A Wide-Band Low-Profile Antenna for a High-Integration Phased Array System.

In this paper, a wide-band, low-profile antenna is presented for a high-integration phased array system. The proposed antenna, implemented using a tightly coupled array, operates over roughly the X-K frequency band and is performant at 8 GHz-18.5 GHz. The antenna can scan to ±60 degrees in both the E- and H-planes. Compared to previous tightly coupled antennas with smaller element spacing, the antenna in this paper reaches 9.4 mm, which corresponds to 0.58 λ of high frequency, suitable for engineering application conditions in production. The antenna can be soldered to BGA T/R chips in this space. Additionally, to facilitate flexible assembly for large arrays, the antenna is manufactured modularly using four elements and its parasitic radiation is analyzed. Then, a method for repressing parasitic radiation is presented. Finally, the antenna is fabricated and measured in a microwave chamber, exhibiting an excellent pattern and scanning radiation. The measured performance agrees with the full-wave finite array simulations.

Comparison of intrafractional motion with two frameless immobilization systems in surface-guided intracranial stereotactic radiosurgery.

PURPOSE/OBJECTIVES: The aim of this study is to compare intrafractional motion using two commercial non-invasive immobilization systems for linac-based intracranial stereotactic radiosurgery (SRS) under guidance with a surface-guided radiotherapy (SGRT) system. MATERIALS/METHODS: Twenty-one patients who received intracranial SRS were retrospectively selected. Ten patients were immobilized with a vacuum fixation biteplate system, while 11 patients were immobilized with an open-face mask system. A setup margin of 1 mm was used in treatment planning. Real-time surface motion data in 37 treatment fractions using the vacuum fixation system and 44 fractions using the open-face mask were recorded by an SGRT system. Variances of intrafractional motion along three translational directions and three rotational directions were compared between the two immobilization techniques with Levene's tests. Intrafractional motion variation over time during treatments was also evaluated. RESULTS: Using the vacuum fixation system, the average and standard deviations of the shifts were 0.01 ± 0.18 mm, -0.06 ± 0.30 mm, and  0.02 ± 0.26 mm in the anterior-posterior (AP), superior-inferior (SI), and left-right (LR) directions, and -0.02 ± 0.19°, -0.01 ± 0.13°, and 0.01 ± 0.13° for rotations in yaw, roll, and pitch, respectively; using the open-face mask system, the average and standard deviations of the shifts were -0.06 ± 0.20 mm, -0.02 ± 0.35 mm, and 0.01 ± 0.40 mm in the AP, SI, and LR directions, and were 0.05 ± 0.23°, 0.02 ± 0.21°, and 0.00 ± 0.16° for rotations in yaw, roll, and pitch, respectively. There was a significant increase in intrafractional motion variance over time during treatments. CONCLUSION: Patients with the vacuum fixation system had significantly smaller intrafractional motion variation compared to those with the open-face mask system. Using intrafractional motion techniques such as surface imaging system is recommended to minimize dose deviation due to intrafractional motion. The increase in intrafractional motion over time indicates clinical benefits with shorter treatment time.

Dosimetric comparison of multiple vs single isocenter technique for linear accelerator-based stereotactic radiosurgery: The Importance of the six degree couch.

PURPOSE: Single isocenter technique (SIT) for linear accelerator-based stereotactic radiosurgery (SRS) is feasible. However, SIT introduces the potential for rotational error which can lead to geographical miss. Additional planning treatment volume (PTV) margin is required when using SIT. With the six degrees of freedom (6DoF) couch, rotational error can be minimized. We sought to evaluate the effect of the 6DoF couch on the dosimetry of patients with multiple brain metastases treated with SIT. MATERIALS AND METHODS: Ten consecutive patients treated with SRS to ≥3 metastases were identified. Original treatments had MIT plans (MITP). The lesions were replanned using SIT. Lesions 5-10 cm from isocenter had an additional 1mm of margin. Patients were replanned with these additional margins to account for inability to correct rotational error (SITPM). Multiple dosimetric variables and time metrics were evaluated. Dosimetry planning time (DPT) and patient treatment time (PTT) were evaluated. Statistics were calculated using the Wilcoxon signed-rank test. RESULTS: A total of 73 brain metastases receiving SRS, to a median of 6 lesions per patient, were identified. MITPs treated 73 lesions with 63 isocenters. On average, MITPs had a 19.2% higher brain V12 than SITPs (P = 0.017). For creation of SITPM, 30 lesions required 1 mm of additional margin, while none required 2 mm of margin. This increased V12 by 47.8% on average per patient (P = 0.008) from SITP to SITPM. DPT was 5.5 hours for SITP, while median for MITP was 12.5 hours (P = 0.005) PTT was 30 minutes for SITP, while median for MITP was 144 minutes (P = 0.005). CONCLUSIONS: SITPs are comparable to MITPs if rotational error can be corrected with the use of a 6DoF couch. Increasing margin to account for rotational error leads to a nearly 50% increase in V12, which could result in higher rates of radiation necrosis. Time savings are significant using SIT.

Cytotoxic ent-Abietane-type diterpenoids from the roots of Euphorbia ebracteolata.

Euphoroids A-C (1-3), three new ent-abietane-type diterpenoids, together with ten known analogues (4-13) were obtained from the roots of Euphorbia ebracteolata. The structures of these compounds were determined by extensive spectroscopic data analysis, including UV, HRESIMS, 1D-, and 2D-NMR data. The inhibitory effects of compounds 1-13 on human cancer cells were determined using the MTT assay. The results revealed that new compounds 2 and 3 showed moderate cytotoxic activities against human cancer cell lines. Especially, compound 3 displayed selective cytotoxic effect agains cancer cell lines.

A new method for water quality assessment: by harmony degree equation.

Water quality assessment is an important basic work in the development, utilization, management, and protection of water resources, and also a prerequisite for water safety. In this paper, the harmony degree equation (HDE) was introduced into the research of water quality assessment, and a new method for water quality assessment was proposed according to the HDE: by harmony degree equation (WQA-HDE). First of all, the calculation steps and ideas of this method were described in detail, and then, this method with some other important methods of water quality assessment (single factor assessment method, mean-type comprehensive index assessment method, and multi-level gray correlation assessment method) were used to assess the water quality of the Shaying River (the largest tributary of the Huaihe in China). For this purpose, 2 years (2013-2014) dataset of nine water quality variables covering seven monitoring sites, and approximately 189 observations were used to compare and analyze the characteristics and advantages of the new method. The results showed that the calculation steps of WQA-HDE are similar to the comprehensive assessment method, and WQA-HDE is more operational comparing with the results of other water quality assessment methods. In addition, this new method shows good flexibility by setting the judgment criteria value HD0 of water quality; when HD0 = 0.8, the results are closer to reality, and more realistic and reliable. Particularly, when HD0 = 1, the results of WQA-HDE are consistent with the single factor assessment method, both methods are subject to the most stringent "one vote veto" judgment condition. So, WQA-HDE is a composite method that combines the single factor assessment and comprehensive assessment. This research not only broadens the research field of theoretical method system of harmony theory but also promotes the unity of water quality assessment method and can be used for reference in other comprehensive assessment.

[Expression, purification and identification of recombinant Norovirus GII 4 capsid].

OBJECTIVE: The Norovirus GII 4 capsid protein was expressed by baculovirus expression system. METHODS: The Norovirus GII 4 capsid gene was insert into the HT A plasmid. After sequencing, the recombinant plasmid was transformed into the MAX Efficiency DH10BacT competent cell to express the recombinant capsid protein of Norovirus GII 4. The recombinant capsid protein was purified by Ni-NTA His bind resin affinity chromatography purification column and was identified by Norovirus rapid test kit and SDS-PAGE. RESULTS: The recombinant protein was successfully expressed with the molecular weight about 60 kD, and it has good immunogenicity. CONCLUSION: The Norovirus GII 4 capsid express plasmid is constructed successfully and the recombinant capsid protein of GII 4 is got in this study.

[Survey on fungi invasion of feed ingredients in 2013-2014 from parts of China].

OBJECTIVE: To survey the fungi contamination of four kinds of feed ingredients in 2013- 2014 from parts of China. METHODS: A total of 795 feed ingredients including soybean meal, cottonseed meal, wheat bran and distillers dried grains with soluble( DDGS) were collected from representative enterprises in different parts of China. Food safety national standards GB 4789. 15-2010 microbiological examination of food hygiene enumeration of molds and yeast and GB / T 4789. 16-2003 was used to enumerate, isolate and identify fungi, respectively. RESULTS: A total of 25 genus 54species kinds of fungi were isolated and the fungi from Aspergillus, Penicillium, Fusarium were the common contamination fungi in feed ingredients. Wheat bran was the most serious contaminated feed ingredients by fungi, and the detection rate of fungi contamination in four seasons were all greater than 84. 9%, and the exceeding feed limit rate was amount to 20. 8%. The fungi detection rate and contamination level were relatively lower in cottonseed meal and soybean meal, and the exceeding feed limit rate was 0. 9% and 1. 4%, respectively. There were types of feed ingredients, seasonal and regional differences for Aspergillus flavus and Fusarium moniliforme contamination. The detection rate of Aspergillus flavus in wheat bran was higher in four seasons and all surveyed areas, and autumn and winter and huazhong district were with the highest contamination level. The detection rate of Fusarium moniliforme for soybean meal in autumn and winter and huabei district was higher than others. The detection rate of Aspergillus flavus for DDGS was very low, but the detection rate of Fusarium moniliforme was higher, especially for autumn and huazhong district, the detection rate was 40. 4%and 50. 0%, respectively. CONCLUSION: The feed ingredients from China were commonly contaminated by fungi. It is recommended that strengthening the fungi contamination monitoring of feed ingredients from summer and autumn, huabei and huazhong district was an important prevention method.

[Survey on fungi contamination of feed ingredients in China].

OBJECTIVE: To survey the fungi contamination of different feed ingredients in China. METHODS: Soybean meal, cottonseed meal, wheat bran and distillers dried grains with soluble (DDGS) were collected from feed enterprises in different part of the country. Feed ingredient samples were diluted and inoculated and the key factors were screened which influenced the isolation. RESULTS: Potato dextrose agar (containing chloramphenicol 0.1 g/L) and 10(-1) dilution were the optimum culture medium and dilution respectively. The range of fungi contamination was from 31% (DDGS) to 88% (wheat bran). The fungi contamination frequencies of feed ingredients varied from region to region, and varied from kind to kind. The contamination of Aspergillus flavus and Fusarium spp. were also different in the regions and sample types. The average contamination percentage of Aspergillus flavus (25%) is higher than Fusarium spp. (11%), and their contamination level is highest in northeast China and lowest in south China, wheat bran and cottonseed meal were the highest and DDGS was the lowest. CONCLUSION: The fungi contamination, including Aspergillus flavus and Fusarium spp. of feed ingredients all over the country should be pay more attention. It is recommended that prevention of feed ingredients from fungi contamination is needed.

[Comparative evaluation of stx-PCR, Vero cell assay and Verotoxin enzyme imminoassay for detection of Shiga toxin-producing Escherichia coli].

OBJECTIVE: To evaluate the suitability of stx-PCR, Vero cell assay and commercial enzyme immunoassay for detection of Shiga toxin Escherichia coli and to compare sensitivity and specificity of three different methods for detection of Shiga toxin-producing Escherichia coli. METHODS: Using stx-PCR, Vero cell assay and commercial enzyme immunoassay to detect 35 Escherichia coli reference strains and 45 strains isolated from food. RESULTS: The three methods all had good specificity. 31 strains gave positive reaction in the Vero cell assay and in the stx-PCR. The consistency between the Vero cell assay and stx-PCR was 100%. Only 38 strains can be detected by commercial enzyme immunoassay. CONCLUSION: stx-PCR method can serve as a routine rapid detection method in the laboratory. Vero cell assay is recommended to be the gold standard to determine whether the bacteria had the functionally active toxin. Commercial kit was suitable for preliminary rapid detection during clinical testing and outbreaks of food-borne disease.

[Study on tetrodotoxin detection and toxic puffer fish identification of roasted fish fillet at the retail in Beijing and Qingdao].

OBJECTIVE: The roasted fish fillet sample at the retail collected in Beijing and Qingdao were detected for TTX, and the TTX positive samples was analyzed for fish species identification. METHODS: TTX was tested by EUSA method and the cytochrome c oxidase I (COI) genome of TTX-positive samples was extracted and identified by DNA barcode. RESULTS: Totally, 90 samples were tested by EUSA and 58 (64.4%) samples were positive for TTX with the levels ranging from 0.10 mg/kg to 63.81 mg/kg. Among the TTX positive samples, 24 (41.3%) were identified containing toxic puffer fish and 21 (87.5%) were Lagocephalus lunaris, the highly toxic puffer fish. CONCLUSION: Some roasted fish fillet samples obtained from the retail in two cities were positive for TTX and contained toxic puffer fish. Based on these results, we suggest that roasted fish fillet producers should prevent toxic puffer fish from mixing in the raw material and the I regulators should strengthen the TTX surveillance and product labeling supervision of roasted fish fillet.

Technical recommendations for implementation of Volumetric Modulated Arc Therapy and Helical Tomotherapy Total Body Irradiation.

As a component of myeloablative conditioning before allogeneic hematopoietic stem cell transplantation (HSCT), Total Body Irradiation (TBI) is employed in radiotherapy centers all over the world. In recent and coming years, many centers are changing their technical setup from a conventional TBI technique to multi-isocenter conformal arc therapy techniques such as Volumetric Modulated Arc Therapy (VMAT) or Helical Tomotherapy (HT). These techniques allow better homogeneity and control of the target prescription dose, and provide more freedom for individualized organ-at-risk sparing. The technical design of multi-isocenter/multi-plan conformal TBI is complex and should be developed carefully. A group of early adopters with conformal TBI experience using different treatment machines and treatment planning systems came together to develop technical recommendations and share experiences, in order to assist departments wishing to implement conformal TBI, and to provide ideas for standardization of practices.

[Expression and identification of recombinant Staphylococcus aureus enterotoxin A].

OBJECTIVE: To clone the sequence of Staphylococcus aureus enterotoxin A (SEA) gene, construct its expression vector, and obtain high levels of recombinant Staphylococcus aureus enterotoxin A (rSEA) with high purity. METHODS: The enterotoxin A gene was synthesized and inserted into the prokaryotic expressed vector pET28a possessing histiding-tag. The recombinant vector was transfected into E. Coli BL21 (DE3) after it had been verified by DNA sequencing. The strain can express the recombinant protein after the induction by the IPTG. The recombinant protein was purified by Ni-NTA His Bind affinity purification column. RESULTS: The recombinant protein was obtained. SDS-PAGE showed that its molecular mass was about 30kD. The western bolt showed that it can specifically bind rabbit anti-SEA antibody. The BALB/c mouse was immunized by the recombinant protein followed by detection of anti-SEA antibody by ELISA. The results revealed that the protein has reactogenicity and immunogenicity, which provides the foundation for either the preparation of monoclonal antibodies or the further study of the immunological detection of SEA. CONCLUSION: The rSEA expression vector was constructed successfully and highly expressed the rSEA protein.

[Development and application of real-time PCR for identification and detection of horse meat in animal-origin products].

OBJECTIVE: To develop a real-time PCR method for identification and detection of domestic horse meat (Equus caballus) in animal-origin products. METHODS: The primer and TaqMan-probe was designed and synthesized according to the EU reference laboratory and 87 bp fragments was amplified for horse ingredients. The specificity and sensitivity was tested by artificially spiked horse meat into other domestic meat, such as cattle, sheep, pork, chicken, duck and rabbit. 122 samples of cattle and sheep products were random collected in Beijing market and the detection of horse meat was carried out. RESULTS: The real-time PCR in this study has high specificity and sensitivity for horse meat. No cross-reaction was observed between the horse and sheep, pork, chicken, duck and rabbit meat. There was little cross reaction between horse and cattle when the CT value reach 33. 81. The method can detect 0.1% of horse meat mixed with other domestic animal-origin products. No horse meat ingredients were detected in 122 samples in this survey. CONCLUSION: There was no horse meat mixed into cattle and sheep products in Beijing marked.

Application and Comparison of Different Models for Quantifying the Aquatic Community in a Dam-Controlled River.

In order to develop a better model for quantifying aquatic community using environmental factors that are easy to get, we construct quantitative aquatic community models that utilize the different relationships between water environmental impact factors and aquatic biodiversity as follows: a multi-factor linear-based (MLE) model and a black box-based 'Genetic algorithm-BP artificial neural networks' (GA-BP) model. A comparison of the model efficiency and their outputs is conducted by applying the models to real-life cases, referring to the 49 groups of seasonal data observed over seven field sampling campaigns in Shaying River, China, and then performing model to reproduce the seasonal and inter-annual variation of the water ecological characteristics in the Huaidian (HD) site over 10 years. The results show that (1) the MLE and GA-BP models constructed in this paper are effective in quantifying aquatic communities in dam-controlled rivers; and (2) the performance of GA-BP models based on black-box relationships in predicting the aquatic community is better, more stable, and reliable; (3) reproducing the seasonal and inter-annual aquatic biodiversity in the HD site of Shaying River shows that the seasonal variation of species diversity for phytoplankton, zooplankton, and zoobenthos are inconsistent, and the inter-annual levels of diversity are low due to the negative impact of dam control. Our models can be used as a tool for aquatic community prediction and can become a contribution to showing how quantitative models in other dam-controlled rivers to assisting in dam management strategies.

Experimental Investigation of Cumulative Damage and Self-Healing Properties of Smart Cementitious Composite under Continuous Compression Load.

This study investigated the effect of sustained loading on the cumulative damage of a newly developed smart cement-based self-healing composite material (SMA-ECC). SMA-ECC is composed of engineered cementitious composite (ECC) and shape memory alloy (SMA) fibers. A uniaxial compressive test with five predefined loading levels (0%, 30%, 40%, 50%, and 60% of compressive strength) was conducted on SMA-ECC hollow-cylindrical specimens and ECC control hollow-cylindrical specimens. The cumulative damage was mainly determined by changes in the total water absorption of different groups of specimens during three different periods (not loaded, at a predefined loading level, and after unloading). A normalized water content index was proposed to couple the effects of self-healing, sustained loading, and cumulative damage. The test results indicate that the cumulative water absorption of SMA-ECC was 35% lower than that of ECC, which may indicate less irreparable damage. In addition, the self-healing ability of SMA-ECC specimens under different compression load levels was evaluated through normalized water content analysis. SMA-ECC exhibited a 100% repair rate at load levels of 30% and 40%. At a higher load level of 60%, the repair rate of SMA-ECC was 76%. These results collectively emphasize the significant impermeability and self-healing performance of SMA-ECC after unloading.

3D Microfluidic System for Evaluating Inhibitory Effect of Chinese Herbal Medicine Oldenlandia diffusa on Human Malignant Glioma Invasion Combined with Network Pharmacology Analysis.

OBJECTIVE: To investigate the anti-invasion efficacy of the ethanol extract of Oldenlandia diffusa Will. (EEOD) on a three-dimensional (3D) human malignant glioma (MG) cell invasion and perfusion model based on microfluidic chip culture and the possible mechanism of action of Oldenlandia diffusa Will. (OD). METHODS: The comprehensive pharmacodynamic analysis method in this study was based on microfluidic chip 3D cell perfusion culture technology, and the action mechanism of Chinese medicine (CM) on human MG cells was investigated through network pharmacology analysis. First, the components of EEOD were analyzed by ultraperformance liquid chromatography with quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF/MS). Then, cell viability and apoptosis were assessed to determine the optimum concentration of EEOD for invasion experiments, and two-dimensional (2D) migration and invasion abilities of U87 and U251 MG cells were evaluated using scratch wound and Transwell assays. The possible mechanism underlying the effects of EEOD on glioma was analyzed through a network pharmacology approach. RESULTS: Thirty-five compounds of EEOD were detected by UPLC-Q-TOF/MS. EEOD suppressed the viability of MG cells, promoted their apoptosis, and inhibited their migratory and invasive potentials (all P<0.05). Network pharmacology analysis showed that OD inhibited the invasion of MG cells by directly regulating MAPK and Wnt pathways through MAPK, EGFR, MYC, GSK3B, and other targets. The anti-invasion effect of OD was also found to be related to the indirect regulation of microtubule cytoskeleton organization. CONCLUSIONS: ]EEOD could inhibit the invasion of human MG cells, and the anti-invasion mechanism of OD might be regulating MAPK and Wnt signaling pathways and microtubule cytoskeleton organization.

Evaluation of repeatability and reproducibility of radiomic features produced by the fan-beam kV-CT on a novel ring gantry-based PET/CT linear accelerator.

BACKGROUND: The RefleXion X1 is a novel radiotherapy delivery system on a ring gantry equipped with fan-beam kV-CT and PET imaging subsystems. The day-to-day scanning variability of radiomics features must be evaluated before any attempt to utilize radiomics features. PURPOSE: This study aims to characterize the repeatability and reproducibility of radiomic features produced by the RefleXion X1 kV-CT. MATERIALS AND METHODS: The Credence Cartridge Radiomics (CCR) phantom includes six cartridges of varied materials. It was scanned 10 times on the RefleXion X1 kVCT imaging subsystem over a 3-month period using the two most frequently used scanning protocols (BMS and BMF). Fifty-five radiomic features were extracted for each ROI on each CT scan and analyzed using LifeX software. The coefficient of variation (COV) was computed to evaluate the repeatability. Intraclass correlation coefficient (ICC) and concordance correlation coefficient (CCC) were used to evaluate the repeatability and reproducibility of the scanned images using 0.9 as the threshold. This process is repeated on a GE PET-CT scanner using several built-in protocols as a comparison. RESULTS: On average, 87% of the features on both scan protocols on the RefleXion X1 kVCT imaging subsystem can be considered repeatable as they met COV < 10% criteria. On GE PET-CT, this number is similar at 86%. When we tighten the criteria to COV <5%, the RefleXion X1 kVCT imaging subsystem showed much better repeatability with 81% of features on average whereas GE PET-CT showed only 73.5% on average. About 91% and 89% of the features with ICC > 0.9 respectively for BMS and BMF protocols on RefleXion X1. On the other hand, the percentage of features with ICC > 0.9 on GE PET-CT ranges from 67% to 82%. The RefleXion X1 kVCT imaging subsystem showed excellent intra-scanner reproducibility between the scanning protocols much better than the GE PET CT scanner. For the inter-scanner reproducibility, the percentage of features with CCC > 0.9 ranged from 49% to 80%. between X1 and GE PET-CT scanning protocols. CONCLUSIONS: Clinically useful CT radiomic features produced by the RefleXion X1 kVCT imaging subsystem are reproducible and stable over time, demonstrating its utility as a quantitative imaging platform.

Target Coverage and Normal Organ Sparing in Dose-Escalated Total Marrow and Lymphatic Irradiation: A Single-Institution Experience.

Purpose/Objectives: The aim of this study is to report historical treatment planning experience at our institution for patients receiving total marrow and lymphatic irradiation (TMLI) as part of the conditioning regimen prior to hematopoietic stem cell transplant. Materials/Methods: Based on a review of all historical clinical TMLI treatments plans, we retrieved a 12-Gy cohort of 108 patients with a prescription dose of 12 Gy to the skeletal bones, lymph nodes, spleen, and spinal canal, and retrieved a 20-Gy cohort of 120 patients with an escalated prescription dose of 20 Gy to the skeletal bones, lymph nodes, spleen, and spinal cord, and 12 Gy to the brain and liver. Representative dosimetric parameters including mean and median dose, D80, and D10 (dose covering 80% and 10% of the structure volume, respectively) for targets and normal organs were extracted and compared between the two groups of patients. Results: For the 12-Gy cohort, the average mean dose for normal organs ranged from 18.3% to 78.3% of 12 Gy, and the average median dose ranged from 18.3% to 77.5% of 12 Gy. For the 20-Gy cohort, the average mean dose for normal organs ranged from 13.0% to 76.0% of 20 Gy, and the average median dose ranged from 12.5% to 75.0% of 20 Gy. Compared to the mean dose to normal organs in the 12-Gy cohort, the average mean dose to normal organs increased from 0.0% to 73.1%, with only four normal organs showing a >50% increase. Normal organ dose in TMLI plans using volumetric modulated arc therapy fields fell within the dose range in historical TMLI plans. Conclusion: Dosimetric data in historical TMLI plans at our institution are summarized at prescription dose levels of 12 Gy and 20 Gy, respectively. Compared to the normal organ dose with a prescription dose of 12 Gy, the mean and median dose to most normal organs at an escalated prescription dose of 20 Gy had an increase less than prescription dose scaling. Dosimetric results from this study can be used as reference data to facilitate clinical implementation of TMLI at other institutions.

Auto-segmentation for total marrow irradiation.

Purpose: To evaluate the accuracy and efficiency of Artificial-Intelligence (AI) segmentation in Total Marrow Irradiation (TMI) including contours throughout the head and neck (H&N), thorax, abdomen, and pelvis. Methods: An AI segmentation software was clinically introduced for total body contouring in TMI including 27 organs at risk (OARs) and 4 planning target volumes (PTVs). This work compares the clinically utilized contours to the AI-TMI contours for 21 patients. Structure and image dicom data was used to generate comparisons including volumetric, spatial, and dosimetric variations between the AI- and human-edited contour sets. Conventional volume and surface measures including the Sørensen-Dice coefficient (Dice) and the 95th% Hausdorff Distance (HD95) were used, and novel efficiency metrics were introduced. The clinical efficiency gains were estimated by the percentage of the AI-contour-surface within 1mm of the clinical contour surface. An unedited AI-contour has an efficiency gain=100%, an AI-contour with 70% of its surface<1mm from a clinical contour has an efficiency gain of 70%. The dosimetric deviations were estimated from the clinical dose distribution to compute the dose volume histogram (DVH) for all structures. Results: A total of 467 contours were compared in the 21 patients. In PTVs, contour surfaces deviated by >1mm in 38.6% ± 23.1% of structures, an average efficiency gain of 61.4%. Deviations >5mm were detected in 12.0% ± 21.3% of the PTV contours. In OARs, deviations >1mm were detected in 24.4% ± 27.1% of the structure surfaces and >5mm in 7.2% ± 18.0%; an average clinical efficiency gain of 75.6%. In H&N OARs, efficiency gains ranged from 42% in optic chiasm to 100% in eyes (unedited in all cases). In thorax, average efficiency gains were >80% in spinal cord, heart, and both lungs. Efficiency gains ranged from 60-70% in spleen, stomach, rectum, and bowel and 75-84% in liver, kidney, and bladder. DVH differences exceeded 0.05 in 109/467 curves at any dose level. The most common 5%-DVH variations were in esophagus (86%), rectum (48%), and PTVs (22%). Conclusions: AI auto-segmentation software offers a powerful solution for enhanced efficiency in TMI treatment planning. Whole body segmentation including PTVs and normal organs was successful based on spatial and dosimetric comparison.

Volumetric modulated arc therapy based total marrow and lymphoid irradiation: Workflow and clinical experience.

Background: The aim of this study is to report historical treatment planning experience at our institution for patients receiving total marrow and lymphatic irradiation (TMLI) using volumetric modulated arc therapy (VMAT) as part of the conditioning regimen prior to hematopoietic stem cell transplant. Methods: We identified a total of fifteen patients with VMAT TMLI, ten with a prescription dose of 20 Gy (targeting the skeletal bones, lymph nodes, spleen, and spinal canal, with 12 Gy to the brain and liver) and five with a prescription dose of 12-16 Gy (targeting the skeletal bones, lymph nodes, spleen, and spinal canal). Representative dosimetric parameters including total treatment time, mean and median dose, D80, and D10 (dose covering 80% and 10% of the structure volume, respectively) for targets and normal organs were extracted and compared to historical patients treated with helical tomotherapy. Results: The median treatment time for the first and subsequent fractions was 1.5 and 1.1 hours, respectively. All the target volumes had a mean dose greater than the prescribed dose except the ribs, which had an average mean dose of 19.5 Gy. The skeletal bones had an average mean dose of 21.1 Gy. The brain and liver have average mean doses of 14.8 and 14.1 Gy, respectively. The mean lung dose had an average of 7.6 ± 0.6 Gy for the 20-Gy cohort. Relative to the prescription dose of 20 Gy, the average mean dose for the normal organ volumes ranged from 16.5% to 72.0%, and the average median dose for the normal organs ranged from 16.5% to 71.0%. Dosimetry for patients treated to 12-16 Gy fell within expected ranges based on historical helical tomotherapy plans. Conclusions: Dosimetric data in the VMAT TMLI plans at our institution are summarized for 20 Gy and 12-16 Gy cohorts. Dose distributions and treatment times are overall similar to plans generated with helical tomotherapy. TMLI may be delivered effectively using a VMAT technique, even at escalated doses.