AAPM MEDICAL PHYSICS PRACTICE GUIDELINE 2.b.: Commissioning and quality assurance of X-ray-based image-guided radiotherapy systems.

The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education, and professional practice of medical physics. The AAPM has more than 8000 members and is the principal organization of medical physicists in the United States. The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner. Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized.

Genetic diversity of the ATAQ gene in Rhipicephalus microplus collected in Mexico and implications as anti-tick vaccine.

The cattle tick Rhipicephalus microplus has a large impact on cattle production due to its bloodsucking habit and transmission of pathogens that cause babesiosis and anaplasmosis. Application of acaricides constitutes the major control method but is often accompanied by serious drawbacks, including environmental contamination and an increase in acaricide resistance by ticks. The recent development of anti-tick vaccines has provided positive results in the post-genomic era, owing to the rise of reverse vaccinological and bioinformatics approaches to analyze and identify candidate protective antigens for use against ticks. The ATAQ protein is considered a novel antigen for the control of the cattle tick R. microplus; it is expressed in midguts and Malpighian tubules of all ticks from the Rhipicephalus genus. However, genetic diversity studies are required. Here, the ATAQ gene was sequenced of seven R. microplus tick isolates from different regions in Mexico to understand the genetic diversity. The results showed that sequence identity among the Mexican isolates ranged between 98 and 100% and 97.8-100% at the nucleotide and protein levels, respectively. Alignments of deduced amino acid sequences from different R. microplus ATAQ isolates in Mexico revealed a high degree of conservation. However, the Mexican isolates differed from the R. microplus "Mozambique" strain, at 20 amino acid residues. Finally, the analysis of more R. microplus isolates, and possibly of other Rhipicephalus species, to determine the genetic diversity in the ATAQ locus is essential to suggest this antigen as a vaccine candidate that might control tick infestations.

Glutathione Directly Intercepts DNA Radicals To Inhibit Oxidative DNA-Protein Cross-Linking Induced by the One-Electron Oxidation of Guanine.

Oxidative DNA damage can lead to cancer, and as enzymatic DNA repair systems become compromised during the aging process, the role of exogenous antioxidants becomes more critical. Here, we examined whether such non-enzymatic DNA repair can be effected by the common cellular antioxidant glutathione, investigating both permanent DNA damage products and the guanine radical intermediates that form them, using the flash-quench technique to carry out the one-electron oxidation of guanine. In gel-shift assays, the presence of reduced glutathione at physiological (millimolar) concentrations strongly inhibits oxidative DNA-protein cross-linking. In contrast, the oxidized glutathione dimer affords only a minimal amount of protection, even at elevated pH where there is more of the strongly reducing thiolate form. In flash photolysis experiments, the formation and decay of the guanine neutral radical were monitored at 510 nm. Transient absorption measurements with a guanine-rich 22-mer DNA duplex on the millisecond time scale show that the yield of this long-lived signal is significantly diminished in the presence of reduced glutathione, suggesting a reduction process that is fast relative to the measurement. Indeed, transient absorption experiments carried out on faster time scales show that the microsecond decay of the guanine radical signal is visibly faster with glutathione present. Glutathione is perhaps best known as an electron source in enzymatic reactions, to maintain cysteines in reduced states in proteins and to deactivate reactive oxygen species. However, these results show that another important task for glutathione may be to directly intercept DNA radicals before permanent DNA damage can occur.

Charge Density Influence on Enthalpy of Formation of Uranyl Peroxide Cage Cluster Salts.

More than 60 unique uranyl peroxide cage clusters have been reported that contain as many as 124 uranyl ions and that have overall diameters extending to 4 nm. They self-assemble in water under ambient conditions, are models for understanding structure-size-property relations as well as testing computational models for actinides, and have potential applications in nuclear fuel cycles. High-temperature drop solution calorimetry has been used to derive the enthalpies of formation of the salts of seven topologically diverse uranyl peroxide cage clusters containing from 22 to 28 uranyl ions that are bridged by various combinations of peroxide, pyrophosphate, and phosphite. The enthalpies of formation of these seven salts, as well as three salts of other uranyl peroxide clusters reported earlier, are dominated by the interactions of the alkali countercations with the clusters. There is an approximately linear relationship between the enthalpies of formation of the cluster salts and the charge density of the corresponding uranyl peroxide cluster, wherein salts containing clusters with higher charge densities have more negative enthalpies of formation.

Unimolecular reaction energies for polycyclic aromatic hydrocarbon ions.

Imaging photoelectron photoion coincidence spectroscopy was employed to explore the unimolecular dissociation of the ionized polycyclic aromatic hydrocarbons (PAHs) acenaphthylene, fluorene, cyclopenta[d,e,f]phenanthrene, pyrene, perylene, fluoranthene, dibenzo[a,e]pyrene, dibenzo[a,l]pyrene, coronene and corannulene. The primary reaction is always hydrogen atom loss, with the smaller species also exhibiting loss of C2H2 to varying extents. Combined with previous work on smaller PAH ions, trends in the reaction energies (E0) for loss of H from sp2-C and sp3-C centres, along with hydrocarbon molecule loss were found as a function of the number of carbon atoms in the ionized PAHs ranging in size from naphthalene to coronene. In the case of molecules which possessed at least one sp3-C centre, the activation energy for the loss of an H atom from this site was 2.34 eV, with the exception of cyclopenta[d,e,f]phenanthrene (CPP) ions, for which the E0 was 3.44 ± 0.86 eV due to steric constraints. The hydrogen loss from PAH cations and from their H-loss fragments exhibits two trends, depending on the number of unpaired electrons. For the loss of the first hydrogen atom, the energy is consistently ca. 4.40 eV, while the threshold to lose the second hydrogen atom is much lower at ca. 3.16 eV. The only exception was for the dibenzo[a,l]pyrene cation, which has a unique structure due to steric constraints, resulting in a low H loss reaction energy of 2.85 eV. If C2H2 is lost directly from the precursor cation, the energy required for this dissociation is 4.16 eV. No other fragmentation channels were observed over a large enough sample set for trends to be extrapolated, though data on CH3 and C4H2 loss obtained in previous studies is included for completeness. The dissociation reactions were also studied by collision induced dissociation after ionization by atmospheric pressure chemical ionization. When modeled with a simple temperature-based theory for the post-collision internal energy distribution, there was reasonable agreement between the two sets of data.

Investigating the importance of edge-structure in the loss of H/H2 of PAH cations: the case of dibenzopyrene isomers.

We present a detailed study of the main dehydrogenation processes of two dibenzopyrene cation (C24H14+) isomers, namely dibenzo(a,e)pyrene (AE+) and dibenzo(a,l)pyrene (AL+). First, action spectroscopy under VUV photons was performed using synchrotron radiation in the 8-20 eV range. We observed lower dissociation thresholds for the non-planar molecule (AL+) than for the planar one (AE+) for the main dissociation pathways: H and 2H/H2 loss. In order to rationalize the experimental results, dissociation paths were investigated by means of density functional theory calculations. In the case of H loss, which is the dominant channel at the lowest energies, the observed difference between the two isomers can be explained by the presence in AL+ of two C-H bonds with considerably lower adiabatic dissociation energies. In both isomers the 2H/H2 loss channels are observed only at about 1 eV higher than H loss. We suggest that this is due to the propensity of bay H atoms to easily form H2. In addition, in the case of AL+, we cannot exclude a competition between 2H and H2 channels. In particular, the formation of a stable dissociation product with a five-membered ring could account for the low energy sequential loss of 2 hydrogens. This work shows the potential role of non-compact PAHs containing bay regions in the production of H2 in space.

Lattice Dynamics of the Rhombohedral Polymorphs of CaSi2.

The structures of two trigonal-rhombohedral CaSi2 polymorphs (space group R3̅m) were studied by X-ray diffraction and polarized Raman scattering spectroscopy. Raman-active even-parity vibrational modes of A1g and Eg are unambiguously identified and assigned to the specific lattice eigenmodes. Experimental data are found to be in very good agreement with those predicted by density functional theory lattice dynamics calculations. The transformation of 6R structural modification of CaSi2 into its 3R polymorph, by high-temperature annealing in vacuum is also reported.

Evaluation of 4D CT acquisition methods designed to reduce artifacts.

Four-dimensional computed tomography (4D CT) is used to account for respiratory motion in radiation treatment planning, but artifacts resulting from the acquisition and postprocessing limit its accuracy. We investigated the efficacy of three experimental 4D CT acquisition methods to reduce artifacts in a prospective institutional review board approved study. Eighteen thoracic patients scheduled to undergo radiation therapy received standard clinical 4D CT scans followed by each of the alternative 4D CT acquisitions: 1) data oversampling, 2) beam gating with breathing irregularities, and 3) rescanning the clinical acquisition acquired during irregular breathing. Relative values of a validated correlation-based artifact metric (CM) determined the best acquisition method per patient. Each 4D CT was processed by an extended phase sorting approach that optimizes the quantitative artifact metric (CM sorting). The clinical acquisitions were also postprocessed by phase sorting for artifact comparison of our current clinical implementation with the experimental methods. The oversampling acquisition achieved the lowest artifact presence among all acquisitions, achieving a 27% reduction from the current clinical 4D CT implementation (95% confidence interval = 34-20). The rescan method presented a significantly higher artifact presence from the clinical acquisition (37%; p < 0.002), the gating acquisition (26%; p < 0.005), and the oversampling acquisition (31%; p < 0.001), while the data lacked evidence of a significant difference between the clinical, gating, and oversampling methods. The oversampling acquisition reduced artifact presence from the current clinical 4D CT implementation to the largest degree and provided the simplest and most reproducible implementation. The rescan acquisition increased artifact presence significantly, compared to all acquisitions, and suffered from combination of data from independent scans over which large internal anatomic shifts occurred.

Assessment of a quantitative metric for 4D CT artifact evaluation by observer consensus.

The benefits of four-dimensional computed tomography (4D CT) are limited by the presence of artifacts that remain difficult to quantify. A correlation-based metric previously proposed for ciné 4D CT artifact identification was further validated as an independent artifact evaluator by using a novel qualitative assessment featuring a group of observers reaching a consensus decision on artifact location and magnitude. The consensus group evaluated ten ciné 4D CT scans for artifacts over each breathing phase of coronal lung views assuming one artifact per couch location. Each artifact was assigned a magnitude score of 1-5, 1 indicating lowest severity and 5 indicating highest severity. Consensus group results served as the ground truth for assessment of the correlation metric. The ten patients were split into two cohorts; cohort 1 generated an artifact identification threshold derived from receiver operating characteristic analysis using the Youden Index, while cohort 2 generated sensitivity and specificity values from application of the artifact threshold. The Pearson correlation coefficient was calculated between the correlation metric values and the consensus group scores for both cohorts. The average sensitivity and specificity values found with application of the artifact threshold were 0.703 and 0.476, respectively. The correlation coefficients of artifact magnitudes for cohort 1 and 2 were 0.80 and 0.61, respectively, (p < 0.001 for both); these correlation coefficients included a few scans with only two of the five possible magnitude scores. Artifact incidence was associated with breathing phase (p < 0.002), with presentation less likely near maximum exhale. Overall, the correlation metric allowed accurate and automated artifact identification. The consensus group evaluation resulted in efficient qualitative scoring, reduced interobserver variation, and provided consistent identification of artifact location and magnitudes.

Can a 3 months treatment with oral Desogestrel prior to insertion of the etonogestrel-releasing contraceptive implant improve continuation rate at 1 year? A randomized trial.

OBJECTIVE: To evaluate if daily oral 75 µg of Desogestrel (DSG) for 3 months prior to the insertion of etonogestrel-releasing contraceptive implant (ENG-IMPLANT) might help reduce its premature discontinuation. RESULTS: A total of 66 women were randomized in the ENG-IMPLANT group (26) and in the DSG + ENG-IMPLANT group (40), respectively, in the Geneva University Hospitals and Basel University Hospital, from August 15th, 2016 through September 30th, 2019. In the DSG + ENG-IMPLANT group, patients were given a 3 months' supply of 75 µg of DSG before the insertion of the ENG-IMPLANT. All women were seen after 3 months for bleeding and satisfaction evaluation, and at 12 months post ENG-IMPLANT insertion. Higher levels of satisfaction at 12-months were found in the ENG-IMPLANT group compared to the DSG + ENG-IMPLANT group (8.5 ± 1.7 vs. 6.6 ± 2.9, p = 0.012). There were no statistically significant differences regarding tolerance (7.8 ± 2.5 vs 6.8 ± 2.6, p = 0.191) and contraceptive continuation (80% vs 72.4%, p = 0.544) between groups. CONCLUSION: DSG prior to insertion of the ENG-IMPLANT did not improve its continuation rate neither its satisfaction at 1 year. Trial registration NCT05174195. Retrospectively registered, the 30th December 2021.

Argonaute5 and its associated small RNAs modulate the transcriptional response during the rhizobia-Phaseolus vulgaris symbiosis.

Both plant- and rhizobia-derived small RNAs play an essential role in regulating the root nodule symbiosis in legumes. Small RNAs, in association with Argonaute proteins, tune the expression of genes participating in nodule development and rhizobial infection. However, the role of Argonaute proteins in this symbiosis has been overlooked. In this study, we provide transcriptional evidence showing that Argonaute5 (AGO5) is a determinant genetic component in the root nodule symbiosis in Phaseolus vulgaris. A spatio-temporal transcriptional analysis revealed that the promoter of PvAGO5 is active in lateral root primordia, root hairs from rhizobia-inoculated roots, nodule primordia, and mature nodules. Transcriptional analysis by RNA sequencing revealed that gene silencing of PvAGO5 affected the expression of genes involved in the biosynthesis of the cell wall and phytohormones participating in the rhizobial infection process and nodule development. PvAGO5 immunoprecipitation coupled to small RNA sequencing revealed the small RNAs bound to PvAGO5 during the root nodule symbiosis. Identification of small RNAs associated to PvAGO5 revealed miRNAs previously known to participate in this symbiotic process, further supporting a role for AGO5 in this process. Overall, the data presented shed light on the roles that PvAGO5 plays during the root nodule symbiosis in P. vulgaris.

Zika virus infection in pregnancy: a protocol for the joint analysis of the prospective cohort studies of the ZIKAlliance, ZikaPLAN and ZIKAction consortia.

INTRODUCTION: Zika virus (ZIKV) infection in pregnancy has been associated with microcephaly and severe neurological damage to the fetus. Our aim is to document the risks of adverse pregnancy and birth outcomes and the prevalence of laboratory markers of congenital infection in deliveries to women experiencing ZIKV infection during pregnancy, using data from European Commission-funded prospective cohort studies in 20 centres in 11 countries across Latin America and the Caribbean. METHODS AND ANALYSIS: We will carry out a centre-by-centre analysis of the risks of adverse pregnancy and birth outcomes, comparing women with confirmed and suspected ZIKV infection in pregnancy to those with no evidence of infection in pregnancy. We will document the proportion of deliveries in which laboratory markers of congenital infection were present. Finally, we will investigate the associations of trimester of maternal infection in pregnancy, presence or absence of maternal symptoms of acute ZIKV infection and previous flavivirus infections with adverse outcomes and with markers of congenital infection. Centre-specific estimates will be pooled using a two-stage approach. ETHICS AND DISSEMINATION: Ethical approval was obtained at each centre. Findings will be presented at international conferences and published in peer-reviewed open access journals and discussed with local public health officials and representatives of the national Ministries of Health, Pan American Health Organization and WHO involved with ZIKV prevention and control activities.

Photoprocessing of large PAH cations.

In cosmic environments, polycyclic aromatic hydrocarbons (PAHs) strongly interact with vacuum ultraviolet (VUV) photons emitted by young stars. Trapped PAH cations ranging in size from 30 to 48 carbon atoms were irradiated by tunable synchrotron light (DESIRS beamline at SOLEIL). Their ionization and dissociation cross sections were determined and compared with TD-DFT computed photoabsorption cross sections. Evidence for radiative cooling is reported.

Automated identification and reduction of artifacts in cine four-dimensional computed tomography (4DCT) images using respiratory motion model.

PURPOSE: Four-dimensional computed tomography (4DCT) images are often marred by artifacts that substantially degrade image quality and confound image interpretation. Human observation remains the standard method of 4DCT artifact evaluation, which is time-consuming and subjective. We develop a method to automatically identify and reduce artifacts in cine 4DCT images. METHODS: We proposed an algorithm that consisted of two main stages: deformable image registration and respiratory motion simulation. Specifically, each 4DCT phase image was registered to the breath-holding CT image using the block-matching method, with erroneous spatial matches removed by the least median of squares filter and the full displacement vector field generated by the moving least squares interpolation. The lung's respiratory motion trajectory was then recovered from the displacement vector field using the parameterized polynomial function, with fitting parameters estimated by combinatorial optimization. In this way, artifacts were located according to deviations between image points and their motion trajectories and further corrected based on position prediction. RESULTS: The mean spatial error (standard deviation) was 1.00 (0.85) mm after registration as opposed to 6.96 (4.61) mm before registration. In addition, we took human observation conducted by medical experts as the gold standard. The average sensitivity, specificity, and accuracy of the proposed method in artifact identification were 0.97, 0.84, and 0.89, respectively. CONCLUSIONS: The proposed method identified and reduced artifacts accurately and automatically, providing an alternative way to analyze 4DCT image quality and to correct problematic images for radiation therapy.

VUV photo-processing of PAH cations: quantitative study on the ionization versus fragmentation processes.

Interstellar polycyclic aromatic hydrocarbons (PAHs) are strongly affected by the absorption of vacuum ultraviolet (VUV) photons in the interstellar medium (ISM), yet the branching ratio between ionization and fragmentation is poorly studied. This is crucial for the stability and charge state of PAHs in the ISM in different environments, affecting in turn the chemistry, the energy balance, and the contribution of PAHs to the extinction and emission curves. We studied the interaction of PAH cations with VUV photons in the 7 - 20 eV range from the synchrotron SOLEIL beamline, DESIRS. We recorded by action spectroscopy the relative intensities of photo-fragmentation and photo-ionization for a set of eight PAH cations ranging in size from 14 to 24 carbon atoms, with different structures. At photon energies below ~13.6 eV fragmentation dominates for the smaller species, while for larger species ionization is immediately competitive after the second ionization potential (IP). At higher photon energies, all species behave similarly, the ionization yield gradually increases, leveling off between 0.8 and 0.9 at ~18 eV. Among isomers, PAH structure appears to mainly affect the fragmentation cross section, but not the ionization cross section. We also measured the second IP for all species and the third IP for two of them, all are in good agreement with theoretical ones confirming that PAH cations can be further ionized in the diffuse ISM. Determining actual PAH dication abundances in the ISM will require detailed modeling. Our measured photo-ionization yields for several PAH cations provide a necessary ingredient for such models.

Pre-radiotherapy FDG PET predicts radiation pneumonitis in lung cancer.

BACKGROUND: A retrospective analysis is performed to determine if pre-treatment [18 F]-2-fluoro-2-deoxyglucose positron emission tomography/computed tomography (FDG PET/CT) image derived parameters can predict radiation pneumonitis (RP) clinical symptoms in lung cancer patients. METHODS AND MATERIALS: We retrospectively studied 100 non-small cell lung cancer (NSCLC) patients who underwent FDG PET/CT imaging before initiation of radiotherapy (RT). Pneumonitis symptoms were evaluated using the Common Terminology Criteria for Adverse Events version 4.0 (CTCAEv4) from the consensus of 5 clinicians. Using the cumulative distribution of pre-treatment standard uptake values (SUV) within the lungs, the 80th to 95th percentile SUV values (SUV(80) to SUV(95) were determined. The effect of pre-RT FDG uptake, dose, patient and treatment characteristics on pulmonary toxicity was studied using multiple logistic regression. RESULTS: The study subjects were treated with 3D conformal RT (n=23), intensity modulated RT (n=64), and proton therapy (n=13). Multiple logistic regression analysis demonstrated that elevated pre-RT lung FDG uptake on staging FDG PET was related to development of RP symptoms after RT. A patient of average age and V(30) with SUV(95)=1.5 was an estimated 6.9 times more likely to develop grade ≥ 2 radiation pneumonitis when compared to a patient with SUV(95)=0.5 of the same age and identical V(30). Receiver operating characteristic curve analysis showed the area under the curve was 0.78 (95% CI=0.69 - 0.87). The CT imaging and dosimetry parameters were found to be poor predictors of RP symptoms. CONCLUSIONS: The pretreatment pulmonary FDG uptake, as quantified by the SUV(95), predicted symptoms of RP in this study. Elevation in this pre-treatment biomarker identifies a patient group at high risk for post-treatment symptomatic RP.

La conyugalidad como muestra de transformación / The marriage like transformation

La presente investigación pretendió realizar un primer acercamiento de tipo exploratorio frente a las transformaciones que se han dado en el concepto de conyugalidad en personas pertenecientes a las últimas tres generaciones. Para la realización del proyecto se empleó como instrumento la entrevista a profundidad a través de la cual se hallaron resultados que indican que la conyugalidad ha sufrido grandes trasformaciones desde el imaginario de cada individuo, donde los avances de la medicina y la ocupación de la misma en el cuerpo de la mujer, el cuidado de los hijos y la reproducción, los cambios en el derecho jurídico de la participación femenina en asuntos que eran exclusivamente masculinos, las revoluciones de los años setenta y la inmigración de las familias del campo a los centros urbanos entre otras, han influenciado el comportamiento individual, ocasionando transformaciones en la forma como se enfrentan y se asumen los diversos aconteceres de la vida humana.

This research aimed at an initial exploratory approach, given the changes that have occurred in the concept of marital persons belonging to the past three generations. To achieve the project was used as a tool indepth interviews through which results were found indicating that conjugal has undergone major transformations since the way each individual, where advances in medicine and the occupation of the same in the body of women, child care and reproduction, changes in the legal right of women's participation in matters that were exclusively male, the revolutions of the 70s and the migration of rural families to urban centers among others, have influenced individual behavior, causing changes in the way they are facing and will assume the various happenings of human life.