Large-Scale Assessment of Scan-Time Variability and Multiple-Procedure Efficiency for Cross-Sectional Neuroradiological Exams in Clinical Practice.

Scheduling of CT and MR exams requires reasonable estimates for expected scan duration. However, scan-time variability and efficiency gains from combining multiple exams are not quantitatively well characterized. In this work, we developed an informatics approach to quantify typical duration, duration variability, and multiple-procedure efficiency on a large scale, and used the approach to analyze 48,766 CT- and MR-based neuroradiological exams performed over one year. We found MR exam durations demonstrated higher absolute variability, but lower relative variability and lower multiple-procedure efficiency, compared to CT exams (p < 0.001). Our approach enables quantification of real-world operational performance and variability to inform optimal patient scheduling, efficient resource utilization, and sustainable service planning.

Development and Preliminary Evaluation of a Murine Model of Chronic Radiation-Induced Proctitis.

PURPOSE: Radiotherapy (RT) is commonly used to treat most pelvic malignancies. While treatment is often effective, curative radiation doses to the rectum can result in chronic radiation-induced proctitis, which is characterized by diarrhea, tenesmus, and/or rectal bleeding, recently termed pelvic radiation disease. An animal model of chronic radiation-induced proctitis would be useful to test both preventative and therapeutic strategies to limit this morbidity but has been elusive because of the high rodent mortality associated with acute bowel RT injury. The objective of this research was to develop a novel mouse model of chronic radiation-induced proctitis using advanced technology. METHODS AND MATERIALS: Using an X-RAD 225-Cx (Precision X-Ray) small animal irradiator, multiple plan configurations were evaluated for planning treatment volume and organ-at-risk avoidance to deliver a 15 Gy 3D conformal treatment plan. The final plan was verified by high resolution 3D dosimetry (PRESAGE/optical-CT), and delivered using a single arc. Mice were monitored for mortality for 250 days, followed by histopathological correlates including mucicarmine, Masson's trichrome, and fecal pellet length. RESULTS: Six beam arrangements were considered: single and parallel-opposed fields with whole-pelvis coverage, and collimated fields in parallel-opposed, 3-field, 4-field, and arc geometries. A collimated arc plan offered superior planning treatment volume coverage and organ-at-risk avoidance compared to whole-pelvis irradiation. Treatment verification with PRESAGE 3D dosimetry (Heuris Inc) showed >99% of voxels passing gamma analysis with 2%/2 mm criteria. Our treatment resulted in no acute mortality and 40% mortality at 250 days. Histopathological analysis showed increased mucous production and fibrosis of the irradiated colon, but no change in fecal pellet length. CONCLUSIONS: Our model was able to target successfully lower colon and rectum with lower mortality than other published models. This permitted measurement of late effects that recapitulate some features of rectal damage in humans.

Monte Carlo comparison of superficial dose between flattening filter free and flattened beams.

This study investigates the superficial dose from FFF beams in comparison with the conventional flattened ones using a Monte Carlo (MC) method. Published phase-space files which incorporated real geometry of a TrueBeam accelerator were used for the dose calculation in phantom and clinical cases. The photon fluence on the central axis is 3 times that of a flattened beam for a 6 MV FFF beam and 5 times for a 10 MV beam. The mean energy across the field in air at the phantom surface is 0.92-0.95 MeV for the 6 MV FFF beam and 1.18-1.30 MeV for the corresponding flattened beam. At 10 MV, the values are 1.52-1.72 and 2.15-2.87 MeV for the FFF and flattened beams, respectively. The phantom dose at the depth of 1 mm in the 6 MV FFF beam is 6% ± 2.5% (of the maximum dose) higher compared to the flattened beam for a 25 × 25 cm(2) field and 14.6% ± 1.9% for the 2 × 2 cm(2) field. For the 10 MV beam, the corresponding differences are 3.4% ± 1.5% and 10.7% ± 0.6%. The skin dose difference at selected points on the patient's surface between the plans using FFF and flattened beams in the head-and-neck case was 6.5% ± 2.3% (1SD), and for the breast case it was 6.4% ± 2.3%. The Monte Carlo simulations showed that due to the lower mean energy in the FFF beam, the clinical superficial dose is higher without the flattening filter compared to the flattened beam.

Is wax equivalent to tissue in electron conformal therapy planning? A Monte Carlo study of material approximation introduced dose difference.

With CT-based Monte Carlo (MC) dose calculations, material composition is often assigned based on the standard Hounsfield unit ranges. This is known as the density threshold method. In bolus electron conformal therapy (BolusECT), the bolus material, machineable wax, would be assigned as soft tissue and the electron density is assumed equivalent to soft tissue based on its Hounsfield unit. This study investigates the dose errors introduced by this material assignment. BEAMnrc was used to simulate electron beams from a Trilogy accelerator. SPRRZnrc was used to calculate stopping power ratios (SPR) of tissue to wax, SPR (tissue) (wax), and tissue to water, SPR(tissue) (water), for 6, 9, 12, 15, and 18 MeV electron beams, of which 12 and 15MeV beams are the most commonly used energies in BolusECT. DOSXYZnrc was applied in dose distribution calculations in a tissue phantom with either flat wax slabs of various thicknesses or a wedge-shaped bolus on top. Dose distribution for two clinical cases, a chest wall and a head and neck, were compared with the bolus material treated as wax or tissue. The SPR(tissue) (wax) values for 12 and 15MeV beams are between 0.935 and 0.945, while the SPR(tissue) (water) values are between 0.990 and 0.991. For a 12 MeV beam, the dose in tissue immediately under the bolus is overestimated by 2.5% for a 3 cm bolus thickness if the wax bolus is treated as tissue. For 15 MeV beams, the error is 1.4%. However, in both clinical cases the differences in the PTV DVH is negligible. Due to stopping power differences, dose differences of up to 2.5% are observed in MC simulations if the bolus material is misassigned as tissue in BolusECT dose calculations. However, for boluses thinner than 2 cm that are more likely encountered in practice, the error is within clinical tolerance.

Strong association of de novo copy number mutations with autism.

We tested the hypothesis that de novo copy number variation (CNV) is associated with autism spectrum disorders (ASDs). We performed comparative genomic hybridization (CGH) on the genomic DNA of patients and unaffected subjects to detect copy number variants not present in their respective parents. Candidate genomic regions were validated by higher-resolution CGH, paternity testing, cytogenetics, fluorescence in situ hybridization, and microsatellite genotyping. Confirmed de novo CNVs were significantly associated with autism (P = 0.0005). Such CNVs were identified in 12 out of 118 (10%) of patients with sporadic autism, in 2 out of 77 (3%) of patients with an affected first-degree relative, and in 2 out of 196 (1%) of controls. Most de novo CNVs were smaller than microscopic resolution. Affected genomic regions were highly heterogeneous and included mutations of single genes. These findings establish de novo germline mutation as a more significant risk factor for ASD than previously recognized.