Toward quantitative intrafractional monitoring in paraspinal SBRT using a proprietary software application: clinical implementation and patient results.

Objective.We report on paraspinal motion and the clinical implementation of our proprietary software that leverages Varian's intrafraction motion review (IMR) capability for quantitative tracking of the spine during paraspinal SBRT. The work is based on our prior development and analysis on phantoms.Approach.To address complexities in patient anatomy, digitally reconstructed radiographs (DRR's) that highlight only the spine or hardware were constructed as tracking reference. Moreover, a high-pass filter and first-pass coarse search were implemented to enhance registration accuracy and stability. For evaluation, 84 paraspinal SBRT patients with sites spanning across the entire vertebral column were enrolled with prescriptions ranging from 24 to 40 Gy in one to five fractions. Treatments were planned and delivered with 9 IMRT beams roughly equally distributed posteriorly. IMR was triggered every 200 or 500 MU for each beam. During treatment, the software grabbed the IMR image, registered it with the corresponding DRR, and displayed the motion result in near real-time on auto-pilot mode. Four independent experts completed offline manual registrations as ground truth for tracking accuracy evaluation.Main results.Our software detected ≥1.5 mm and ≥2 mm motions among 17.1% and 6.6% of 1371 patient images, respectively, in either lateral or longitudinal direction. In the validation set of 637 patient images, 91.9% of the tracking errors compared to manual registration fell within ±0.5 mm in either direction. Given a motion threshold of 2 mm, the software accomplished a 98.7% specificity and a 93.9% sensitivity in deciding whether to interrupt treatment for patient re-setup.Significance.Significant intrafractional motion exists in certain paraspinal SBRT patients, supporting the need for quantitative motion monitoring during treatment. Our improved software achieves high motion tracking accuracy clinically and provides reliable guidance for treatment intervention. It offers a practical solution to ensure accurate delivery of paraspinal SBRT on a conventional Linac platform.

A simple N,N'-dicyclohexylurea adduct of ß-alanine can self-assemble to generate nano-morphological versatility in response to different environmental conditions.

A single ω-amino acid based molecule "Boc-ß-Ala-N,N'-dicyclohexylurea" can form diverse nanostructures such as nano-vesicles, nano-tubes, nano-rods and nano-fibrils by self-assembly, in response to various environmental conditions. Interestingly, the nano-vesicular structures generated from this molecule can encapsulate the highly potent anticancer drug methotrexate, which can be released by salt triggered disruption of these vesicles. This phenomenon indicates the probability of its use in targeted delivery of drugs or any bio-active molecule, utilizing this encapsulation efficiency. Moreover, a surface-induced morphological transformation of these nano-vesicles to nano-fibers can be realized while they interact with hydrocarbon-functionalized surfaces. This phenomenon indicates the probability of their utilization in model study of peptide interaction behavior at liquid-solid interfaces and can be used in advanced study of various biological phenomena and bio-technological applications.