Quantum Repeater Node Demonstrating Unconditionally Secure Key Distribution.

Long-distance quantum communication requires quantum repeaters to overcome photon loss in optical fibers. Here we demonstrate a repeater node with two memory atoms in an optical cavity. Both atoms are individually and repeatedly entangled with photons that are distributed until each communication partner has independently received one of them. An atomic Bell-state measurement followed by classical communication serves to establish a key. We demonstrate scaling advantage of the key rate, increase the effective attenuation length by a factor of 2, and beat the error-rate threshold of 11% for unconditionally secure communication, the corner stones for repeater-based quantum networks.

Use of Receiver Operating Curve Analysis and Machine Learning With an Independent Dose Calculation System Reduces the Number of Physical Dose Measurements Required for Patient-Specific Quality Assurance.

PURPOSE: Our purpose was to assess the use of machine learning methods and Mobius 3D (M3D) dose calculation software to reduce the number of physical ion chamber (IC) dose measurements required for patient-specific quality assurance during corona virus disease 2019. METHODS AND MATERIALS: In this study, 1464 inversely planned treatments using Pinnacle or Raystation treatment planning software (TPS) were delivered using Elekta Versa HD and Varian Truebeam and Truebeam STx linear accelerators between June 2018 and November 2019. For each plan, an independent dose calculation was performed using M3D, and an absolute dose measurement was taken using a Pinpoint IC inside the Mobius phantom. The point dose differences between the TPS and M3D calculation and between TPS and IC measurements were calculated. Agreement between the TPS and IC was used to define the ground truth plan failure. To reduce the on-site personnel during the pandemic, 2 methods of receiver operating characteristic analysis (n = 1464) and machine learning (n = 603) were used to identify patient plans that would require physical dose measurements. RESULTS: In the receiver operating characteristic analysis, a predelivery M3D difference threshold of 3% identified plans that failed an IC measurement at a 4% threshold with 100% sensitivity and 76.3% specificity. This indicates that fewer than 25% of plans required a physical dose measurement. A threshold of 1% on a machine learning model was able to identify plans that failed an IC measurement at a 3% threshold with 100% sensitivity and 54.3% specificity, leading to fewer than 50% of plans that required a physical dose measurement. CONCLUSIONS: It is possible to identify plans that are more likely to fail IC patient-specific quality assurance measurements before delivery. This possibly allows for a reduction of physical measurements taken, freeing up significant clinical resources and reducing the required amount of on-site personnel while maintaining patient safety.

Deterministic Shaping and Reshaping of Single-Photon Temporal Wave Functions.

Thorough control of the optical mode of a single photon is essential for quantum information applications. We present a comprehensive experimental and theoretical study of a light-matter interface based on cavity quantum electrodynamics. We identify key parameters like the phases of the involved light fields and demonstrate absolute, flexible, and accurate control of the time-dependent complex-valued wave function of a single photon over several orders of magnitude. This capability will be an important tool for the development of distributed quantum systems with multiple components that interact via photons.

Development and clinical evaluation of an ionization chamber array with 3.5 mm pixel pitch for quality assurance in advanced radiotherapy techniques.

PURPOSE: To characterize a new air vented ionization chamber technology, suitable to build detector arrays with small pixel pitch and independence of sensitivity on dose per pulse. METHODS: The prototype under test is a linear array of air vented ionization chambers, consisting of 80 pixels with 3.5 mm pixel pitch distance and a sensitive volume of about 4 mm(3). The detector has been characterized with (60)Co radiation and MV x rays from different linear accelerators (with flattened and unflattened beam qualities). Sensitivity dependence on dose per pulse has been evaluated under MV x rays by changing both the source to detector distance and the beam quality. Bias voltage has been varied in order to evaluate the charge collection efficiency in the most critical conditions. Relative dose profiles have been measured for both flattened and unflattened distributions with different field sizes. The reference detectors were a commercial array of ionization chambers and an amorphous silicon flat panel in direct conversion configuration. Profiles of dose distribution have been measured also with intensity modulated radiation therapy (IMRT), stereotactic radiosurgery (SRS), and volumetric modulated arc therapy (VMAT) patient plans. Comparison has been done with a commercial diode array and with Gafchromic EBT3 films. RESULTS: Repeatability and stability under continuous gamma irradiation are within 0.3%, in spite of low active volume and sensitivity (∼200 pC/Gy). Deviation from linearity is in the range [0.3%, -0.9%] for a dose of at least 20 cGy, while a worsening of linearity is observed below 10 cGy. Charge collection efficiency with 2.67 mGy/pulse is higher than 99%, leading to a ±0.9% sensitivity change in the range 0.09-2.67 mGy/pulse (covering all flattened and unflattened beam qualities). Tissue to phantom ratios show an agreement within 0.6% with the reference detector up to 34 cm depth. For field sizes in the range 2 × 2 to 15 × 15 cm(2), the output factors are in agreement with a thimble chamber within 2%, while with 25 × 25 cm(2) field size, an underestimation of 4.0% was found. Agreement of field and penumbra width measurements with the flat panel is of the order of 1 mm down to 1 × 1 cm(2) field size. Flatness and symmetry values measured with the 1D array and the reference detectors are comparable, and differences are always smaller than 1%. Angular dependence of the detector, when compared to measurements taken with a cylindrical chamber in the same phantom, is as large as 16%. This includes inhomogeneity and asymmetry of the design, which during plan verification are accounted for by the treatment planning system (TPS). The detector is capable to reproduce the dose distributions of IMRT and VMAT plans with a maximum deviation from TPS of 3.0% in the target region. In the case of VMAT and SRS plans, an average (maximum) deviation of the order of 1% (4%) from films has been measured. CONCLUSIONS: The investigated technology appears to be useful both for Linac QA and patient plan verification, especially in treatments with steep dose gradients and nonuniform dose rates such as VMAT and SRS. Major limitations of the present prototype are the linearity at low dose, which can be solved by optimizing the readout electronics, and the underestimation of output factors with large field sizes. The latter problem is presently not completely understood and will require further investigations.

Optical Synthesis of Large-Amplitude Squeezed Coherent-State Superpositions with Minimal Resources.

We propose and experimentally realize a novel versatile protocol that allows the quantum state engineering of heralded optical coherent-state superpositions. This scheme relies on a two-mode squeezed state, linear mixing, and a n-photon detection. It is optimally using expensive non-Gaussian resources to build up only the key non-Gaussian part of the targeted state. In the experimental case of a two-photon detection based on high-efficiency superconducting nanowire single-photon detectors, the freely propagating state exhibits a 67% fidelity with a squeezed even coherent-state superposition with a size |α|(2)=3. The demonstrated procedure and the achieved rate will facilitate the use of such superpositions in subsequent protocols, including fundamental tests and optical hybrid quantum information implementations.

Demonstration of a memory for tightly guided light in an optical nanofiber.

We report the experimental observation of slow-light and coherent storage in a setting where light is tightly confined in the transverse directions. By interfacing a tapered optical nanofiber with a cold atomic ensemble, electromagnetically induced transparency is observed and light pulses at the single-photon level are stored in and retrieved from the atomic medium. The decay of efficiency with storage time is also measured and related to concurrent decoherence mechanisms. Collapses and revivals can be additionally controlled by an applied magnetic field. Our results based on subdiffraction-limited optical mode interacting with atoms via the strong evanescent field demonstrate an alternative to free-space focusing and a novel capability for information storage in an all-fibered quantum network.

Cultural transmission and the evolution of human behaviour: a general approach based on the Price equation.

Transmitted culture can be viewed as an inheritance system somewhat independent of genes that is subject to processes of descent with modification in its own right. Although many authors have conceptualized cultural change as a Darwinian process, there is no generally agreed formal framework for defining key concepts such as natural selection, fitness, relatedness and altruism for the cultural case. Here, we present and explore such a framework using the Price equation. Assuming an isolated, independently measurable culturally transmitted trait, we show that cultural natural selection maximizes cultural fitness, a distinct quantity from genetic fitness, and also that cultural relatedness and cultural altruism are not reducible to or necessarily related to their genetic counterparts. We show that antagonistic coevolution will occur between genes and culture whenever cultural fitness is not perfectly aligned with genetic fitness, as genetic selection will shape psychological mechanisms to avoid susceptibility to cultural traits that bear a genetic fitness cost. We discuss the difficulties with conceptualizing cultural change using the framework of evolutionary theory, the degree to which cultural evolution is autonomous from genetic evolution, and the extent to which cultural change should be seen as a Darwinian process. We argue that the nonselection components of evolutionary change are much more important for culture than for genes, and that this and other important differences from the genetic case mean that different approaches and emphases are needed for cultural than genetic processes.

Microcontroller-based locking in optics experiments.

Optics experiments critically require the stable and accurate locking of relative phases between light beams or the stabilization of Fabry-Perot cavity lengths. Here, we present a simple and inexpensive technique based on a stand-alone microcontroller unit to perform such tasks. Easily programmed in C language, this reconfigurable digital locking system also enables automatic relocking and sequential functioning. Different algorithms are detailed and applied to fringe locking and to low- and high-finesse optical cavity stabilization, without the need of external modulations or error signals. This technique can readily replace a number of analog locking systems advantageously in a variety of optical experiments.

SU-E-T-556: Integration of Lung Blocks in the Inverse Planning Process of Modulated Arc Total Body Irradiation Using Cone Beam CT.

PURPOSE: The sizing and placement of lung blocks for total-body irradiation (TBI) is critical to prevent lung toxicities and maintain effective treatments. During modulated-arc TBI (MATBI) treatment, the patient is stationary near the floor while open-field beams with varying exposures are delivered. The inverse planning process currently aims for a uniform dose to the body, without accounting for the presence of lung blocks. This study investigates the possibility of including the effect of these blocks in the MATBI optimization process. METHODS: Dosimetric comparisons were performed using a water tank and a simple stack of solid water slabs. Lungs blocks made of cerrobend were fabricated and imaged using on-board megavoltage CBCT (MVCBCT). The reconstructed MVCBCT images were precisely registered with the reference CT for inverse planning. The cerrobend blocks were contoured in the planning system and the density was overridden to 9.3 g/cm3 . Simulated doses in Pinnacle were compared to ion chamber, diode array and gaf-chromic film measurements obtained at 1.0, 5.0, 10.0 and 20.0 cm depths. Specific optimization objectives on the lungs were tested on 5 patients including a lung re-treatment. RESULTS: The maximum difference between ion chamber measurements and the treatment planning predictions was 2.4%. The measurements profiles with the diode array correlated reasonably well (<5%) with predictions. Gaf-chromic films demonstrated good accuracy at depth but large differences (>10%) on the surface. Lung blocks reconstructed with MVCBCT were structuraly accurate without significant metal artifacts. A comparison of MATBI plans on patients shows that inclusion of lung blocks during optimization can reduce hot and cold areas in the lungs and the sternum. CONCLUSION: Reasonable predictions of the lung block transmission can be obtained following the developed technique using megavoltage CBCT. Thus, lung blocks can be included in the MATBI inverse planning process, which can help prevent complications and local failure.

SU-E-J-96: Investigation into the Accuracy of Deformable Registration Algorithms for Use in Dose Summation: A Case Study in Combined Modalities.

PURPOSE: To better understand the accuracy and limitation of deformable registration algorithms for dose summation by studying the results produced through two different deformable registration techniques for a clinical case of combining a Cyberknife radiosurgery plan and an electron boost to the scar tissues. METHODS: A patient was treated with a Cyberknife plan with supine CT and an electron boost plan with prone CT concurrently. The CT, RT structures and dose grids were exported from the Cyberknife MultiPlan system and the Pinnacle system and imported into two commercial DICOM viewing systems equipped with deformable registration algorithms. One of the systems uses intensity-based free-form deformable registration while the other uses B-spline free-form deformable registration. The electron boost plan was first registered to the CK plan using rigid registration, then secondly using deformable registration in each system. The region of interest used for registration was chosen to encompass the whole CT volumes due to the supine vs. prone positions. RESULTS: The summation doses for the Cyberknife CTV and critical structures do not differ between rigid registration and deformable registration for both systems. The electron boost volume does show higher mean dose received for the deformable registration compared with rigid registration for both systems (12.90 Gy vs. 11.71 Gy and 12.39 Gy vs. 11.53 Gy). There are slight variations between the doses produced by the two systems for all the structures, with an averaged difference of approximately 0.02% to 2.63%. CONCLUSIONS: These results show that for cases like this one, where the two treatment volumes do not overlap, there will not be significant differences between rigid and deformable registration, and that the only significant difference in summation dose between the different deformable registration algorithms is where the volume is deformed the most, in this case, the electron boost volume.

SU-E-T-123: Understanding the Meaning of IMRT QA Passing Rates with a 2D Diode Array.

PURPOSE: A lower than ideal tolerance limit is used in intensity-modulated radiation therapy quality assurance (IMRT QA) with a 2D diode array due to passing rate fluctuations. The objective is to identify patterns in the passing rates to predict sources of uncertainty that can affect treatment delivery, for example, the need to re-calibrate the multileaf collimator when the passing rates start to decrease. METHODS: Five complex clinical prostate IMRT plans were evaluated with a 2D diode array. The QA for each plan was repeated five times during one and a half month period. One of the plans was randomly selected and repeated the same day five consecutive times. The planar doses calculated by the treatment planning system were compared to the measurements of the 2D diode array. The individual passing rates per beam per plan were compared. RESULTS: The average passing rate for each plan ranged from 94% to 97%. While the average percent difference of this ranged between -7.67% to 17.61%. Additionally, the minimum and maximum standard deviation among all beams was 0.13% and 9.63% respectively. We also compared the standard deviation of a plan QA repeated during different days versus a plan QA repeated during the same day. For the former the highest standard deviation was 6.05 % while for the later 0.21%. We noticed that the largest discrepancy between the passing rates was for angles at around 155° and 205°. CONCLUSION: These results show some inconsistency in the IMRT QA passing rates from one day to the next. Moreover, lower passing rates for a specific angle like the ones shown here can represent possible mechanical or tuning problems with the linear accelerator at these specific locations. Early identification of these sources of uncertainty can greatly improve the precision of the treatment delivery.

Questioning the cultural evolution of altruism.

The evolutionary foundations of helping among nonkin in humans have been the object of intense debates in the past decades. One thesis has had a prominent influence in this debate: the suggestion that genuine altruism, strictly defined as a form of help that comes at a net fitness cost for the benefactor, might have evolved owing to cultural transmission. The gene-culture coevolution literature is wont to claim that cultural evolution changes the selective pressures that normally act to limit the emergence of altruistic behaviours. This paper aims to recall, however, that cultural transmission yields altruism only to the extent that it relies on maladaptive mechanisms, such as conformist imitation and (in some cases) payoff-biased transmission. This point is sometimes obscured in the literature by a confusion between genuine altruism, maladaptive by definition, and mutualistic forms of cooperation, that benefit all parties in the long run. Theories of cultural altruism do not lift the selective pressures weighing on strictly altruistic actions; they merely shift the burden of maladaptation from social cognition to cultural transmission.

A diamond target for megavoltage cone-beam CT.

PURPOSE: To determine the properties of a megavoltage cone-beam CT system using the unflattened beam from a sintered diamond target at 4 and 6 MV. METHODS: A sintered diamond target was used in place of a graphite target as part of an imaging beam line (an unflattened beam from a graphite target) installed on a linear accelerator. The diamond target, with a greater density than the graphite target, permitted imaging at the lower beam energy (4 MV) required with the graphite target and the higher beam energy (6 MV) conventionally used with the tungsten/stainless steel target and stainless steel flattening filter. Images of phantoms and patients were acquired using the different beam lines and compared. The beam spectra and dose distributions were determined using Monte Carlo simulation. RESULTS: The diamond target allowed use of the same beam energy as for treatment, simplifying commissioning and quality assurance. Images acquired with the diamond target at 4 MV were similar to those obtained with the graphite target at 4 MV. The slight reduction in low energy photons due to the higher-Z sintering material in the diamond target had minimal effect on image quality. Images acquired at 6 MV with the diamond target showed a small decrease in contrast-to-noise ratio, resulting from a decrease in the fraction of photons in the beam in the energy range to which the detector is most sensitive. CONCLUSIONS: The diamond target provides images of a similar quality to the graphite target. Diamond allows use of the higher beam energy conventionally used for treatment, provides a higher dose rate for the same beam current, and potentially simplifies installation and maintenance of the beam line.

What is "mirror" in the premotor cortex? A review.

We review the findings of 24 fMRI studies examining activations in the premotor cortex (Brodmann's areas 6 and 44) during passive observation of actions. We found that such activations regularly occurred. Looking for functional differentiation in the premotor cortex, we found that one parameter was associated with systematic differences in location: this was the presence or absence of targets. Observing biological actions with a physical target, compared to a visual control showing no action at all, consistently activated the ventral premotor cortex (BA 6), and did so significantly more than observing target-less actions (with the same control). In contrast, the activity in BA 44 ("Broca's area") was not modulated by the presence or absence of targets. We propose that the ventral precentral gyrus, and not BA 44, shares the visual properties of "mirror" neurons found in area F5 of the macaque brain.

Characteristics of megavoltage cone-beam digital tomosynthesis.

This article reports on the image characteristics of megavoltage cone-beam digital tomosynthesis (MVCB DT). MVCB DT is an in-room imaging technique, which enables the reconstruction of several two-dimensional slices from a set of projection images acquired over an arc of 20 degrees-40 degrees. The limited angular range reduces the acquisition time and the dose delivered to the patient, but affects the image quality of the reconstructed tomograms. Image characteristics (slice thickness, shape distortion, and contrast-to-noise ratio) are studied as a function of the angular range. Potential clinical applications include patient setup and the development of breath holding techniques for gated imaging.

Sci-Thurs PM: Delivery-12: Correction and calibration of megavoltage cone-beam CT images for the calculation of the dose of the day.

PURPOSE: To show that accurate dose calculations can be achieved with megavoltage cone-beam CT (MVCBCT) images of head-and-neck (H&N) and prostate sites, allowing the verification of the daily dose distribution received by these patients. METHOD AND MATERIALS: Corrections for the cupping and missing data artifacts seen on MVCBCT images were developed for both H&N and pelvic imaging. MVCBCT images of six H&N and two prostate patients were acquired weekly during the course of their treatment. Several regions of interest were contoured including: the prostate and rectum and the spinal cord and parotids. Dose calculation was performed with the MVCBCT images using the plan beams. Variations from treatment plan dosimetric endpoints were analyzed. RESULTS: Dose calculations with kVCT and corrected MVCBCT images of the H&N (pelvic) regions show standard deviations of 1.9% (0.6%). The mean dose to the right parotid of H&N patients had an average increase of 18% during treatment. The maximum dose to 1% of the spinal cord went up by 2% on average. For prostate patients on one fraction the dose received by 95% of the prostate diminished by 3%. One patient had an average increase of 3.6% of the maximum dose received by 1% of the rectum. CONCLUSION: MVCBCT can be used to verify daily dose distributions for H&N and prostate patients. An increase in the mean dose to normal tissues was observed during H&N treatment. Underdosage of the prostate and the dosimetric consequences of volume changes in rectum and bladder were observed. Research supported by Siemens.

[Pulmonary mucormycosis: difficulties in diagnosis and treatment]. / Mucormycoses pulmonaires: difficultés diagnostiques et thérapeutiques.

INTRODUCTION: Mucormycosis is a rare opportunistic fungal infection due to filamentous fungi of the order Mucorales in the class Zygomycetes. Rhino-cerebral and pulmonary manifestations predominate on account of the airborn spread of the spores. Gastro-intestinal, cutaneous and disseminated disease is less common. The principal risk factors are immuno-suppression and diabetic keto-acidosis. CASE REPORTS: One case of fatal pulmonary mucormycosis and two cases of colonisation illustrate both the extreme severity of this disease and the diagnostic difficulties facing the physician. The ubiquitous nature of the organism leads to frequent colonisation and, moreover, the symptomatology readily mimics that of invasive pulmonary aspergillosis. The diagnosis of mucormycosis can only be confirmed by pathological and mycological examination of biopsy specimens. These requirements conflict with the need for urgent treatment with surgical debridement, amphotericin B and control of the underlying pathology. Sadly the mortality remains very high, between 50 and 80% in published series. CONCLUSION: Currently there is hope of new therapeutic approaches with posaconozole but the ineffectiveness of voriconozole and the echinocandines, used more and more against aspergillus, raises the possibility of an increase in mucormycosis by selection.

Dose-guided radiation therapy with megavoltage cone-beam CT.

Recent advances in fractionated external beam radiation therapy have increased our ability to deliver radiation doses that conform more tightly to the tumour volume. The steeper dose gradients delivered in these treatments make it increasingly important to set precisely the positions of the patient and the internal organs. For this reason, considerable research now focuses on methods using three-dimensional images of the patient on the treatment table to adapt either the patient position or the treatment plan, to account for variable organ locations. In this article, we briefly review the different adaptive methods being explored and discuss a proposed dose-guided radiation therapy strategy that adapts the treatment for future fractions to compensate for dosimetric errors from past fractions. The main component of this strategy is a procedure to reconstruct the dose delivered to the patient based on treatment-time portal images and pre-treatment megavoltage cone-beam computed tomography (MV CBCT) images of the patient. We describe the work to date performed to develop our dose reconstruction procedure, including the implementation of a MV CBCT system for clinical use, experiments performed to calibrate MV CBCT for electron density and to use the calibrated MV CBCT for dose calculations, and the dosimetric calibration of the portal imager. We also present an example of a reconstructed patient dose using a preliminary reconstruction program and discuss the technical challenges that remain to full implementation of dose reconstruction and dose-guided therapy.

The use of megavoltage cone-beam CT to complement CT for target definition in pelvic radiotherapy in the presence of hip replacement.

In Europe and the USA combined, over half a million people had a hip joint replaced in 2005, contributing to the increasing number of radiotherapy patients with metallic hip prostheses. The treatment plan for external beam radiation therapy is based on the delineation of the anatomy in the planning CT scan. When implanted objects of high atomic number (Z) material are present, however, severe image artefacts are generated in conventional CT, strongly hindering the ability to delineate some organs. This is particularly the case for the planning of prostate patients with hip prostheses. This short communication presents the use of a new imaging modality, megavoltage cone-beam CT, to complement the regular CT for target definition of prostate cancer treatment of patients with hip replacements.

[Megavoltage cone-beam CT: Recent developments and clinical applications]. / Mégavoltage cone-beam CT: récents développements et applications cliniques pour la radiothérapie conformationnelle avec modulation d'intensité.

The Megavoltage cone-beam (MV CBCT) system consists of a new a-Si flat panel adapted for MV imaging and an integrated workflow application allowing the automatic acquisition of projection images, cone-beam CT image reconstruction, CT to CBCT image registration and couch position adjustment. This provides a 3D patient anatomy volume in the actual treatment position, relative to the treatment isocenter, moments before the dose delivery, that can be tightly aligned to the planning CT, allowing verification and correction of the patient position, detection of anatomical changes and dose calculation. In this paper, we present the main advantages and performance of this MV CBCT system and summarize the different clinical applications. Examples of the image-guided treatment process from the acquisition of the MV CBCT scan to the correction of the couch position and dose delivery will be presented for spinal and lung lesions and for head and neck, and prostate cancers.