Complete patient exposure during paediatric brain cancer treatment for photon and proton therapy techniques including imaging procedures.

Background: In radiotherapy, especially when treating children, minimising exposure of healthy tissue can prevent the development of adverse outcomes, including second cancers. In this study we propose a validated Monte Carlo framework to evaluate the complete patient exposure during paediatric brain cancer treatment. Materials and methods: Organ doses were calculated for treatment of a diffuse midline glioma (50.4 Gy with 1.8 Gy per fraction) on a 5-year-old anthropomorphic phantom with 3D-conformal radiotherapy, intensity modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT) and intensity modulated pencil beam scanning (PBS) proton therapy. Doses from computed tomography (CT) for planning and on-board imaging for positioning (kV-cone beam CT and X-ray imaging) accounted for the estimate of the exposure of the patient including imaging therapeutic dose. For dose calculations we used validated Monte Carlo-based tools (PRIMO, TOPAS, PENELOPE), while lifetime attributable risk (LAR) was estimated from dose-response relationships for cancer induction, proposed by Schneider et al. Results: Out-of-field organ dose equivalent data of proton therapy are lower, with doses between 0.6 mSv (testes) and 120 mSv (thyroid), when compared to photon therapy revealing the highest out-of-field doses for IMRT ranging between 43 mSv (testes) and 575 mSv (thyroid). Dose delivered by CT ranged between 0.01 mSv (testes) and 72 mSv (scapula) while a single imaging positioning ranged between 2 µSv (testes) and 1.3 mSv (thyroid) for CBCT and 0.03 µSv (testes) and 48 µSv (scapula) for X-ray. Adding imaging dose from CT and daily CBCT to the therapeutic demonstrated an important contribution of imaging to the overall radiation burden in the course of treatment, which is subsequently used to predict the LAR, for selected organs. Conclusion: The complete patient exposure during paediatric brain cancer treatment was estimated by combining the results from different Monte Carlo-based dosimetry tools, showing that proton therapy allows significant reduction of the out-of-field doses and secondary cancer risk in selected organs.

Differences in carbonate chemistry up-regulation of long-lived reef-building corals.

With climate projections questioning the future survival of stony corals and their dominance as tropical reef builders, it is critical to understand the adaptive capacity of corals to ongoing climate change. Biological mediation of the carbonate chemistry of the coral calcifying fluid is a fundamental component for assessing the response of corals to global threats. The Tara Pacific expedition (2016-2018) provided an opportunity to investigate calcification patterns in extant corals throughout the Pacific Ocean. Cores from colonies of the massive Porites and Diploastrea genera were collected from different environments to assess calcification parameters of long-lived reef-building corals. At the basin scale of the Pacific Ocean, we show that both genera systematically up-regulate their calcifying fluid pH and dissolved inorganic carbon to achieve efficient skeletal precipitation. However, while Porites corals increase the aragonite saturation state of the calcifying fluid (Ωcf) at higher temperatures to enhance their calcification capacity, Diploastrea show a steady homeostatic Ωcf across the Pacific temperature gradient. Thus, the extent to which Diploastrea responds to ocean warming and/or acidification is unclear, and it deserves further attention whether this is beneficial or detrimental to future survival of this coral genus.

Performance of automatic exposure control on dose and image quality: comparison between slot-scanning and flat-panel digital radiography systems.

BACKGROUND: EOSedge™* (EOS Imaging, Paris, France) is an X-ray imaging system using automatic exposure control (AEC) with tube current modulation, in order to optimize dose deposition in patients. PURPOSE: This study aims at characterizing EOSedge organ dose deposition in comparison to a digital radiography (DR) system and the previous EOS system (EOS-1st generation), in relation to their respective image quality levels. METHOD: Organ doses were measured in an anthropomorphic female adult phantom and a 5-year-old pediatric phantom using optically stimulated luminescence (OSL) dosimeters, which were carefully calibrated within the studied energy range. Organ doses were recorded on the EOSedge and the Fuji Visionary DRF (Fujifilm Medical Systems U.S.A., Inc, Lexington, MA). The resulting effective doses were compared to the EOS-1st-generation values present in the literature. Image quality assessment was carried out on end-user images. Quantitative image quality metrics were computed for all tested modalities on a quality assurance phantom. Qualitative assessment of EOSedge image quality was based on anthropomorphic phantom acquisitions against the EOS-1st-generation system, and on clinical images against the tested DR system. RESULTS: For a full-spine exam, and on the female adult phantom (respectively, the pediatric phantom), an effective dose of 92 µSv (respectively, 32 µSv) was obtained on EOSedge, and 572 µSv (respectively, 179 µSv) on the DR system; these values were compared to effective dose values of 290 µSv (respectively, 200 µSv) from the literature on EOS-1st generation, leading to an effective dose reduction factor of 6 with respect to the DR system, and of 3-6 with respect to EOS-1st generation. EOSedge provides the best compromise between contrast-to-noise ratio (CNR) and dose, with more consistent CNR values than the other tested modalities, in a range of attenuation from 10 to 40 cm of poly(methyl methacrylate) (PMMA). Within this range, EOSedge is also comparable to DR for 10 and 20 cm of PMMA, and better than DR for 30 and 40 cm of PMMA, both in terms of spatial resolution and low-contrast detection. The anatomical landmarks of interest in the follow-up of spinal deformities can be detected in all tested modalities. CONCLUSION: Results showed that EOSedge provides significant dose reduction factors for full spine imaging in both adults and children compared to the other tested modalities, without compromising image quality. We believe that this work could help raise awareness on the capabilities of modern X-ray systems, when equipped with appropriate AEC strategies, to perform ultra-low-dose, long-axis images.

Toward a comparison and an optimization of CT protocols using new metrics of dose and image quality part I: prediction of human observers using a model observer for detection and discrimination tasks in low-dose CT images in various scanning conditions.

In the context of reducing the patient dose coming from CT scanner examinations without penalizing the diagnosis, the assessment of both patient dose and image quality (IQ) with relevant metrics is crucial. The present study represents the first stage in a larger work, aiming to compare and optimize CT protocols using dose and IQ new metrics. We proposed here to evaluate the capacity of the Non-PreWhitening matched filter with an eye (NPWE) model observer to be a robust and accurate estimation of IQ. We focused our work on two types of clinical tasks: a low contrast detection task and a discrimination task. We designed a torso-shaped phantom, including Plastic Water®slabs with cylindrical inserts of different diameters, sections and compositions. We led a human observer study with 13 human observers on images acquired in multiple irradiation and reconstruction scanning conditions (voltage, pitch, slice thickness, noise level of the reconstruction algorithm, energy level in dual-energy mode and dose), to evaluate the behavior of the model observer compared to the human responses faced to changing conditions. The model observer presented the same trends as the human observers with generally better results. We rescaled the NPWE model on the human responses by scanning conditions (kVp, pitch, slice thickness) to obtain the best agreement between both observer types, estimated using the Bland-Altman method. The impact of some scanning parameters was estimated using the correct answer rate given by the rescaled NPWE model, for both tasks and each insert size. In particular, the comparison between the dual-energy mode at 74 keV and the single-energy mode at 120 kVp showed that, if the 120 kVp voltage provided better results for the smallest insert at the lower doses for both tasks, their responses were equivalent in many cases.

A study on identification of bacteria in environmental samples using single-cell Raman spectroscopy: feasibility and reference libraries.

We report on our recent efforts towards identifying bacteria in environmental samples by means of Raman spectroscopy. We established a database of Raman spectra from bacteria submitted to various environmental conditions. This dataset was used to verify that Raman typing is possible from measurements performed in non-ideal conditions. Starting from the same dataset, we then varied the phenotype and matrix diversity content included in the reference library used to train the statistical model. The results show that it is possible to obtain models with an extended coverage of spectral variabilities, compared to environment-specific models trained on spectra from a restricted set of conditions. Broad coverage models are desirable for environmental samples since the exact conditions of the bacteria cannot be controlled.

Single bacteria identification by Raman spectroscopy.

We report on rapid identification of single bacteria using a low-cost, compact, Raman spectroscope. We demonstrate that a 60-s procedure is sufficient to acquire a comprehensive Raman spectrum in the range of 600 to 3300 cm⁻¹. This time includes localization of small bacteria aggregates, alignment on a single individual, and spontaneous Raman scattering signal collection. Fast localization of small bacteria aggregates, typically composed of less than a dozen individuals, is achieved by lensfree imaging over a large field of view of 24 mm². The lensfree image also allows precise alignment of a single bacteria with the probing beam without the need for a standard microscope. Raman scattered light from a 34-mW continuous laser at 532 nm was fed to a customized spectrometer (prototype Tornado Spectral Systems). Owing to the high light throughput of this spectrometer, integration times as low as 10 s were found acceptable. We have recorded a total of 1200 spectra over seven bacterial species. Using this database and an optimized preprocessing, classification rates of ~90% were obtained. The speed and sensitivity of our Raman spectrometer pave the way for high-throughput and nondestructive real-time bacteria identification assays. This compact and low-cost technology can benefit biomedical, clinical diagnostic, and environmental applications.

Neuraminidase alters red blood cells in sepsis.

OBJECTIVE: To investigate the influence of neuraminidase, an enzyme that cleaves sialic acid from the red blood cell (RBC) membrane, on RBC shape and biochemistry in critically ill patients. DESIGN: Prospective, observational study and in vitro laboratory study. SETTING: A 31-bed medico-surgical department of intensive care and a university-affiliated cell biology laboratory. SUBJECTS: Acutely ill patients with and without sepsis and healthy volunteers. INTERVENTIONS: Blood sampling in volunteers. MEASUREMENTS AND MAIN RESULTS: Neuraminidase activity was measured using a fluorescent assay. RBC shape was assessed by the second coefficient of dissymmetry of Pearson using a flow cytometry technique at 25 degrees C. Intraerythrocytic 2,3-diphosphoglycerate and lactate contents were also measured. Neuraminidase activity was significantly higher in septic patients compared with nonseptic patients and healthy volunteers (5.42 [4.85-6.00] vs. 4.53 [4.23-5.23] and 1.26 [0.83-1.83] mU/mL; all p < 0.05). Neuraminidase treatment modified the RBC shape in vitro in a dose-response fashion, and most of these alterations were present after 10 hours of incubation. Incubation of RBCs with phosphatidylinositol phospholipase C modified RBC shape and increased sialic acid concentrations in the supernatant, suggesting a leakage of neuraminidase from the RBC membrane. Alterations in shape were associated with increased 2,3-diphosphoglycerate (0.46 +/- 0.25 vs. 0.19 +/- 0.05 mumol/mL; p = 0.006) and lactate content (0.81 +/- 0.07 vs. 0.66 +/- 0.05 mmoL/L; p = 0.002). CONCLUSIONS: In sepsis, desialylation under the influence of increased neuraminidase activity may contribute to the alterations in RBC rheology. Inhibition of neuraminidase may represent a new therapeutic option to ameliorate RBC rheology and perhaps oxygen delivery to the cells.