Deep learning method for predicting weekly anatomical changes in patients with nasopharyngeal carcinoma during radiotherapy.

BACKGROUND: Patients may undergo anatomical changes during radiotherapy, leading to an underdosing of the target or overdosing of the organs at risk (OARs). PURPOSE: This study developed a deep-learning method to predict the tumor response of patients with nasopharyngeal carcinoma (NPC) during treatment. This method can predict the anatomical changes of a patient. METHODS: The participants included 230 patients with NPC. The data included planning computed tomography (pCT) and routine cone-beam CT (CBCT) images. The CBCT image quality was improved to the CT level using an advanced method. A long short-term memory network-generative adversarial network (LSTM-GAN) is proposed, which can harness the forecasting ability of LSTM and the generation ability of GAN. Four models were trained to predict the anatomical changes that occurred in weeks 3-6 and named LSTM-GAN-week 3 to LSTM-GAN-week 6. The pCT and CBCT were used as input, and the tumor target volumes (TVs) and OARs were delineated on the predicted and real images (ground truth). Finally, the models were evaluated using contours and dosimetry parameters. RESULTS: The proposed method predicted the anatomical changes, with a dice similarity coefficient above 0.94 and 0.90 for the TVs and surrounding OARs, respectively. The dosimetry parameters were close between the prediction and ground truth. The deviations in the prescription, minimum, and maximum doses of the tumor targets were below 0.5 Gy. For serial organs (brain stem and spinal cord), the deviations in the maximum dose were below 0.6 Gy. For parallel organs (bilateral parotid glands), the deviations in the mean dose were below 0.8 Gy. CONCLUSION: The proposed method can predict the tumor response to radiotherapy in the future such that adaptation can be scheduled on time. This study provides a proactive mechanism for planning adaptation, which can enable personalized treatment and save clinical time by anticipating and preparing for treatment strategy adjustments.

In-beam PET treatment monitoring of carbon therapy patients: Results of a clinical trial at CNAO.

PURPOSE: Carbon ion therapy treatments can be monitored non-invasively with in-beam Positron Emission Tomography (PET). At CNAO the INSIDE in-beam PET scanner has been used in a clinical trial (NCT03662373) to monitor cancer treatments with proton and carbon therapy. In this work we present the analysis results of carbon therapy data, acquired during the first phase of the clinical trial, analyzing data of nine patients treated at CNAO for various malignant tumors in the head-and-neck region. MATERIALS AND METHODS: The patient group contained two patients requiring replanning, and seven patients without replanning, based on established protocols. For each patient the PET images acquired along the course of treatment were compared with a reference, applying two analysis methods: the beam-eye-view (BEV) method and the γ-index analysis. Time trends in several parameters were investigated, as well as the agreement with control CTs, if available. RESULTS: Regarding the BEV-method, the average sigma value σ was 3.7 mm of range difference distributions for patients without changes (sensitivity of the INSIDE detector). The 3D-information obtained from the BEV analysis was partly in agreement with what was observed in the control CT. The data quality and quantity was insufficient for a definite interpretation of the time trends. CONCLUSION: We analyzed carbon therapy data acquired with the INSIDE in-beam PET detector using two analysis methods. The data allowed to evaluate sensitivity of the INSIDE detector for carbon therapy and to make several recommendations for the future.

Potential anatomical triggers for plan adaptation of cervical cancer external beam radiotherapy.

This study aimed to identify potential anatomical variation triggers using magnetic resonance imaging for plan adaption of cervical cancer patients to ensure dose requirements were met over an external beam radiotherapy course. Magnetic resonance images (MRIs) acquired before and during treatment were rigidly registered to a pre-treatment computerised tomography (CT) image for 11 retrospective cervix cancer datasets. Target volumes (TVs) and organs at risk (OARs) were delineated on both MRIs and propagated onto the CT. Treatment plans were generated based on the pre-treatment contours and applied to the mid-treatment contours. Anatomical and dosimetric changes between each timepoint were assessed. The anatomical changes included the change in centroid position and volume size. Dosimetric changes included the V30Gy and V40Gy for the OARs, and V95%, V100%, D95% and D98% for the TVs. Correlation with dosimetric and anatomical changes were assessed to determine potential replan triggers. Changes in the bowel volume and position in the superior-inferior direction, and the high-risk CTV anterior posterior position were highly correlated with a change in dose to the bowel and target, respectively. Hence changes in bowel and high-risk CTV could be used as a potential replan triggers.

Robustness of intensity modulated proton treatment of esophageal cancer for anatomical changes and breathing motion.

BACKGROUND AND PURPOSE: In this study, we assessed the robustness of intensity modulated proton therapy (IMPT) in esophageal cancer for anatomical variations during treatment. METHODS: The first sixty esophageal cancer patients, treated clinically with chemoradiotherapy were included. The treatment planning strategy was based on an internal target volume (ITV) approach, where the ITV was created from the clinical target volumes (CTVs) delineated on all phases of a 4DCT. For optimization, a 3 mm isotropic margin was added to the ITV, combined with robust optimization using 5 mm setup and 3 % range uncertainty. Each patient received weekly repeat CTs (reCTs). Robust plan re-evaluation on all reCTs, and a robust dose summation was performed. To assess the factors influencing ITV coverage, a multivariate linear regression analysis was performed. Additionally, clinical adaptations were evaluated. RESULTS: The target coverage was adequate (ITV V94%>98 % on the robust voxel-wise minimum dose) on most reCTs (91 %), and on the summed dose in 92 % of patients. Significant predictors for ITV coverage in the multivariate analysis were diaphragm baseline shift and water equivalent depth (WED) of the ITV in the beam direction. Underdosage of the ITV mainly occurred in week 1 and 4, leading to treatment adaptation of eight patients, all on the first reCT. CONCLUSION: Our IMPT treatment of esophageal cancer is robust for anatomical variations. Adaptation appears to be most effective in the first week of treatment. Diaphragm baseline shifts and WED are predictive factors for ITV underdosage, and should be incorporated in an adaptation protocol.

Response of selenium pools to drought stress by regulating physio­biochemical attributes and anatomical changes in Gentiana macrophylla.

Selenium (Se), as a vital stress ameliorant, possesses a beneficial effect on mediating detrimental effects of environmental threats. However, the mechanisms of Se in mitigating the deleterious effects of drought are still poorly understood. Gentiana macrophylla Pall. is a well-known Chinese medicinal herb, and its root, as the main medicinal site, has significant therapeutic effects. The purpose of this experiment was to investigate the functions of Se on the seedling growth and physiobiochemical characteristics in G. macrophylla subjected to drought stress. The changes in microstructure and chloroplast ultrastructure of G. macrophylla leaves under drought exposure were characterized by scanning electron microscopy (SEM), scanning electron microscopes and energy dispersive X-Ray spectroscope (SEM-EDX), and transmission electron microscopy (TEM), respectively. Results revealed that drought stress induced a notable increase in oxidative toxicity in G. macrophylla, as evidenced by elevated levels of hydrogen peroxide (H2O2), lipid peroxidation (MDA), enhanced antioxidative response, decreased plant photosynthetic function, and inhibited plant growth. Chloroplasts integrity with damaged membranes and excess osmiophilic granule were observed in the drought-stressed plants. Se supplementation notably recovered the stomatal morphology, anatomical structure damage, and chloroplast ultrastructure of G. macrophylla leaves caused by drought exposure. Exogenous Se application markedly enhanced SPAD, photosynthetic stomatal exchange parameters, and photosystem II activity. Se supplementation significantly promoted the activities of superoxide dismutase (SOD), ascorbate peroxidase (APX), and catalase (CAT), while reducing levels of MDA, superoxide anion (O2-.) and H2O2, and improving membrane integrity. Furthermore, the ameliorative effects of Se were also suggested by increased contents of osmotic substances (soluble sugar and proline), boosted content of gentiopicroside and loganinic acid in roots, and alleviated the inhibition in plant growth and biomass. Fourier transform infrared (FTIR) analysis of Se-treated G. macrophylla roots under drought stress demonstrated that Se-stimulated metabolites including O-H, C-H, N-H, C-N, and CO functional groups, were involved in resisting drought stress. Correlation analysis indicated an obvious negative correlation between growth parameters and MDA, O2-. and H2O2 content, while a positive correlation with photosynthetic gas exchange parameters. Principal component analysis (PCA) results explained the total variance into two principal components contributing the maximum (93.50 %) among the drought exposure with or without Se due to the various experiment indexes. In conclusion, Se exerts beneficial properties on drought-induced detrimental effects in G. macrophylla by relieving oxidative stress, improving photosynthesis indexes, PSII activity, regulating anatomical changes, altering levels of gentiopicroside and loganinic acid, and promoting growth of drought-stressed G. macrophylla.

Natural Physiological Changes During Pregnancy.

Pregnancy causes physiological changes that support the growing fetus and get the mother ready for labor and delivery. Some of these modifications affect biochemical levels; they are normally stable, while others could imitate symptoms of illness. It is critical to distinguish between pathology associated with disease and typical physiological changes. This review article focuses on the significant changes that occur throughout a typical pregnancy.

Anatomical changes and dosimetric analysis of the neck region based on FBCT for nasopharyngeal carcinoma patients during radiotherapy.

BACKGROUND: The study aimed to investigate anatomical changes in the neck region and evaluate their impact on dose distribution in patients with nasopharyngeal carcinoma (NPC) undergoing intensity modulated radiation therapy (IMRT). Additionally, the study sought to determine the optimal time for replanning during the course of treatment. METHODS: Twenty patients diagnosed with NPC underwent IMRT, with weekly pretreatment kV fan beam computed tomography (FBCT) scans in the treatment room. Metastasized lymph nodes in the neck region and organs at risk (OARs) were redelineation using the images from the FBCT scans. Subsequently, the original treatment plan (PLAN0) was replicated to each FBCT scan to generate new plans labeled as PLAN 1-6. The dose-volume histograms (DVH) of the new plans and the original plan were compared. One-way repeated measure ANOVA was utilized to establish threshold(s) at various time points. The presence of such threshold(s) would signify significant change(s), suggesting the need for replanning. RESULTS: Progressive volume reductions were observed over time in the neck region, the gross target volume for metastatic lymph nodes (GTVnd), as well as the submandibular glands and parotids. Compared to PLAN0, the mean dose (Dmean) of GTVnd-L significantly increased in PLAN5, while the minimum dose covering 95% of the volume (D95%) of PGTVnd-L showed a significant decrease from PLAN3 to PLAN6. Similarly, the Dmean of GTVnd-R significantly increased from PLAN4 to PLAN6, whereas the D95% of PGTVnd-R exhibited a significant decrease during the same period. Furthermore, the dose of bilateral parotid glands, bilateral submandibular glands, brainstem and spinal cord was gradually increased in the middle and late period of treatment. CONCLUSION: Significant anatomical and dosimetric changes were noted in both the target volumes and OARs. Considering the thresholds identified, it is imperative to undertake replanning at approximately 20 fractions. This measure ensures the delivery of adequate doses to target volumes while mitigating the risk of overdosing on OARs.

The impact of sinusitis on dose distribution in a radiotherapy plan by in silico study.

OBJECTIVES: To assess the impact of changes in sinus aeration on dose variation in nasopharyngeal cases using a single beam with various field sizes and real patient computed tomography (CT) images. METHODS: The calculations were carried out on a computer equipped with an Intel Xeon (R) Gold 5118 processor operating at 2.30 GHz in 2022 at Taibah University, Al Madinah Al Munawwarah for a retrospective nasopharyngeal case. At the patient level, the impact on dose distribution was examined for different field sizes by comparing the percentage depth dose. The dose discrepancy was evaluated by comparing the dose delivered without considering the anatomical changes observed in the initial fraction to the dose adjusted to account for these changes using a 2D gamma analysis. With a criterion of 1% dose difference and 1 mm distance to agreement, the gamma level for analysis was set at 95%. RESULTS: The study findings indicated that the observed effect diminished by approximately 50% for both 5 cm x 5 cm and 10 cm x 10 cm field sizes compared to the 3 cm x 3 cm size, where there was an overlap between the planning target volume and sinusitis. CONCLUSION: The study concluded that the impact of dose discrepancy was more pronounced in smaller field sizes.

Anatomical changes in resection cavity during brain radiotherapy.

BACKGROUND AND PURPOSE: Brain tumors are in general treated with a maximal safe resection followed by radiotherapy of remaining tumor including the resection cavity (RC) and chemotherapy. Anatomical changes of the RC during radiotherapy can have impact on the coverage of the target volume. The aim of the current study was to quantify the potential changes of the RC and to identify risk factors for RC changes. MATERIALS AND METHODS: Sixteen patients treated with pencil beam scanning proton therapy between October 2019 and April 2020 were retrospectively analyzed. The RC was delineated on pre-treatment computed tomography (CT) and magnetic resonance imaging, and weekly CT-scans during treatment. Isotropic expansions were applied to the pre-treatment RC (1-5 mm). The percentage of volume of the RC during treatment within the expanded pre-treatment volumes was quantified. Potential risk factors (volume of RC, time interval surgery-radiotherapy and relationship of RC to the ventricles) were evaluated using Spearman's rank correlation coefficient. RESULTS: The average variation in relative RC volume during treatment was 26.1% (SD 34.6%). An expansion of 4 mm was required to cover > 95% of the RC volume in > 90% of patients. There was a significant relationship between the absolute volume of the pre-treatment RC and the volume changes during treatment (Spearman's ρ = - 0.644; p = 0.007). CONCLUSION: RCs are dynamic after surgery. Potentially, an additional margin in brain cancer patients with an RC should be considered, to avoid insufficient target coverage. Future research on local recurrence patterns is recommended.

Adsorptive-Photocatalytic Performance for Antibiotic and Personal Care Product Using Cu0.5Mn0.5Fe2O4.

The amount of antibiotics and personal care products entering local sewage systems and ultimately natural waters is increasing and raising concerns about long-term human health effects. We developed an adsorptive photocatalyst, Cu0.5Mn0.5Fe2O4 nanoparticles, utilizing co-precipitation and calcination with melamine, and quantified its efficacy in removing paraben and oxytetracycline (OTC). During melamine calcination, Cu0.5Mn0.5Fe2O4 recrystallized, improving material crystallinity and purity for the adsorptive-photocatalytic reaction. Kinetic experiments showed that all four parabens and OTC were removed within 120 and 45 min. We found that contaminant adsorption and reaction with active radicals occurred almost simultaneously with the photocatalyst. OTC adsorption could be adequately described by the Brouers-Sotolongo kinetic and Freundlich isotherm models. OTC photocatalytic degradation started with a series of reactions at different carbon locations (i.e., decarboxamidation, deamination, dehydroxylation, demethylation, and tautomerization). Further toxicity testing showed that Zea mays L. and Vigna radiata L. shoot indexes were less affected by treated water than root indexes. The Zea mays L. endodermis thickness and area decreased considerably after exposure to the 25% (v/v)-treated water. Overall, Cu0.5Mn0.5Fe2O4 nanoparticles exhibit a remarkable adsorptive-photocatalytic performance for the degradation of tested antibiotics and personal care products.

Anatomical changes in the male pelvis between the supine and upright positions-A feasibility study for prostate treatments in the upright position.

Treating and imaging patients in the upright orientation is gaining acceptance in radiation oncology and radiology and has distinct advantages over the recumbent position. An IRB approved study to investigate the positions and orientations of the male pelvic organs between the supine and upright positions was conducted. The study comprised of scanning 15 male volunteers (aged 55-75 years) on a 0.6 T Fonar MRI scanner in the supine and upright positions with a full bladder and in the upright position with an empty bladder. The Pelvic study revealed that in the upright position the 1. Position and shape of the prostate are not impacted significantly by bladder fill. 2. Distance between the sacrum and the anterior bladder wall is significantly smaller. 3. Anterior-Posterior length and the bladder width is significantly larger. 4. Seminal vesicles are pushed down by the bladder. 5. Top of the penile bulb is further away from the apex of the prostate. These observed differences could positively impact upright prostate treatments by 1. Reducing the risk of small bowel approximating the treatment volume. 2. Prostate treatments can be done with a reduced focus on bladder fill. 3. Radiation beams for treating intermediate risk prostrate can be made smaller or a larger portion of the seminal vesicles can be treated with the same beam size than typically used for supine treatments. 4. Reducing the average dose to the penile bulb.

Anatomical adaptation of water-stressed Eugenia uniflora using green synthesized silver nanoparticles and melatonin.

Cell and sub-cellular anatomical adjustments are adaptations utilized by plants to tolerate abiotic stress. Both melatonin and Morinda lucida-silver nanoparticles (ML-AgNPs) are recognized as bio-stimulants. The study examined the morphological changes and adaptive characteristics of these bio-stimulants under water-stress Eugenia uniflora. Twenty-four hours was spent priming the seeds with melatonin (0.06 mg/L), ML-AgNPs (0.06 mg/L), and a mixture (1:1) of the two. The seeds were sown and subjected to water stress for 7 days. The leaves, stems, and roots of water-stressed E. uniflora were sectioned, dried, and examined using a microscope. Drought stress led to the production of non-glandular trichomes on the abaxial and the transformation of paracytic stomata into diacytic stomata. During water stress, melatonin enlarges intercellular gaps and stomata, increases sponge and palisade parenchyma, and thickens epidermis (stem and root) and fibers. The ML-AgNPs diminished the size of mesophyll, intercellular gaps, stomata, and stem fiber. The ML-AgNPs increased the size of bulliform cells and activated the mechanical resistance features of sclerophyllous leaves (thick-celled epidermis and sclerieds) and ray parenchyma (root and stem). Equally, Melatonin and ML-AgNPs increased stem and root anatomical characteristics (xylem, bark, pith, cortex, epidermis, and vascular bundles). Stomata of E. uniflora are susceptible to alterations and undergo cell division into two new stomata (stomatogensis) in response to varying conditions (melatonin and ML-AgNPs). Melatonin adopted a strategy for maintaining a high plant water status, possibly by osmoregulation, whereas E. uniflora primed with ML-AgNPs survived by minimizing transpirational water loss through morphological changes.

SurVolT: Surface to Volume conversion Tool. A proof of concept.

PURPOSE: To develop SurVolT, a conversion tool able to apply volumetric changes to DICOM Computed Tomography (CT) data using daily surface (obj) data acquired with AlignRT® (VisionRT Ltd.), primarily designed and validated for breast treatments. MATERIALS AND METHODS: SurVolT proceeds in 4 steps: 1. AlignRT .obj files extraction, 2. Contour deformation where the surface data points are matched to the initial external contour on a Region Of Interest, ROImatch, on which the anatomy is supposed to be unchanged. Then, external contour substitution is performed on the ROIttt covering the treated breast area. This is validated on a female torso phantom with a tissue-equivalent bolus mimicking an edema. The Planning Treatment Volume (PTV) contour from the initial CT is also deformed according to the new external contour in the ROIttt. 3. Volumetric data estimation according to the new external contour, validated on an anthropomorphic pelvis phantom. 4. Import of new DICOM data into the Treatment Planning System (TPS). Finally, the workflow is applied on a first patient presenting an anatomical change during the treatment. RESULTS: The validation of step 2 and 3 shows a bolus thickness estimation of 5.8±1.2mm (expected 5 mm) and the non-rigid deformation of initial CT images follows the new external contour at the ROIttt bolus site while revealing negligible deformation elsewhere. CONCLUSION: This first proof of concept introducing a Surface Guided Radiotherapy (SGRT) tool allowing daily surface data to volume conversion is a fundamental step toward SGRT-based adaptive radiotherapy.

Applicability and usage of dose mapping/accumulation in radiotherapy.

Dose mapping/accumulation (DMA) is a topic in radiotherapy (RT) for years, but has not yet found its widespread way into clinical RT routine. During the ESTRO Physics workshop 2021 on "commissioning and quality assurance of deformable image registration (DIR) for current and future RT applications", we built a working group on DMA from which we present the results of our discussions in this article. Our aim in this manuscript is to shed light on the current situation of DMA in RT and to highlight the issues that hinder consciously integrating it into clinical RT routine. As a first outcome of our discussions, we present a scheme where representative RT use cases are positioned, considering expected anatomical variations and the impact of dose mapping uncertainties on patient safety, which we have named the DMA landscape (DMAL). This tool is useful for future reference when DMA applications get closer to clinical day-to-day use. Secondly, we discussed current challenges, lightly touching on first-order effects (related to the impact of DIR uncertainties in dose mapping), and focusing in detail on second-order effects often dismissed in the current literature (as resampling and interpolation, quality assurance considerations, and radiobiological issues). Finally, we developed recommendations, and guidelines for vendors and users. Our main point include: Strive for context-driven DIR (by considering their impact on clinical decisions/judgements) rather than perfect DIR; be conscious of the limitations of the implemented DIR algorithm; and consider when dose mapping (with properly quantified uncertainties) is a better alternative than no mapping.

Effects of high air temperature, drought, and both combinations on maize: A case study.

High air temperature (HAT) and natural soil drought (NSD) have seriously affected crop yield and frequently take place in a HAT-NSD combination. Maize (Zea mays) is an important crop, thermophilic but not heat tolerant. In this study, HAT, NSD, and HAT-NSD effects on maize inbred line Huangzao4 -were characterized. Main findings were as follows: H2O2 and O- accumulated much more in immature young leaves than in mature old leaves under the stresses. Lateral roots were highly distributed near the upper pot mix layers under HAT and near root tips under HAT-NSD. Saccharide accumulated mainly in stressed root caps (RC) and formed a highly accumulated saccharide band at the boundary between RC and meristematic zone. Lignin deposition was in stressed roots under NSD and HAT-NSD. Chloroplasts increased in number and formed a high-density ring around leaf vascular bundles (VB) under HAT and HAT-NSD, and sparsely scattered in the peripheral area of VBs under NSD. The RC cells containing starch granules were most under NAD-HAT but least under HAT. Under NSD and HAT-NSD followed by re-watering, anther number per tassel spikelet reduced to 3. These results provide multiple clues for further distinguishing molecular mechanisms for maize to tolerate these stresses.

Effect of Potassium Deficiency on Physiological Responses and Anatomical Structure of Basil, Ocimum basilicum L.

The aim of this study was to investigate the effect of a variable supply of potassium to culture medium on physiological and anatomical parameters (histological sections at the third internode) in basil, Ocimum basilicum. Thirty-four-day-old plants grown on basic nutrient medium were divided into four batches and grown on media with varying doses of potassium: 0.375 mM, 0.250 mM, 0.125 mM and 0 mM K+. After 64 days of culture, a final harvest was performed. The results showed that root and shoot growth in basil was decreased with decreased K+ concentration. This restriction was associated with a reduction in root elongation and leaf expansion, which was coupled with a decrease in chlorophyll and carotenoid contents. The estimation of electrolyte leakage reveals that this parameter was increased by potassium deficiency. With respect to total polyphenol and flavonoid contents, only the third leaf-stage extracts exhibited a decrease under low-K+ conditions. However, variability in response of phenolic compounds was recorded depending on the organ and the K+ concentration in the medium. Stem cross sections of potassium-deficient basil plants revealed a decrease in the diameter of these organs, which can be attributed to a restriction of the extent of different tissue territories (cortex and medulla), as well as by a reduction in cell size. These effects were associated with a decrease in the number of conducting vessels and an increase in the number of woody fibers.

Localized Pancreatitis in an Elderly Patient Without Suspected Etiology.

Once pancreatic inflammation is triggered, it spreads throughout the pancreas. Here, we present a case of localized pancreatitis wherein the inflammation was confined to the pancreatic head. A 91-year-old woman was admitted with complaints of vomiting and epigastric pain. Blood tests showed elevated pancreatic enzyme levels, whereas imaging studies showed an enlarged pancreatic head and an area of increased density in the surrounding fatty tissue extending along the retroperitoneum below the subrenal pole. Atrophy of the pancreatic parenchyma in the pancreatic body and tail and dilatation of the main pancreatic duct were observed. The patient was diagnosed with acute pancreatitis, was kept nil by mouth, and was administered supplemental fluids. The symptoms resolved within two weeks. Age-related anatomical and histological changes in the pancreas may influence the development of pancreatitis, making it difficult to rule out the possibility of cancer. As age-related changes in the pancreas could lead to the development of pancreatitis, it is an important differential diagnosis of abdominal pain, even in older patients without suspected etiologies.

Bone versus soft-tissue setup in proton therapy for patients with oesophageal cancer.

BACKGROUND: The aim of this study was to investigate the effect of patient positioning based on either bone or soft-tissue matching for PT in oesophageal cancer and its impact on plan adaptation. MATERIALS AND METHODS: Two retrospective patient cohorts treated with radiotherapy were included in the study. Cohort A consisted of 26 consecutive patients with a planning 4DCT scan (CT1) and a surveillance 4DCT scan (CT2) at fraction ten. Cohort B consisted of 17 patients selected based on large anatomical changes identified during treatment resulting in a rescan (CT2). Mean dose to the iCTV (sum of the CTVs in all respiratory phases) was 50.4 Gy (RBE) in 28 fractions or 41.4 Gy (RBE) in 23 fractions. A nominal pencil beam scanning plan was created using two posterior beams and robust optimization (5 mm setup, 3.5% range). For each patient, two rigid registrations were made between average (avg) CT1 and CT2: a match on the vertebral column (bone match) and a match on the iCTV (soft-tissue match). Robustness towards setup (5 mm) and range (3.5%) errors was evaluated at CT2. Robustness towards respiration was evaluated by recalculation of the plan on all phases of the CT2 scan. Dose coverage <96% would trigger adaptation. The statistical significance (p-value <0.05) between dose coverage for the two registration methods was assessed using the Wilcoxon signed rank test. RESULTS: All plans fulfilled V95%iCTV>99% for the nominal plan and V95%iCTV>97% for all respiratory phases and robustness scenarios at CT1. In two (8%) and three (18%) patients, V95%iCTV<96% on CT2 for Cohort A and B, respectively when bone match was used. For soft-tissue match, V95%iCTV >96% for all patients. V95%iCTV was significantly higher (p-value = 0.0001) for soft-tissue match than bone match. CONCLUSION: Anatomical changes during the treatment course led to target dose deterioration and a need for plan adaptation when using a bone match.

Blackleg in Cattle in the Irkutsk Region.

Blackleg is an acute, toxic, infectious, non-contagious disease of domestic and wild ruminants that occurs while the animals are pastured. This article describes an outbreak of blackleg on a farm in Siberia (Russia) in 2019. We provide a detailed description of the cases based on the results of comprehensive diagnostic and epidemiological investigations. For description of case and evaluation, we used the following methods: owner observations, descriptive epidemiology, clinical diagnostics, pathological examination and bacteriology. The distinctive features (in addition to the characteristic features) were as follows: the outbreak of the disease occurred in early spring when there was abundant snow cover and under unfavorable living conditions of animals and traumas; the disease appeared in both vaccinated and unvaccinated cattle; the characteristic clinical signs were low-grade fever, the absence of crepitus, and the presence of haematomas containing erythrocytes with basophilic granularity; thrombs in vessel and vacuolization in tissue of the adrenal gland. This paper aimed to present classical and new clinical and pathology changes in cattle with blackleg in winter conditions of Russian Siberia.