Monte Carlo modeling of Halcyon and Ethos radiotherapy beam using CAD geometry: validation and IAEA-compliant phase space.

Objective.A Monte Carlo (MC) model of a Halcyon and Ethos (Varian Medical Systems, a Siemens Healthineers Company) radiotherapy beam was validated and field-independent phase space (PHSP) files were recorded above the dual-layer multileaf collimators (MLC).Approach.The treatment head geometry was modeled according to engineering drawings and the dual-layer MLC was imported from CAD (computer-aided design) files. The information for the incident electron beam was achieved from an iterative electromagnetic solver. The validation of the model was performed by comparing the dose delivered by the square MLC fields as well as complex field measurements.Main results.An electron phase space was generated from linac simulations and achieved improved MC results. The output factors for square fields were within 1% and the largest differences of 5% were found in the build-up region of PDDs and the penumbra region of profiles. With the more complicated MLC-shaped field (Fishbone), the largest differences of up to 8% were found in the MLC leaf tip region due to the uncertainty of the MLC positioning and the mechanical leaf gap value. The impact of the collimator rotation on the PHSP solution has been assessed with both small and large fields, confirming negligible effects on in-field and out-of-field dose distributions.Significance.A computational model of the Halcyon and Ethos radiotherapy beam with a high accuracy implementation of the MLC was shown to be able to reproduce the radiation beam characteristics with square fields and more complex MLC-shaped fields. The field-independent PHSP files that were produced can be used as an accurate treatment head model above the MLC, and reduce the time to simulate particle transport through treatment head components.

Anti-MDA5 Amyopathic Dermatomyositis-A Diagnostic and Therapeutic Challenge.

Clinically amyopathic Dermatomyositis (CADM) is a rare subtype of idiopathic inflammatory myositis, associated with no muscular manifestations, which is more frequent in Asian women. Anti-melanoma differentiation-associated gene 5 (MDA5) antibodies are a recently discovered type of specific autoantibodies associated with myositis. The anti-MDA5 DM was initially described in Japan and later it was discovered that the target antigen was a protein implicated in the innate immune response against viruses, that is encoded by the melanoma differentiation-associated gene 5. Anti-MDA5 DM is characteristically associated with distinguished mucocutaneus and systemic manifestations, including skin ulcerations, palmar papules, arthritis, and interstitial-lung disease. Patients with anti-MDA5 positivity have a high risk of developing rapid progressive interstitial-lung disease (RP-ILD), with a poor outcome. As a result, despite high mortality, diagnosis is often delayed, necessitating increased awareness of this possible condition. Despite a severe course of lung disease and an increased mortality rate, there is currently no standard treatment. Recent insights based on observational studies and case reports support combined therapy with immunosuppressive drugs and corticotherapy, as soon as the symptoms appear. The aim of this paper is to describe anti-MDA5 DM, focusing on the recent literature about the unique clinical manifestations and therapeutic options, starting from a severe clinical case diagnosed in our Rheumatology Department.

Experience in commissioning the halcyon linac.

PURPOSE: This manuscript describes the experience of two institutions in commissioning the new HalcyonTM platform. Its purpose is to: (a) validate the pre-defined beam data, (b) compare relevant commissioning data acquired independently by two separate institutions, and (c) report on any significant differences in commissioning between the Halcyon linear accelerator and other medical linear accelerators. METHODS: Extensive beam measurements, testing of mechanical and imaging systems, including the multi-leaf collimator (MLC), were performed at the two institutions independently. The results were compared with published recommendations as well. When changes in standard practice were necessitated by the design of the new system, the efficacy of such changes was evaluated as compared to published approaches (guidelines or vendor documentation). RESULTS: Given the proper choice of detectors, good agreement was found between the respective experimental data and the treatment planning system calculations, and between independent measurements by the two institutions. MLC testing, MV imaging, and mechanical system showed unique characteristics that are different from the traditional C-arm linacs. Although the same methodologies and physics equipment can generally be used for commissioning the Halcyon, some adaptation of previous practices and development of new methods were also necessary. CONCLUSIONS: We have shown that the vendor pre-loaded data agree well with the independent measured ones during the commission process. This verifies that a data validation instead of a full-data commissioning process may be a more efficient approach for the Halcyon. Measurement results could be used as a reference for future Halcyon users.

Modeling the truebeam linac using a CAD to Geant4 geometry implementation: dose and IAEA-compliant phase space calculations.

PURPOSE: To create an accurate 6 MV Monte Carlo simulation phase space for the Varian TrueBeam treatment head geometry imported from CAD (computer aided design) without adjusting the input electron phase space parameters. METHODS: GEANT4 v4.9.2.p01 was employed to simulate the 6 MV beam treatment head geometry of the Varian TrueBeam linac. The electron tracks in the linear accelerator were simulated with Parmela, and the obtained electron phase space was used as an input to the Monte Carlo beam transport and dose calculations. The geometry components are tessellated solids included in GEANT4 as GDML (generalized dynamic markup language) files obtained via STEP (standard for the exchange of product) export from Pro/Engineering, followed by STEP import in Fastrad, a STEP-GDML converter. The linac has a compact treatment head and the small space between the shielding collimator and the divergent are of the upper jaws forbids the implementation of a plane for storing the phase space. Instead, an IAEA (International Atomic Energy Agency) compliant phase space writer was implemented on a cylindrical surface. The simulation was run in parallel on a 1200 node Linux cluster. The 6 MV dose calculations were performed for field sizes varying from 4 x 4 to 40 x 40 cm2. The voxel size for the 60 x 60 x 40 cm3 water phantom was 4 x 4 x 4 mm3. For the 10 x 10 cm2 field, surface buildup calculations were performed using 4 x 4 x 2 mm3 voxels within 20 mm of the surface. RESULTS: For the depth dose curves, 98% of the calculated data points agree within 2% with the experimental measurements for depths between 2 and 40 cm. For depths between 5 and 30 cm, agreement within 1% is obtained for 99% (4 x 4), 95% (10 x 10), 94% (20 x 20 and 30 x 30), and 89% (40 x 40) of the data points, respectively. In the buildup region, the agreement is within 2%, except at 1 mm depth where the deviation is 5% for the 10 x 10 cm2 open field. For the lateral dose profiles, within the field size for fields up to 30 x 30 cm2, the agreement is within 2% for depths up to 10 cm. At 20 cm depth, the in-field maximum dose difference for the 30 x 30 cm2 open field is within 4%, while the smaller field sizes agree within 2%. Outside the field size, agreement within 1% of the maximum dose difference is obtained for all fields. The calculated output factors varied from 0.938 +/- 0.015 for the 4 x 4 cm2 field to 1.088 +/- 0.024 for the 40 x 40 cm2 field. Their agreement with the experimental output factors is within 1%. CONCLUSIONS: The authors have validated a GEANT4 simulated IAEA-compliant phase space of the TrueBeam linac for the 6 MV beam obtained using a high accuracy geometry implementation from CAD. These files are publicly available and can be used for further research.

Linking computer-aided design (CAD) to Geant4-based Monte Carlo simulations for precise implementation of complex treatment head geometries.

Most of the treatment head components of medical linear accelerators used in radiation therapy have complex geometrical shapes. They are typically designed using computer-aided design (CAD) applications. In Monte Carlo simulations of radiotherapy beam transport through the treatment head components, the relevant beam-generating and beam-modifying devices are inserted in the simulation toolkit using geometrical approximations of these components. Depending on their complexity, such approximations may introduce errors that can be propagated throughout the simulation. This drawback can be minimized by exporting a more precise geometry of the linac components from CAD and importing it into the Monte Carlo simulation environment. We present a technique that links three-dimensional CAD drawings of the treatment head components to Geant4 Monte Carlo simulations of dose deposition.

Microscopic model of critical current noise in Josephson junctions.

We present a simple microscopic model to show how fluctuating two-level systems in a Josephson junction tunnel barrier of thickness L can modify the potential energy of the barrier and produce critical current noise spectra. We find low frequency 1/f noise that goes as L5. Our values are in good agreement with recent experimental measurements of critical current noise in Al/AlOx/Al Josephson junctions. We also investigate the sensitivity of the noise on the nonuniformity of the tunnel barrier.

Epidemiological surveillance of syphilis patients in Colentina Hospital (Bucharest, Romania).

Syphilis remains a global health problem with an estimated 12 million people infected each year. In Romania a decrease in the syphilis prevalence can be observed. From 2002 (12,702 cases) and 2003 (9,698 cases) until 2006 (5,657 syphilis cases) the reduction can be explained through the intensified efforts of the Ministry of Pubic Health to fight STI. The decrease is probably not related to an improvement of the general health status and not a consequence of some epidemiological prevention and control measures but probably was done by the reorientation of the patients to the general practitioners and to the private practice medical offices and to the lack of reporting of the cases. In Colentina Hospital a similar abrupt decrease of new cases was registered from 2004 (259 cases) to 2006 (110 cases). General problems related to syphilis cases recorded at Colentina Hospital included the patient presentation for consultation in the advanced stages of the disease, the socio-economic and educational factors, proxenetism and the sexual aggression of minors. There is a need in strengthening of the public health component in the control and surveillance of HIV/AIDS and STI. This may need changes in the legal framework to improve reporting and to target vulnerable groups in prevention activities. Laboratory capacity needs to be increased in order to be able to properly diagnose STI and improve the control and patient management. The reporting needs to be improved and simplified as for reporting protocol, reporting forms, case definitions to be taken into account in the renewed STI surveillance.

Mode-coupling approach to non-Newtonian Hele-Shaw flow.

The Saffman-Taylor viscous fingering problem is investigated for the displacement of a non-Newtonian fluid by a Newtonian one in a radial Hele-Shaw cell. We execute a mode-coupling approach to the problem and examine the morphology of the fluid-fluid interface in the weak shear limit. A differential equation describing the early nonlinear evolution of the interface modes is derived in detail. Owing to vorticity arising from our modified Darcy's law, we introduce a vector potential for the velocity in contrast to the conventional scalar potential. Our analytical results address how mode-coupling dynamics relates to tip splitting and sidebranching in both shear-thinning and shear-thickening cases. The development of non-Newtonian interfacial patterns in rectangular Hele-Shaw cells is also analyzed.