The Radiation Therapist profession through the lens of new technology: A practice development paper based on the ESTRO Radiation Therapist Workshops.

Technological advances in radiation therapy impact on the role and scope of practice of the radiation therapist. The European Society of Radiotherapy and Oncology (ESTRO) recently held two workshops on this topic and this position paper reflects the outcome of this workshop, which included radiation therapists from all global regions. Workflows, quality assurance, research, IGRT and ART as well as clinical decision making are the areas of radiation therapist practice that will be highly influenced by advancing technology in the near future. This position paper captures the opportunities that this will bring to the radiation therapist profession, to the practice of radiation therapy and ultimately to patient care.

An asynchronous wireless network for capturing event-driven data from large populations of autonomous sensors.

Networks of spatially distributed radiofrequency identification sensors could be used to collect data in wearable or implantable biomedical applications. However, the development of scalable networks remains challenging. Here we report a wireless radiofrequency network approach that can capture sparse event-driven data from large populations of spatially distributed autonomous microsensors. We use a spectrally efficient, low-error-rate asynchronous networking concept based on a code-division multiple-access method. We experimentally demonstrate the network performance of several dozen submillimetre-sized silicon microchips and complement this with large-scale in silico simulations. To test the notion that spike-based wireless communication can be matched with downstream sensor population analysis by neuromorphic computing techniques, we use a spiking neural network machine learning model to decode prerecorded open source data from eight thousand spiking neurons in the primate cortex for accurate prediction of hand movement in a cursor control task.

Design and Validation of Miniaturized Repetitive Transcranial Magnetic Stimulation (rTMS) Head Coils.

Repetitive transcranial magnetic stimulation (rTMS) is a rapidly developing therapeutic modality for the safe and effective treatment of neuropsychiatric disorders. However, clinical rTMS driving systems and head coils are large, heavy, and expensive, so miniaturized, affordable rTMS devices may facilitate treatment access for patients at home, in underserved areas, in field and mobile hospitals, on ships and submarines, and in space. The central component of a portable rTMS system is a miniaturized, lightweight coil. Such a coil, when mated to lightweight driving circuits, must be able to induce B and E fields of sufficient intensity for medical use. This paper newly identifies and validates salient theoretical considerations specific to the dimensional scaling and miniaturization of coil geometries, particularly figure-8 coils, and delineates novel, key design criteria. In this context, the essential requirement of matching coil inductance with the characteristic resistance of the driver switches is highlighted. Computer simulations predicted E- and B-fields which were validated via benchtop experiments. Using a miniaturized coil with dimensions of 76 mm × 38 mm and weighing only 12.6 g, the peak E-field was 87 V/m at a distance of 1.5 cm. Practical considerations limited the maximum voltage and current to 350 V and 3.1 kA, respectively; nonetheless, this peak E-field value was well within the intensity range, 60-120 V/m, generally held to be therapeutically relevant. The presented parameters and results delineate coil and circuit guidelines for a future miniaturized, power-scalable rTMS system able to generate pulsed E-fields of sufficient amplitude for potential clinical use.

Comparative Study of Eclipse and RayStation Multi-Criteria Optimization-Based Prostate Radiotherapy Treatment Planning Quality.

Multi-criteria optimization (MCO) function has been available on commercial radiotherapy (RT) treatment planning systems to improve plan quality; however, no study has compared Eclipse and RayStation MCO functions for prostate RT planning. The purpose of this study was to compare prostate RT MCO plan qualities in terms of discrepancies between Pareto optimal and final deliverable plans, and dosimetric impact of final deliverable plans. In total, 25 computed tomography datasets of prostate cancer patients were used for Eclipse (version 16.1) and RayStation (version 12A) MCO-based plannings with doses received by 98% of planning target volume having 76 Gy prescription (PTV76D98%) and 50% of rectum (rectum D50%) selected as trade-off criteria. Pareto optimal and final deliverable plan discrepancies were determined based on PTV76D98% and rectum D50% percentage differences. Their final deliverable plans were compared in terms of doses received by PTV76 and other structures including rectum, and PTV76 homogeneity index (HI) and conformity index (CI), using a t-test. Both systems showed discrepancies between Pareto optimal and final deliverable plans (Eclipse: -0.89% (PTV76D98%) and -2.49% (Rectum D50%); RayStation: 3.56% (PTV76D98%) and -1.96% (Rectum D50%)). Statistically significantly different average values of PTV76D98%,HI and CI, and mean dose received by rectum (Eclipse: 76.07 Gy, 0.06, 1.05 and 39.36 Gy; RayStation: 70.43 Gy, 0.11, 0.87 and 51.65 Gy) are noted, respectively (p < 0.001). Eclipse MCO-based prostate RT plan quality appears better than that of RayStation.

Trialkylphosphonium Oxoborate as C(sp3 )-H Oxyanion Hole Catalyst for Diels-Alder Reaction.

We have developed a catalytic protocol for Diels-Alder reaction using trialkylphosphonium oxoborates as oxyanion hole catalysts. The reaction can be operated under ambient conditions. Dienes could easily polymerize under acidic condition. Nonetheless, these acid-sensitive substrates are compatible with the catalytic protocol and the reaction scope covers a wide range of substrates.

Predictive Factors for Chemoradiation-Induced Oral Mucositis and Dysphagia in Head and Neck Cancer: A Scoping Review.

Despite advances in head and neck cancer treatment, virtually all patients experience chemoradiation-induced toxicities. Oral mucositis (OM) and dysphagia are among the most prevalent and have a systemic impact on patients, hampering treatment outcome and harming quality of life. Accurate prediction of severe cases is crucial for improving management strategies and, ultimately, patient outcomes. This scoping review comprehensively maps the reported predictors and critically evaluates the performance, methodology, and reporting of predictive models for these conditions. A total of 174 studies were identified from database searches, with 73 reporting OM predictors, 97 reporting dysphagia predictors, and 4 reporting both OM and dysphagia predictors. These predictors included patient demographics, tumor classification, chemoradiotherapy regimen, radiation dose to organs-at-risk, genetic factors, and results of clinical laboratory tests. Notably, many studies only conducted univariate analysis or focused exclusively on certain predictor types. Among the included studies, numerous predictive models were reported: eight for acute OM, five for acute dysphagia, and nine for late dysphagia. The area under the receiver operating characteristic curve (AUC) ranged between 0.65 and 0.81, 0.60 and 0.82, and 0.70 and 0.85 for acute oral mucositis, acute dysphagia, and late dysphagia predictive models, respectively. Several areas for improvement were identified, including the need for external validation with sufficiently large sample sizes, further standardization of predictor and outcome definitions, and more comprehensive reporting to facilitate reproducibility.

Computed Tomography-Based Radiomics for Long-Term Prognostication of High-Risk Localized Prostate Cancer Patients Received Whole Pelvic Radiotherapy.

Given the high death rate caused by high-risk prostate cancer (PCa) (>40%) and the reliability issues associated with traditional prognostic markers, the purpose of this study is to investigate planning computed tomography (pCT)-based radiomics for the long-term prognostication of high-risk localized PCa patients who received whole pelvic radiotherapy (WPRT). This is a retrospective study with methods based on best practice procedures for radiomics research. Sixty-four patients were selected and randomly assigned to training (n = 45) and testing (n = 19) cohorts for radiomics model development with five major steps: pCT image acquisition using a Philips Big Bore CT simulator; multiple manual segmentations of clinical target volume for the prostate (CTVprostate) on the pCT images; feature extraction from the CTVprostate using PyRadiomics; feature selection for overfitting avoidance; and model development with three-fold cross-validation. The radiomics model and signature performances were evaluated based on the area under the receiver operating characteristic curve (AUC) as well as accuracy, sensitivity and specificity. This study's results show that our pCT-based radiomics model was able to predict the six-year progression-free survival of the high-risk localized PCa patients who received the WPRT with highly consistent performances (mean AUC: 0.76 (training) and 0.71 (testing)). These are comparable to findings of other similar studies including those using magnetic resonance imaging (MRI)-based radiomics. The accuracy, sensitivity and specificity of our radiomics signature that consisted of two texture features were 0.778, 0.833 and 0.556 (training) and 0.842, 0.867 and 0.750 (testing), respectively. Since CT is more readily available than MRI and is the standard-of-care modality for PCa WPRT planning, pCT-based radiomics could be used as a routine non-invasive approach to the prognostic prediction of WPRT treatment outcomes in high-risk localized PCa.

Comparative Study of Plan Robustness for Breast Radiotherapy: Volumetric Modulated Arc Therapy Plans with Robust Optimization versus Manual Flash Approach.

A previous study investigated robustness of manual flash (MF) and robust optimized (RO) volumetric modulated arc therapy plans for breast radiotherapy based on five patients in 2020 and indicated that the RO was more robust than the MF, although the MF is still current standard practice. The purpose of this study was to compare their plan robustness in terms of dose variation to clinical target volume (CTV) and organs at risk (OARs) based on a larger sample size. This was a retrospective study involving 34 female patients. Their plan robustness was evaluated based on measured volume/dose difference between nominal and worst scenarios (ΔV/ΔD) for each CTV and OARs parameter, with a smaller difference representing greater robustness. Paired sample t-test was used to compare their robustness values. All parameters (except CTV ΔD98%) of the RO approach had smaller ΔV/ΔD values than those of the MF. Also, the RO approach had statistically significantly smaller ΔV/ΔD values (p < 0.001-0.012) for all CTV parameters except the CTV ΔV95% and ΔD98% and heart ΔDmean. This study's results confirm that the RO approach was more robust than the MF in general. Although both techniques were able to generate clinically acceptable plans for breast radiotherapy, the RO could potentially improve workflow efficiency due to its simpler planning process.

Trialkylphosphonium oxoborates as C(sp3)-H oxyanion holes and their application in catalytic chemoselective acetalization.

The use of trialkylphosphonium oxoborates (TOB) as catalysts is reported. The site-isolated borate counter anion in a TOB catalyst increases the availability of C(sp3)-H to interact with electron donor substrates. The catalytic protocol is applicable to a wide range of substrates in the acetalization reaction and provides excellent chemoselectivity in the acetalization over thioacetalization in the presence of alcohols and thiols, which is otherwise hard to achieve using typical acid catalysts. Experimental and computational studies revealed that the TOB catalysts have multiple preorganized C(sp3)-Hs that serve as a mimic of oxyanion holes, which can stabilize the oxyanion intermediates via multiple C(sp3)-H non-classical hydrogen bond interactions.

Versatile On-Chip Programming of Circuit Hardware for Wearable and Implantable Biomedical Microdevices.

Wearable and implantable microscale electronic sensors have been developed for a range of biomedical applications. The sensors, typically millimeter size silicon microchips, are sought for multiple sensing functions but are severely constrained by size and power. To address these challenges, a hardware programmable application-specific integrated circuit design is proposed and post-process methodology is exemplified by the design of battery-less wireless microchips. Specifically, both mixed-signal and radio frequency circuits are designed by incorporating metal fuses and anti-fuses on the top metal layer to enable programmability of any number of features in hardware of the system-on-chip (SoC) designs. This is accomplished in post-foundry editing by combining laser ablation and focused ion beam processing. The programmability provided by the technique can significantly accelerate the SoC chip development process by enabling the exploration of multiple internal circuit parameters without the requirement of additional programming pads or extra power consumption. As examples, experimental results are described for sub-millimeter size complementary metal-oxide-semiconductor microchips being developed for wireless electroencephalogram sensors and as implantable microstimulators for neural interfaces. The editing technique can be broadly applicable for miniaturized biomedical wearables and implants, opening up new possibilities for their expedited development and adoption in the field of smart healthcare.

First-spike coding promotes accurate and efficient spiking neural networks for discrete events with rich temporal structures.

Spiking neural networks (SNNs) are well-suited to process asynchronous event-based data. Most of the existing SNNs use rate-coding schemes that focus on firing rate (FR), and so they generally ignore the spike timing in events. On the contrary, methods based on temporal coding, particularly time-to-first-spike (TTFS) coding, can be accurate and efficient but they are difficult to train. Currently, there is limited research on applying TTFS coding to real events, since traditional TTFS-based methods impose one-spike constraint, which is not realistic for event-based data. In this study, we present a novel decision-making strategy based on first-spike (FS) coding that encodes FS timings of the output neurons to investigate the role of the first-spike timing in classifying real-world event sequences with complex temporal structures. To achieve FS coding, we propose a novel surrogate gradient learning method for discrete spike trains. In the forward pass, output spikes are encoded into discrete times to generate FS times. In the backpropagation, we develop an error assignment method that propagates error from FS times to spikes through a Gaussian window, and then supervised learning for spikes is implemented through a surrogate gradient approach. Additional strategies are introduced to facilitate the training of FS timings, such as adding empty sequences and employing different parameters for different layers. We make a comprehensive comparison between FS and FR coding in the experiments. Our results show that FS coding achieves comparable accuracy to FR coding while leading to superior energy efficiency and distinct neuronal dynamics on data sequences with very rich temporal structures. Additionally, a longer time delay in the first spike leads to higher accuracy, indicating important information is encoded in the timing of the first spike.

Standardized Reporting on the Preoperative CT Assessment of Potential Living Renal Transplant Donors: Can We Create a Universal Report Standard to Meet the Needs of Transplant Urologists?

Purpose: Determine whether standardized template reporting for the preoperative assessment of potential living renal transplant donors improves the comprehensiveness of radiology reports to meet the needs of urologists performing renal transplants. Methods: Urologist and radiologist stakeholders from renal transplant centres in our province ratified a standardized reporting template for evaluation of potential renal donors. Three centres (A, B, and C) were designated "intervention" groups. Centre D was the control group, given employment of a site-specific standardized template prior to study commencement. Up to 100 consecutive CT scan reports per centre, pre- and post-implementation of standardized reporting, were evaluated for reporting specific outcome measures. Results: At baseline, all intervention groups demonstrated poor reporting of urologist-desired outcome measures. Centre A discussed 5/13 variables (38%), Centre B discussed 6/13 variables (46%), and Centre C only discussed 1/13 variables (8%) with ≥90% reliability. The control group exhibited consistent reporting, with 11/13 variables (85%) reported at ≥90% reliability. All institutions in the intervention group exhibited excellent compliance to structured reporting post-template implementation (Centres A = 95%, B = 100%, and C = 77%, respectively). Additionally, all intervention centres demonstrated a significant improvement in the comprehensiveness of reports post-template implementation, with statistically significant increases in the reporting of all variables under-reported at baseline (P > .01). Conclusion: Standardized templates across our province for CT scans of potential renal donors promote completeness of reports. Radiologists can reliably provide our surgical colleagues with needed preoperative anatomy and incidental findings, helping to determine suitable transplant donors and reduce potential complications associated with organ retrieval.

Addition of CT to Improve the Diagnostic Confidence for the Detection of Sacroiliac Joint Erosions in Patients with Equivocal MRI Findings.

PURPOSE: To determine if CT can improve the diagnostic confidence for the detection of sacroiliac joint (SIJ) erosions in patients with equivocal MRI findings. METHODS: A retrospective analysis of adult patients who had an SIJ MRI and a subsequent SIJ CT within 12 months was conducted. Using a 5-point Likert scale, two reviewers evaluated the de-identified MRI and CT images in randomized order and in separate sessions to answer the question: "Does the patient have SIJ erosions?". A Fisher's exact test was used to analyze the difference in diagnostic confidence, and intraclass correlation coefficient (ICC) was used to determine interrater reliability. RESULTS: 54 patients were included in the analysis (average age, 43.9 years). The average time interval between initial SIJ MRI and subsequent CT was 14.4 weeks (range, 5.6-50.3 weeks). CT resulted in significantly more cases with definitive diagnostic confidence than cases with probable or equivocal confidence compared to MRI (P < .001). Amongst cases with equivocal findings on MRI, 73.2% of cases had definitive diagnoses on CT. There was moderate interrater agreement for MRI, with an ICC of .490 [95% CI, .258-.669], and excellent agreement for CT, with an ICC of .832 [95% CI, .728-.899]. CONCLUSION: Overall, CT led to significantly increased diagnostic confidence and higher interrater reliability for the detection of SIJ erosions compared to MRI. Judicious use of CT may be useful in detecting SIJ erosions in patients with equivocal MRI findings.

Stress Exposure of Evolved Bacteriophages under Laboratory versus Food Processing Conditions Highlights Challenges in Translatability.

Bacterial viruses, or bacteriophages, are highly potent, target-specific antimicrobials. Bacteriophages can be safely applied along the food production chain to aid control of foodborne pathogens. However, bacteriophages are often sensitive to the environments encountered in food matrices and under processing conditions, thus limiting their applicability. We sought to address this challenge by exposing commercially available Listeria monocytogenes bacteriophage, P100, to three stress conditions: desiccation, elevated temperature, and low pH, to select for stress-resistant bacteriophages. The stressed bacteriophage populations lost up to 5.1 log10 in infectivity; however, the surviving subpopulation retained their stress-resistant phenotype through five passages with a maximum of 2.0 log10 loss in infectivity when exposed to the same stressor. Sequencing identified key mutation regions but did not reveal a clear mechanism of resistance. The stress-selected bacteriophage populations effectively suppressed L. monocytogenes growth at a modest multiplicity of infection of 0.35-0.43, indicating no trade-off in lytic ability in return for improved survivability. The stressed subpopulations were tested for survival on food grade stainless steel, during milk pasteurization, and within acidic beverages. Interestingly, air drying on stainless steel and pasteurization in milk led to significantly less stress and titer loss in bacteriophage compared to similar stress under model lab conditions. This led to a diminished benefit for stress-selection, thus highlighting a major challenge in real-life translatability of bacteriophage adaptational evolution.

A Compact Circuit for Boosting Electric Field Intensity in Repetitive Transcranial Magnetic Stimulation (rTMS).

The concept of a portable, wearable system for repetitive transcranial stimulation (rTMS) has attracted widespread attention, but significant power and field intensity requirements remain a key challenge. Here, a circuit topology is described that significantly increases induced electric field intensity over that attainable with similar current levels and coils in conventional rTMS systems. The resultant electric field is essentially monophasic, and has a controllable, shortened duration. The system is demonstrated in a compact circuit implementation for which an electric field of 94 V/m at a depth of 2 cm is measured (147 V/m at 1 cm depth) with a power supply voltage of 80 V, a maximum current of 500 A, and an effective pulse duration (half amplitude width) of 7 µsec. The peak electric field is on the same order as that of commercially available systems at full power and comparable depths. An electric field boost of 5x is demonstrated in comparison with our system operated conventionally, employing a 70 µsec rise time. It is shown that the power requirements for rTMS systems depend on the square of the product of electric field Ep and pulse duration tp, and that the proposed circuit technique enables continuous variation and optimization of the tradeoff between Ep and tp. It is shown that the electric field induced in a medium such as the human brain cortex at a specific depth is proportional to the voltage generated in a given loop of the generating coil, which allows insights into techniques for its optimization. This rTMS electric field enhancement strategy, termed 'boost rTMS (rbTMS)' is expected to increase the effectiveness of neural stimulation, and allow greater flexibility in the design of portable rTMS power systems.Clinical Relevance- This study aims to facilitate a compact, battery-powered rTMS prototype with enhanced electric field which will permit broader and more convenient rTMS treatment at home, in a small clinic, vessel, or field hospital, and potentially, on an ambulatory basis.

The incidence and duration of COVID-19 vaccine-related reactive lymphadenopathy on 18F-FDG PET-CT.

OBJECTIVES: Reactive axillary lymph nodes (ALN) may occur post-COVID-19 vaccination. This may be confused with malignant nodal metastases on oncological imaging. We aimed to determine the reactive ALN incidence and duration on 18F-fluorodeoxyglucose positron emission tomography - computed tomography (18F-FDG PET-CT), and its relationship with gender, age and vaccine type. METHODS: A retrospective study was performed. Two-hundred and four eligible patients had 18F-FDG PET-CT between 01 January 2021 and 31 March 2021, post-vaccination with Pfizer-BioNTech or Oxford-AstraZeneca vaccine. Image analysis was performed on dedicated workstations. SPSS was used for statistical analysis. RESULTS: Thirty-six per cent of patients had reactive ALN until 10 weeks post-vaccination; reducing in frequency and intensity with time. Women were more likely to have reactive ALN compared with men. The frequency and intensity were higher in patients aged <65 years compared with those aged ≥65 years. However, no difference was found between both vaccine types in our study cohort. CONCLUSIONS: Physicians' awareness of COVID-19 vaccine-related reactive ALN on 18F-FDG PET-CT is important to avoid inappropriate upstaging of cancers.

Neural heterogeneity promotes robust learning.

The brain is a hugely diverse, heterogeneous structure. Whether or not heterogeneity at the neural level plays a functional role remains unclear, and has been relatively little explored in models which are often highly homogeneous. We compared the performance of spiking neural networks trained to carry out tasks of real-world difficulty, with varying degrees of heterogeneity, and found that heterogeneity substantially improved task performance. Learning with heterogeneity was more stable and robust, particularly for tasks with a rich temporal structure. In addition, the distribution of neuronal parameters in the trained networks is similar to those observed experimentally. We suggest that the heterogeneity observed in the brain may be more than just the byproduct of noisy processes, but rather may serve an active and important role in allowing animals to learn in changing environments.

Quantitative Point-of-Care Colorimetric Assay Modeling Using a Handheld Colorimeter.

Colorimetric assays typically offer a rapid and convenient method to assess analytes that span healthcare monitoring to water quality testing. However, such tests can only provide qualitative results when employed in resource-limited settings or require bulky and expensive equipment such as lab spectrophotometers to allow quantitative measurements. In this paper, we report on the use of a handheld colorimeter to quantitatively determine the concentration of analytes in a manner that is independent of ambient lighting or initial sample color. The method combines the response of the sensor with first-principles modeling that better describes the nature of the assay compared to linear-in-parameters regression modeling that is typically performed in other studies. This method was successfully demonstrated using a number of colorimetric assays: (1) determination of solution pH using a universal indicator, (2) quantification of the DNase presence using a DNA-gold nanoparticle assay, and (3) quantification of the concentration of the antibiotic tetracycline using a cell-based assay.

Practical microcircuits for handheld acoustofluidics.

Acoustofluidics has promised to enable lab-on-a-chip and point-of-care devices in ways difficult to achieve using other methods. Piezoelectric ultrasonic transducers-as small as the chips they actuate-provide rapid fluid and suspended object transport. Acoustofluidic lab-on-chip devices offer a vast range of benefits in early disease identification and noninvasive drug delivery. However, their potential has long been undermined by the need for benchtop or rack-mount electronics. The piezoelectric ultrasonic transducers within require these equipment and thus acoustofluidic device implementation in a bedside setting has been limited. Here we detail a general process to enable the reader to produce battery or mains-powered microcircuits ideal for driving 1-300 MHz acoustic devices. We include the general design strategy for the circuit, the blocks that collectively define it, and suitable, specific choices for components to produce these blocks. We furthermore illustrate how to incorporate automated resonance finding and tracking, sensing and feedback, and built-in adjustability to accommodate devices' vastly different operating frequencies and powers in a single driver, including examples of fluid and particle manipulation typical of the needs in our discipline. With this in hand, the many groups active in lab-on-a-chip acoustofluidics can now finally deliver on the promise of handheld, point-of-care technologies.

A Scalable and Low Stress Post-CMOS Processing Technique for Implantable Microsensors.

Implantable active electronic microchips are being developed as multinode in-body sensors and actuators. There is a need to develop high throughput microfabrication techniques applicable to complementary metal-oxide-semiconductor (CMOS)-based silicon electronics in order to process bare dies from a foundry to physiologically compatible implant ensembles. Post-processing of a miniature CMOS chip by usual methods is challenging as the typically sub-mm size small dies are hard to handle and not readily compatible with the standard microfabrication, e.g., photolithography. Here, we present a soft material-based, low chemical and mechanical stress, scalable microchip post-CMOS processing method that enables photolithography and electron-beam deposition on hundreds of micrometers scale dies. The technique builds on the use of a polydimethylsiloxane (PDMS) carrier substrate, in which the CMOS chips were embedded and precisely aligned, thereby enabling batch post-processing without complication from additional micromachining or chip treatments. We have demonstrated our technique with 650 µm × 650 µm and 280 µm × 280 µm chips, designed for electrophysiological neural recording and microstimulation implants by monolithic integration of patterned gold and PEDOT:PSS electrodes on the chips and assessed their electrical properties. The functionality of the post-processed chips was verified in saline, and ex vivo experiments using wireless power and data link, to demonstrate the recording and stimulation performance of the microscale electrode interfaces.