Treatment Planning and Delivery of Whole Brain Irradiation with Hippocampal Avoidance in Rats.

BACKGROUND: Despite the clinical benefit of whole brain radiotherapy (WBRT), patients and physicians are concerned by the long-term impact on cognitive functioning. Many studies investigating the molecular and cellular impact of WBRT have used rodent models. However, there has not been a rodent protocol comparable to the recently reported Radiation Therapy Oncology Group (RTOG) protocol for WBRT with hippocampal avoidance (HA) which is intended to spare cognitive function. The aim of this study was to develop a hippocampal-sparing WBRT protocol in Wistar rats. METHODS: The technical and clinical challenges encountered in hippocampal sparing during rat WBRT are substantial. Three key challenges were identified: hippocampal localization, treatment planning, and treatment localization. Hippocampal localization was achieved with sophisticated imaging techniques requiring deformable registration of a rat MRI atlas with a high resolution MRI followed by fusion via rigid registration to a CBCT. Treatment planning employed a Monte Carlo dose calculation in SmART-Plan and creation of 0.5 cm thick lead blocks custom-shaped to match DRR projections. Treatment localization necessitated the on-board image-guidance capability of the XRAD C225Cx micro-CT/micro-irradiator (Precision X-Ray). Treatment was accomplished with opposed lateral fields with 225 KVp X-rays at a current of 13 mA filtered through 0.3 mm of copper using a 40x40 mm square collimator and the lead blocks. A single fraction of 4 Gy was delivered (2 Gy per lateral field) with a 41 second beam on time per field at a dose rate of 304.5 cGy/min. Dosimetric verification of hippocampal sparing was performed using radiochromic film. In vivo verification of HA was performed after delivery of a single 4 Gy fraction either with or without HA using γ-H2Ax staining of tissue sections from the brain to quantify the amount of DNA damage in rats treated with HA, WBRT, or sham-irradiated (negative controls). RESULTS: The mean dose delivered to radiochromic film beneath the hippocampal block was 0.52 Gy compared to 3.93 Gy without the block, indicating an 87% reduction in the dose delivered to the hippocampus. This difference was consistent with doses predicted by Monte Carlo dose calculation. The Dose Volume Histogram (DVH) generated via Monte Carlo simulation showed an underdose of the target volume (brain minus hippocampus) with 50% of the target volume receiving 100% of the prescription isodose as a result of the lateral blocking techniques sparing some midline thalamic and subcortical tissue. Staining of brain sections with anti-phospho-Histone H2A.X (reflecting double-strand DNA breaks) demonstrated that this treatment protocol limited radiation dose to the hippocampus in vivo. The mean signal intensity from γ-H2Ax staining in the cortex was not significantly different from the signal intensity in the cortex of rats treated with WBRT (5.40 v. 5.75, P = 0.32). In contrast, the signal intensity in the hippocampus of rats treated with HA was significantly lower than rats treated with WBRT (4.55 v. 6.93, P = 0.012). CONCLUSION: Despite the challenges of planning conformal treatments for small volumes in rodents, our dosimetric and in vivo data show that WBRT with HA is feasible in rats. This study provides a useful platform for further application and refinement of the technique.

Long-path measurements of ultrasonic attenuation and velocity for very dilute slurries and liquids and detection of contaminates.

The objective was to use multiple paths through the slurry to determine the lowest concentration that provided accurate attenuation measurements and to measure the velocity of sound through an effective long path. Ultrasonic attenuation measurements were obtained for slurries of silica (10 microm diameter) in water for concentrations of 0.1%, 0.25%, 0.5%, 0.75% and 1% silica by weight. Attenuation measurements for concentrations less than 0.1% may prove useful for process control to detect contaminants. A long path is obtained due to multiple reflections occurring within the stainless steel (SS) vessel used; broad-band transducers are affixed on the outside of the thick-walled vessel. The signal in the receive transducer permits the measurement of the attenuation and also the velocity by measuring the time-of-flight. The FFT of the appropriate signal for each echo was obtained and compared with that for water to yield the attenuation as a function of frequency. The attenuation measurements are self-calibrating because they are not affected by changes in the pulser voltage. The data show the feasibility for measuring a concentration of 0.025 wt% silica, which is equivalent to 0.25 g of silica in 1 l of water. Therefore, such measurements can prove useful for detecting contaminants in liquid. The velocity of sound measurements for solutions of hydrogen peroxide in water were obtained and accurate to about 0.3m/s, or 0.02% uncertainty.

Tears of joy.

"Tears of joy" refers to crying when there has been a psychological gain, not a loss. The dynamic explanation of the phenomenon is that the need to repress sadness is lifted because of the gain; genetically the crying is over past losses. A clinical vignette illustrating the phenomenon is given here. It relieved the patient to be told that her symptoms did not mean that she was sick and requiring medication.

Cosine analysis of heart beat data of children in a stressful situation.

The EKG of twenty-four children (mean age = = 5.7 years) was individually and continuously recorded in a dental situation. Measures of cardiac activity (heart rate [HR] and heart rate variability [HRV]) were computed by means of a CDC 1,700 and an IBM 360 computer. Histograms of heart rate (HR) and heart rate variability (HRV) measures were generated. -Successive cosine fits were fitted for each 70 beats within an interval for each individual and these cosine fits were also presented in a histogram which represented a frequency analysis of cyclic functions within individuals. Within and between subject correlations were also computed for all measures. Sinus arrhythmia seemed to account for less of the variance than a yet unexplained cosine fit function having a lower limit of 18.6 seconds in this child population. In this population many measures of HRV seem to be negatively correlated with HR.