Application of a treatment planning system-assisted large-aperture computed tomography simulator to percutaneous biopsy: initial experience of a radiation therapist.

OBJECTIVE: To evaluate the application of treatment planning system (TPS)-assisted large-aperture computed tomography (CT) simulator to percutaneous biopsy. METHODS: This retrospective study enrolled patients that underwent TPS-assisted large-aperture CT simulator-guided percutaneous biopsy from November 2018 to December 2019. Retrospective analyses of puncture accuracy were compared using paired t-test and a Wilcoxon rank sum test. The risk factors for puncture accuracy and complications were identified. RESULTS: A total of 38 patients were included in this study. There were no significant differences between the planned and actual puncture depth and angle. Pulmonary puncture was significantly associated with the accuracy of the puncture angle. The diagnostic rate of malignancy was 76% (29 of 38), of which 20 of 25 patients were in the group initially diagnosed with unconfirmed lesions and nine of 13 patients were in the group of treated patients that needed additional pathological analyses. For patients that underwent a pulmonary biopsy, 12 had minor pneumothorax and three suffered needle track bleeding. No other complications were observed. Regression analyses indicated a significant correlation between puncture angle and the incidence of pneumothorax. CONCLUSION: TPS-assisted large-aperture CT simulator may improve the percutaneous biopsy procedure by combining the advantages of radiotherapy specialties with computer targeting.

A Special Report on 2019 International Planning Competition and a Comprehensive Analysis of Its Results.

PURPOSE: The aim of this work is to introduce the 2019 International Planning Competition and to analyze its results. METHODS AND MATERIALS: A locally advanced non-small cell lung cancer (LA-NSCLC) case using the simultaneous integrated boost approach was selected. The plan quality was evaluated by using a ranking system in accordance with practice guidelines. Planners used their clinical Treatment Planning System (TPS) to generate the best possible plan along with a survey, designed to obtain medical physics aspects information. We investigated the quality of the large population of plans designed by worldwide planners using different planning and delivery systems. The correlations of plan quality with relevant planner characteristics (work experience, department scale, and competition experience) and with technological parameters (TPS and modality) were examined. RESULTS: The number of the qualified plans was 287 with a wide range of scores (38.61-97.99). The scores showed statistically significant differences by the following factors: 1) department scale: the mean score (89.76 ± 8.36) for planners from the departments treating >2,000 patients annually was the highest of all; 2) competition experience: the mean score for the 107 planners with previous competition experience was 88.92 ± 9.59, statistically significantly from first-time participants (p = .001); 3) techniques: the mean scores for planners using VMAT (89.18 ± 6.43) and TOMO (90.62 ± 7.60) were higher than those using IMRT (82.28 ± 12.47), with statistical differences (p <.001). The plan scores were negligibly correlated with the planner's years of work experience or the type of TPS used. Regression analysis demonstrated that plan score was associated with dosimetric objectives that were difficult to achieve, which is generally consistent with a clinical practice evaluation. However, 51.2% of the planners abandoned the difficult component of total lung receiving a dose of 5 Gy in their plan design to achieve the optimal plan. CONCLUSION: The 2019 international planning competition was carried out successfully, and its results were analyzed. Plan quality was not correlated with work experiences or the TPS used, but it was correlated with department scale, modality, and competition experience. These findings differed from those reported in previous studies.

Ultrasensitive label-free detection of circulating tumor cells using conductivity matching of two-dimensional semiconductor with cancer cell.

The excellent conductivity matching of two-dimensional (2D) semiconductor nanomaterials (e.g. MoS2) with cancer cell plays an important role in ultrasensitive label-free impedimetric detection of circulating tumor cells (CTC) (<1 cell/mL). Firstly, 2D semiconductor materials (e.g. 2D MoS2) exfoliated by folic acid (FA) is used to construct MoS2/FA-modified gold electrode (AuE/MoS2/FA). Then, the fabricated electrode is applied for HeLa cell detection in a linear range from 1 to 105 cell/mL with a detection limit of 0.43 cell/mL (S/N = 3). The detection mechanism of high sensitivity might be owing to the electric conductivity matching of MoS2 (0.14 S/m) to cancer cell (0.13-0.23 S/m). A negligible conductivity change induced by cancer cell will produce a large impedance change of semiconductor electrode. Furthermore, HeLa cells dispersed in healthy blood samples are detected by suggested cytosensor in a linear range from 50 to 105 cell/mL with a detection limit of 52.24 cell/mL (S/N = 2). Finally, we demonstrate that the cytosensor is capable of differentiating patients of cervical and liver cancers by the real CTC analysis from healthy control.

Dosimetric superiority of IMRT with jaw tracking technique for whole esophagus and T-shaped field radiotherapy in advanced esophageal cancer.

PURPOSE: For whole esophagus and T-shaped field radiotherapy using intensity modulated radiotherapy (IMRT) technique in advanced esophageal cancer, lower absorbed doses to lung and heart remains a challenge. The aim of this study was to investigate the dosimetric superiority in IMRT plans with jaw tracking technique for whole esophagus radiotherapy. METHODS AND MATERIALS: Thirty-two patients with esophageal cancer were subjected to IMRT treatment plans using Eclipse treatment planning system. For every patient, four different plans were generated with six gantry angles: six large fields IMRT plans with fixed jaw (6F-IMRT), six large fields IMRT plans with jaw tracking technique (6F-IMRT-T), twelve small fields IMRT plans with fixed jaw (12F-IMRT), and twelve small fields IMRT plans with jaw tracking technique (12F-IMRT-T). Dosimetric evaluation was assessed for all plans. RESULTS: For every technique, there were no differences in planning target volume (PTV) coverage and conformity. 6F-IMRT-T plans could significantly reduce lung irradiation with 7.9% (P<0.001) reduction in V5lung and 2.5% (P<0.001) reduction in V20 lung respectively compared to 6F-IMRT plans. 12F-IMRT-T plans resulted in superior plans compared to 12-IMRT plans with a reduction of 2.9% (P<0.001) in V5lung and 0.9% (P<0.001) in V20 lung, respectively. For heart irradiation, 6F-IMRT-T and 12F-IMRT-T plans were slightly superior to 6F-IMRT and 12-IMRT plans respectively with a reduction of 1.1 Gy and 0.5 Gy in the respective mean doses. CONCLUSIONS: By the use of jaw tracking technique, the IMRT plans resulted in further lung and heart sparing compared to fixed jaw plans for radiotherapy in esophageal cancer.

Sensitive Detection of Carcinoembryonic Antigen Using Stability-Limited Few-Layer Black Phosphorus as an Electron Donor and a Reservoir.

The instability of few-layer black phosphorus (FL-BP) hampers its further applications. Here, it can be demonstrated that the instability of FL-BP can also be the advantage for application in biosensor. First, gold nanoparticle/FL-BP (BP-Au) hybrid is facilely synthesized by mixing Au precursor with FL-BP. BP-Au shows outstanding catalytic activity (K = 1120 s-1 g-1 ) and low activation energy (17.53 kJ mol-1 ) for reducing 4-nitrophenol, which is attributed to the electron-reservoir and electron-donor properties of FL-BP, and synergistic interaction of Au nanoparticles and FL-BP. Oxidation of FL-BP after catalytic reaction is further confirmed by transmission electron microscope, X-ray photoelectron spectroscopy, and zeta potentials. Second, the catalytic activity of BP-Au can be reversibly switched from "inactive" to "active" upon treatment with antibody and antigen in solution, thus providing a versatile platform for label-free colorimetric detection of biomarkers. The sensor shows a wide detection range (1 pg mL-1 to -10 µg mL-1 ), high sensitivity (0.20 pg mL-1 ), and selectivity for detecting carcinoembryonic antigen (CEA). Finally, the biosensor has been used to detect CEA in colon and breast cancer clinical samples with satisfactory results. Therefore, the instability of BP can also be the advantage for application in detecting cancer biomarker in clinic.

Dosimetric superiority of flattening filter free beams for single-fraction stereotactic radiosurgery in single brain metastasis.

For single-fraction stereotactic radiosurgery (SRS) using linac in brain metastases, more accurate treatment delivery with higher tumor absorbed doses and lower absorbed doses to normal tissues remains an enormous challenge. The purpose of this study was to investigate the dosimetric superiority in flattening filter free beams (FFF) for volumetric modulated arc therapy (VMAT) in single brain metastasis. 68 patients with single brain metastasis were included in this study. Every patient was subjected to VMAT treatment plans using 6 MV standard flattened (FF) beams (VMAT_FF) and 6 MV FFF beams (VMAT_FFF) with single fraction doses of 20 Gy. Dosimetric evaluation was performed by analysis of target coverage, dose gradients, beam-on time (BOT), gantry speed and number of monitor units (MU). There were no differences between VMAT_FF and VMAT_FFF plans in conformity and MU. VMAT_FFF plans showed obvious superiority in homogeneity, dose gradients and efficiency. For the mean BOT, VMAT_FFF plans provided a significant decrease by 42.8% compared with VMAT_FF. By the use of FFF beams, brain irradiation was minimized with about 2% reductions in low-dose regions (about 5-10 Gy). FFF beams not only resulted in more efficiency by reducing treatment time, but also provided further brain sparing compared to traditional techniques for SRS in single brain metastasis.

Modified Volumetric Modulated Arc Therapy in Left Sided Breast Cancer After Radical Mastectomy With Flattening Filter Free Versus Flattened Beams.

Conventional volumetric modulated arc therapy (C-VMAT) for breast cancer after radical mastectomy had its limitation that resulted in larger volumes of normal tissue receiving low doses. We explored whether there was a way to deal with this disadvantage and determined the potential benefit of flattening filter-free (FFF) beams.Twenty patients with breast cancer after radical mastectomy were subjected to 3D conformal radiotherapy (3DCRT) and VMAT treatment planning. For VMAT plans, 3 different designs were employed with RapidArc form: conventional-VMAT plan (C-VMAT), modified-VMAT plan (M-VMAT), and modified-VMAT plan using FFF beams (M-VMAT-F). Plan quality and efficiency were assessed for all plans.For each technique in homogeneity, there were no statistically significant differences. VMAT plans showed superiority compared with 3DCRT in conformity. C-VMAT plans were obviously not only superior to 3DCRT in the medium to high-dose regions (about 15-50 Gy) but also resulted in larger volumes in low-dose regions (about 0-10 Gy). M-VMAT plans were similar to M-VMAT-F. Both of them might significantly reduce the regions of low dose compared with C-VMAT (V5lung: ∼ 11.5%; V5heart: ∼ 23.8%, P < 0.05), even less than 3DCRT in heart irradiation (V2.5heart, 9.4%, P < 0.05). For liver, contralateral breast, and lung irradiation, M-VMAT-F plans were slightly superior to M-VMAT with a reduction of ∼0.08, 0.2, and 0.24 Gy in the respective mean doses (P < 0.05).C-VMAT plans showed superiority compared with 3DCRT, while also resulted in larger volumes of normal tissue receiving low doses. M-VMAT and M-VMAT-F plans might not only reduce the region in the medium to high doses but also have lower volumes in low-dose regions. M-VMAT-F plans were slightly superior compared with M-VMAT due to further contralateral organs sparing.

The Effect of Flattening Filter Free on Three-dimensional Conformal Radiation Therapy (3D-CRT), Intensity-Modulated Radiation Therapy (IMRT), and Volumetric Modulated Arc Therapy (VMAT) Plans for Metastatic Brain Tumors from Non-small Cell Lung Cancer.

Flattening filter free (FFF) may affect outcome measures of radiotherapy. The objective of this study is to compare the dosimetric parameters in three types of radiotherapy plans, three-dimensional conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT), and volumetric modulated arc therapy (VMAT), with or without the flattening filter (FF), developed for the treatment of metastatic brain tumors from non-small cell lung cancer (NSCLC). From July 2013 to October 2013, 3D-CRT, IMRT, and VMAT treatment plans were designed using 6 MV and 10 MV, with and without FF, for 10 patients with brain metastasis from NSCLC. The evaluation of the treatment plans included homogeneity index (HI), conformity index (CI), monitor units (MU), mean dose (Dmean), treatment time, and the influence of FFF on volumes. There was no difference in CI or HI between FFF and FF models with 3D-CRT, IMRT, and VMAT plans. At 6 MV, a lower Dmean was seen in the FFF model of 3D-CRT and in the VMAT plan at 10 MV. In the IMRT 6 MV, IMRT 10 MV, and VMAT 10 MV plans, higher MUs were seen in the FFF models. FFF treatments are similar in quality to FF plans, generally lead to more monitor units, and are associated with shorter treatment times. FFF plans ranked by the order of superiority in terms of a time advantage are VMAT, 3D-CRT, and IMRT.

Dosimetric comparison of the simultaneous integrated boost in whole-breast irradiation after breast-conserving surgery: IMRT, IMRT plus an electron boost and VMAT.

OBJECTIVES: To compare the target volume coverage and doses to organs at risks (OARs) using three techniques that simultaneous integrated boost (SIB) in whole-breast irradiation (WBI) after breast-conserving surgery, including intensity-modulated radiation therapy (IMRT), IMRT plus an electron boost (IMRT-EB), and volumetric-modulated arc therapy (VMAT). METHODS: A total of 10 patients with early-stage left-sided breast cancer after breast-conserving surgery were included in this study. IMRT, IMRT-EB and VMAT plans were generated for each patient. RESULTS: The conformity index (CI) of the planning target volumes evaluation (PTV-Eval) of VMAT was significantly superior to those of IMRT and IMRT-EB (P < 0.05). The CI of the PTV Eval-boost of VMAT was better than that of IMRT (P = 0.018) and IMRT-EB (P < 0.001), while the CI of the PTV Eval-boost of IMRT was better than that of IMRT-EB (P = 0.002). The V5, V10 and Dmean in ipsilateral lung with VMAT were significantly higher than IMRT (P < 0.05) and IMRT-EB (P < 0.05). The Dmean, V5 and V10 in heart with VMAT were significantly greater than those of IMRT and IMRT-EB (P < 0.05). There was no significant difference in the OARs between IMRT and IMRT-EB (P > 0.05). CONCLUSIONS: Considered the target volume coverage and radiation dose delivered to the OARs (especially the heart and lung), IMRT may be more suitable for the SIB in WBI than IMRT-EB and VMAT. Additional clinical studies with a larger sample size will be needed to assess the long-term feasibility and efficacy of SIB using different radiotherapy techniques.

Planning study of flattening filter free beams for volumetric modulated arc therapy in squamous cell carcinoma of the scalp.

PURPOSE: Flattening filter free (FFF) beams show the potential for a higher dose rate and lower peripheral dose. We investigated the planning study of FFF beams with their role for volumetric modulated arc therapy (VMAT) in squamous cell carcinoma of the scalp. METHODS AND MATERIALS: One patient with squamous cell carcinoma which had involvement of entire scalp was subjected to VMAT using TrueBeam linear accelerator. As it was a rare skin malignancy, CT data of 7 patients with brain tumors were also included in this study, and their entire scalps were outlined as target volumes. Three VMAT plans were employed with RapidArc form: two half-field full-arcs VMAT using 6 MV standard beams (HFF-VMAT-FF), eight half-field quarter-arcs VMAT using 6 MV standard beams (HFQ-VMAT-FF), and HFQ-VMAT using FFF beams (HFQ-VMAT-FFF). Prescribed dose was 25 × 2 Gy (50 Gy). Plan quality and efficiency were assessed for all plans. RESULTS: There were no statistically significant differences among the three VMAT plans in target volume coverage, conformity, and homogeneity. For HFQ-VMAT-FF plans, there was a significant decrease by 12.6% in the mean dose to the brain compared with HFF-VMAT-FF. By the use of FFF beams, the mean dose to brain in HFQ-VMAT-FFF plans was further decreased by 7.4% compared with HFQ-VMAT-FF. Beam delivery times were similar for each technique. CONCLUSIONS: The HFQ-VMAT-FF plans showed the superiority in dose distributions compared with HFF-VMAT-FF. HFQ-VMAT-FFF plans might provide further normal tissue sparing, particularly in the brain, showing their potential for radiation therapy in squamous cell carcinoma of the scalp.

Incorporation of carboxylation multiwalled carbon nanotubes into biodegradable poly(lactic-co-glycolic acid) for bone tissue engineering.

Biodegradable poly(lactic-co-glycolic acid) (PLGA)/carboxyl-functionalized multi-walled carbon nanotube (c-MWCNT) nanocomposites were successfully prepared via solvent casting technique. Rat bone marrow-derived mesenchymal stem cells (MSCs) were employed to assess the biocompatibility of the nanocomposites in vitro. Scanning electron microscopy (SEM) observations revealed that c-MWCNTs gave a better dispersion than unmodified MWCNTs in the PLGA matrix. Surface properties were determined by means of static contact angle, X-ray photoelectron spectroscopy (XPS) and atomic force microscopy (AFM) analysis. The presence of c-MWCNTs increased the mechanical properties of the nanocomposites. Seven-week period in vitro degradation test showed the addition of c-MWCNTs accelerated the hydrolytic degradation of PLGA. In addition, SEM proved that the cells could adhere to and spread on films via cytoplasmic processes. Compared with control groups, MSCs cultured onto PLGA/c-MWCNT nanocomposites exhibited better adhesion and viability and also displayed significantly higher production levels of alkaline phosphatase (ALP) over 21 days culture. These results demonstrated that c-MWCNTs modified PLGA films were beneficial for promoting cell growth and inducing MSCs to differentiate into osteoblasts. This work presented here had potential applications in the development of 3-D scaffolds for bone tissue engineering.

Conjugating folic acid to gold nanoparticles through glutathione for targeting and detecting cancer cells.

Gold nanoparticles (GNPs) were modified with glutathione (GSH) to form GSH-capped GNPs, which have carboxyl groups on the surface of these nanoparticles. Then folic acid (FA) was conjugated with GNPs through the reaction between amino group of FA and carboxyl group of GSH. These folic acid-conjugated nanoparticles (FA-GSH-GNPs) were stable in aqueous solution over a broad range of pH and ionic strength values. The targeting of FA-GSH-GNPs in human cervices carcinoma cells (HeLa cells) with high-level folate receptor expression was confirmed by transmission electron microscopy (TEM) and confocal laser scanning microscopy (CLSM). No cellular uptake of these nanoparticles was observed in A549 cells lack of folate receptor. HeLa cells and mouse fibroblasts incubated with FA-GSH-GNPs were assayed by measuring the relative absorbance of the supernatant collected at low-speed centrifugation. Based on this simple spectroscopic method, HeLa cells have been detected with a detection limit of 10(2)cells/mL.