA between Jiangmen and Hongkong children (P = 0.16). TFCA of a lower-Ca-intake group (Ca < or = 500 mg/d, n19) with mean Ca intake 359 mg/d was 63.1 (SD 10.7)% and that of a higher-Ca-intake group (Ca > 500 mg/d, n15) with mean Ca intake 862 mg/d was 54.8 (SD 7.3)%; the difference in TFCA was significant (P = 0.016). Serum levels of 25-hydroxycholecalciferol of the children were adequate (33.7 (SD 7.7) ng/ml). The present study indicates that growing children accustomed to a low-Ca diet appear to be able to enhance their absorptive capacity. If it is assumed that dietary Ca absorption by Chinese children resembles their TFCA from a single meal of chocolate milk, then the recommended dietary allowance (RDA) for Ca for Chinese children would be lower than the US RDA (800 mg/d), which is based on an estimated 40% Ca absorption as reported for Caucasian children. A comparative absorption study is necessary to determine whether there is any difference in TFCA between Caucasian and Chinese children.