Image quality characterization of an ultra-high-speed kilovoltage cone-beam computed tomography imaging system on an O-ring linear accelerator.

PURPOSE: The quality of on-board imaging systems, including cone-beam computed tomography (CBCT), plays a vital role in image-guided radiation therapy (IGRT) and adaptive radiotherapy. Recently, there has been an upgrade of the CBCT systems fused in the O-ring linear accelerators called HyperSight, featuring a high imaging performance. As the characterization of a new imaging system is essential, we evaluated the image quality of the HyperSight system by comparing it with Halcyon 3.0 CBCT and providing benchmark data for routine imaging quality assurance. METHODS: The HyperSight features ultra-fast scan time, a larger kilovoltage (kV) detector, a more substantial kV tube, and an advanced reconstruction algorithm. Imaging protocols in the two modes of operation, treatment mode with IGRT and the CBCT for planning (CBCTp) mode were evaluated and compared with Halcyon 3.0 CBCT. Image quality metrics, including spatial resolution, contrast resolution, uniformity, noise, computed tomography (CT) number linearity, and calibration error, were assessed using a Catphan and an electron density phantom and analyzed with TotalQA software. RESULTS: HyperSight demonstrated substantial improvements in contrast-to-noise ratio and noise in both IGRT and CBCTp modes compared to Halcyon 3.0 CBCT. CT number calibration error of HyperSight CBCTp mode (1.06%) closely matches that of a full CT scanner (0.72%), making it suitable for adaptive planning. In addition, the advanced hardware of HyperSight, such as ultra-fast scan time (5.9 s) or 2.5 times larger heat unit capacity, enhanced the clinical efficiency in our experience. CONCLUSIONS: HyperSight represented a significant advancement in CBCT imaging. With its image quality, CT number accuracy, and ultra-fast scans, HyperSight has a potential to transform patient care and treatment outcomes. The enhanced scan speed and image quality of HyperSight are expected to significantly improve the quality and efficiency of treatment, particularly benefiting patients.

Bioactivities of Phenolic Compounds from Kiwifruit and Persimmon.

Fruit used in the common human diet in general, and kiwifruit and persimmon particularly, displays health properties in the prevention of heart disease. This study describes a combination of bioactivity, multivariate data analyses and fluorescence measurements for the differentiating of kiwifruit and persimmon, their quenching and antioxidant properties. The metabolic differences are shown, as well in the results of bioactivities and antioxidant capacities determined by ABTS, FRAP, CUPRAC and DPPH assays. To complement the bioactivity of these fruits, the quenching properties between extracted polyphenols and human serum proteins were determined by 3D-fluorescence spectroscopy studies. These properties of the extracted polyphenols in interaction with the main serum proteins in the human metabolism (human serum albumin (HSA), α-ß-globulin (α-ß G) and fibrinogen (Fgn)), showed that kiwifruit was more reactive than persimmon. There was a direct correlation between the quenching properties of the polyphenols of the investigated fruits with serum human proteins, their relative quantification and bioactivity. The results of metabolites and fluorescence quenching show that these fruits possess multiple properties that have a great potential to be used in industry with emphasis on the formulation of functional foods and in the pharmaceutical industry. Based on the quenching properties of human serum proteins with polyphenols and recent reports in vivo on human studies, we hypothesize that HSA, α-ß G and Fgn will be predictors of coronary artery disease (CAD).

Microstructural Control for Characteristics of Biomedical Ti-39Nb-6Zr-0.45Al Alloy.

Ti-39Nb-6Zr-0.45Al alloy was developed for biological applications as exchangeable hard tissue. This alloy has very low elastic modulus, but lower strength than Ti-6Al-4V alloy. This study was performed for improving the strength by various heat treatments and microstructural characteristics and mechanical properties of Ti-39Nb-6Zr-0.45Al alloy were investigated. Heat treatments were conducted at 350 °C, 400 °C, 450 °C, 500 °C, 550 °C and 600 °C, followed by water quenching. Microstructures of Ti-39Nb-6Zr-0.45Al alloy showed two types of different features. One of the features was not visible for grains at low temperature heat conditions (350 °C, 400 °C and 450 °C), because of the effect of cold swaging. On the contrast, at high temperature conditions (500 °C, 550 °C and 600 °C), the grains were visible. Tensile properties had similar tendency to hardness properties under all low temperature conditions. The samples showed high strength and low elongation under low temperatures, but showed the opposite results under high temperature conditions. These results were due to thermal ω phases and secondary α phases inside the matrix of this alloy. ω phases, which were precipitated under low temperature heat treatments, induce high strength and low elongation. In case of high temperature conditions, ω phases disappeared into the matrix and secondary α phases with fine size appeared. γoung's moduli of the samples under all the conditions were lower (about 60 GPa) than those of the as-swaged (about 70 GPa). Consequently, the heattreated Ti-39Nb-6Zr-0.45Al alloy had high strength and very low elastic modulus for biomedical applications.

Antihypertensive Effects of Artemisia scoparia Waldst in Spontaneously Hypertensive Rats and Identification of Angiotensin I Converting Enzyme Inhibitors.

We investigated the antihypertensive effects of Artemisia scoparia (AS) in spontaneously hypertensive rats (SHR). The rats were fed diets containing 2% (w/w) hot water extracts of AS aerial parts for 6 weeks. The AS group had significantly lower systolic and diastolic blood pressure levels than the control group. The AS group also had lower angiotensin I converting enzyme (ACE) activity and angiotensin II content in serum compared to the control group. The AS group showed higher vascular endothelial growth factor and lower ras homolog gene family member A expression levels in kidney compared to the control group. The AS group had significantly lower levels of plasma lipid oxidation and protein carbonyls than the control group. One new and six known compounds were isolated from AS by guided purification. The new compound was determined to be 4'-O-ß-D-glucopyranoyl (E)-4-hydroxy-3-methylbut-2-enyl benzoate, based on its nuclear magnetic resonance and electrospray ionization-mass spectroscopy data.

A new plan quality index for dose painting radiotherapy.

Dose painting radiotherapy is considered a promising radiotherapy technology that enables more targeted dose delivery to tumor rich regions while saving critical normal tissues. Obviously, dose painting planning would be more complicated and hard to be evaluated with current plan quality index systems that were developed under the paradigm of uniform dose prescription. In this study, we introduce a new plan quality index, named "index of achievement (IOA)" that assesses how close the planned dose distribution is to the prescribed one in a dose painting radiotherapy plan. By using voxel-based comparison between planned and prescribed dose distributions in its formulation, the index allows for a single-value evaluation regardless of the number of prescribed dose levels, which cannot be achieved with the conventional indices such as conventional homogeneity index. Benchmark calculations using patient data demonstrated feasibility of the index not only for contour-based dose painting plans, but also for dose painting by numbers plans. Also, it was shown that there is strong correlation between the new index and conventional indices, which indicates a potential of the new index as an alternative to conventional ones in general radiotherapy plan evaluation.

Development of real-time motion verification system using in-room optical images for respiratory-gated radiotherapy.

Phase-based respiratory-gated radiotherapy relies on the reproducibility of patient breathing during the treatment. To monitor the positional reproducibility of patient breathing against a 4D CT simulation, we developed a real-time motion verification system (RMVS) using an optical tracking technology. The system in the treatment room was integrated with a real-time position management system. To test the system, an anthropomorphic phantom that was mounted on a motion platform moved on a programmed breathing pattern and then underwent a 4D CT simulation with RPM. The phase-resolved anterior surface lines were extracted from the 4D CT data to constitute 4D reference lines. In the treatment room, three infrared reflective markers were attached on the superior, middle, and inferior parts of the phantom along with the body midline and then RMVS could track those markers using an optical camera system. The real-time phase information extracted from RPM was delivered to RMVS via in-house network software. Thus, the real-time anterior-posterior positions of the markers were simultaneously compared with the 4D reference lines. The technical feasibility of RMVS was evaluated by repeating the above procedure under several scenarios such as ideal case (with identical motion parameters between simulation and treatment), cycle change, baseline shift, displacement change, and breathing type changes (abdominal or chest breathing). The system capability for operating under irregular breathing was also investigated using real patient data. The evaluation results showed that RMVS has a competence to detect phase-matching errors between patient's motion during the treatment and 4D CT simulation. Thus, we concluded that RMVS could be used as an online quality assurance tool for phase-based gating treatments.

A multi-institutional study for tolerance and action levels of IMRT dose quality assurance measurements in Korea.

The purpose of this study was to suggest tolerance levels for IMRT DQA measurements using confidence limits determined by a multi-institutional study in Korea. Ten institutions were grouped into LINAC (seven linear accelerators) and TOMO (three tomotherapy machines). The DQA processes consisted of point (high- and low-dose regions) and planar (per-field and composite-field) dose measurements using an ion chamber and films (or 2D detector array) inserted into a custom-made acryl phantom (LINAC) or a cheese phantom (TOMO). The five mock structures developed by AAPM TG-119 were employed, but the prostate as well as the H&N structures were modified according to Korean patients' anatomy. The point measurements were evaluated in a ratio of measured and planned doses, while the planar dose distributions were assessed using two gamma criteria of 2 mm/2% and 3 mm/3%. The confidence limit (|mean + 1.96 σ|) for point measurements was determined to be 3.0% in high-dose regions and 5.0% in low-dose regions. The average percentage of points passing the gamma criteria of 2 mm/2% and 3mm/3% for per-field measurements was 92.7 ± 6.5% and 98.2 ± 2.8%, respectively. Thus, the corresponding confidence limit was 79.1% and 92.7%, respectively. The gamma passing rate averaged over all mock tests and institutions for composite-field measurements was 86.1 ± 6.5% at 2 mm/2% and 95.3 ± 3.8% at 3 mm/3%, leading to the confidence limit of 73.3% and 87.9%, respectively. There was no significant difference in the tolerance levels of point dose measurements between LINAC and TOMO groups. In spite of the differences in mock structures and dosimetry tools, our tolerance levels were comparable to those of AAPM and ESTRO guidelines.

Nutritional and pharmaceutical properties of bioactive compounds in organic and conventional growing kiwifruit.

The bioactivity of two kiwifruit's cultivars growing under organic and conventional conditions were studied and compared. The bioactive compounds were extracted with water and ethanol using similar conditions which are applied in pharmaceutical applications and for daily fruit consumption such as tea drink. Antioxidant radical scavenging assays [ferric-reducing/antioxidant power (FRAP); cupric reducing antioxidant capacity (CUPRAC); 2, 2-azino-bis (3-ethylbenzthiazoline-6-sulfonic acid) (ABTS)], fourier transform infrared (FT-IR) and ultraviolet spectroscopy, two (2D-FL) and three-dimensional (3D-FL) fluorometry were used for the detection of biologically active metabolites derived from kiwifruits (total phenols, flavonoids, chlorophylls, carotenoids and ascorbic acid). The correlation between the total phenol content (TPC) and other bioactive compounds, and their total antioxidant capacities (TAC) was calculated for studied kiwifruit's extracts. The interaction between drugs and human serum albumin (HSA) plays an important role in the distribution and metabolism of drugs. The properties of kiwifruit's phenol extracts showed their ability to quench HSA, forming the complexes similar to the ones between the proteins and pure flavonoids such as quercetin. The cultivar 'Bidan' exhibited significantly higher TAC than the classic 'Hayward'. In conclusion, for the first time 'Bidan' organic kiwifruit was analyzed and compared with widely consumed 'Hayward', using its bioactive and fluorescence properties. The influence of physiologically active kiwifruit's compounds on human health, through our investigations in vitro and scientifically proven information, was explained. Relatively high content of bioactive compounds, high antioxidant and fluorescence properties of kiwifruit justify its use as a source of valuable antioxidants.

C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of small (≤ 20 mm) lung nodules: diagnostic accuracy and complications in 161 patients.

OBJECTIVE: The purpose of this study is to retrospectively evaluate the diagnostic accuracy and complications of C-arm cone-beam CT (CBCT)-guided percutaneous transthoracic needle biopsy (PTNB) for small (≤ 20 mm) lung nodules and their possible influencing factors. MATERIALS AND METHODS: From March 2009 to July 2010, 161 consecutive patients (77 men and 84 women; mean [± SD] age, 61 ± 11.8 years; range, 29-85 years) with 173 small (≤ 20 mm) lung nodules underwent CBCT-guided PTNB performed by an experienced chest radiologist in a tertiary referral hospital. The diagnostic accuracy, sensitivity, specificity, and complication rates were statistically evaluated, and influencing factors were assessed using univariate and subsequent multivariate analysis. RESULTS: Of 173 nodules (mean size, 15 ± 3.7 mm), 94 (54.3%) were diagnosed as malignant, 69 (39.9%) as benign, and 10 (5.8%) as indeterminate. On PTNB, 160 nodules were correctly diagnosed and three were false-negatives. Diagnostic accuracy, sensitivity, and specificity were 98.2%, 96.8%, and 100%, respectively. No factors significantly decreased diagnostic accuracy. As for complications, pneumothorax, hemoptysis, and chest pain occurred in 55 (31.8%), 25 (14.5%), and two (1.2%) patients, respectively. Multivariate analysis revealed that the presence of emphysema along the needle pathway was a significant risk factor (odds ratio [OR], 10.11), and the occurrence of hemoptysis was a significant protective factor (OR, 0.28) against pneumothorax. Ground-glass nodules were found to be a significant independent risk factor for hemoptysis (OR, 5.10). CONCLUSION: C-arm CBCT-guided PTNB is highly accurate for small lung nodules, and the diagnostic accuracy does not significantly decrease even in technically challenging conditions.

Analytical determination of bioactive compounds as an indication of fruit quality.

The aim of this investigation was to determine the bioactive compounds in kiwifruit as an indication of quality after extraction using methanol and ethyl acetate. Using FTIR and three-dimensional fluorescence spectroscopy and electrospray ionization/MS, the contents of polyphenols, flavonoids, flavanols, and tannins, and the level of the antioxidant activity by 2, 2-azino-bis (3-ethyl-benzothiazoline-6-sulfonic acid) diammonium salt, 1, 1-diphenyl-2-picrylhydrazyl, ferric-reducing/ antioxidant power, and cupric reducing antioxidant capacity assays were determined and compared. It was found that the methanol extracts of kiwifruit showed significantly higher amounts of bioactive acetate extracts. The cultivar Bidan, in comparison compounds and antioxidant activities than the ethyl with the classic Hayward, showed significantly higher bioactivity. For the first time, Bidan organic kiwifruit was analyzed for its antioxidant activities and compared with the widely consumed Hayward organic based on its bioactive compounds and fluorescence properties. Relatively high content of bioactive compounds and positive antioxidant and antiproliferative properties of kiwifruit determined by the advanced analytical methods justify its use as a source of valuable antioxidants. The methods used are applicable for bioactivity determination, in general, for any food products.

Development of an optical-based image guidance system: technique detecting external markers behind a full facemask.

PURPOSE: Optical image-guided systems (e.g., AlignRT, frameless SonArray, ExacTrac) have been used with advantages of avoiding excessive radiation exposure and real-time patient monitoring. Although these systems showed proven accuracy, they need to modify a full facemask for patients with H&N cancer and brain tumor. We developed an optical-based guidance system to manage interfractional and intrafractional setup errors by tracking external markers behind a full facemask. METHODS: Infra-red (IR) reflecting markers were attached on the face of a head phantom and then the phantom was immobilized by a full face thermoplastic mask. A stereo camera system consisting of two CCD cameras was mounted on the inferior wall of treatment room. The stereo camera system was calibrated to reconstruct 3D coordinates of multiple markers with respect to the isocenter using the direct linear transform (DLT) algorithm. The real-time position of the phantom was acquired, through the stereo camera system, by detecting the IR markers behind the full facemask. The detection errors with respect to the reference positions of planning CT images were calculated in six degrees of freedom (6-DOF) by a rigid-body registration technique. RESULTS: The calibration accuracy of the system was in submillimeter (0.33 mm +/- 0.27 mm), which was comparable to others. The mean distance between each of marker positions of optical images and planning CT images was 0.50 mm +/- 0.67 mm. The maximum deviations of 6-DOF registration were less than 1 mm and 1 degrees for the couch translation and rotation, respectively. CONCLUSIONS: The developed system showed the accuracy and consistency comparable to the commercial optical guided systems, while allowing us to simultaneously immobilize patients with a full face thermoplastic mask.

Quasi-breath-hold technique using personalized audio-visual biofeedback for respiratory motion management in radiotherapy.

PURPOSE: To introduce a respiratory motion management technique, so called quasi-breath-hold (QBH) technique and evaluate its feasibility. As a hybrid technique combining free-breathing-based gating (denoted as gating for convenience) and breath-hold (BH), the QBH is designed to overcome typical limitations existing in either one such as phase-shift, residual motion, complexity, and discomfort. METHODS: The QBH is realized using an audio-visual biofeedback system (AVBFS) and a respiratory motion management program (RMMP). The AVBFS, consisting of two infra-red stereo cameras and a head mounted display, monitors respiratory motion and provides dynamic feedback to patients. The RMMP establishes a personalized respiration model based on deep free breathing. The model is further processed to generate a QBH model by inserting a short breath-hold period into the end point of the-end-of-expiration phase. Then the patient is guided to follow the QBH model through the AVBFS. A simulation study with ten volunteers was performed to evaluate the feasibility of the proposed technique. In the simulation, an in-house developed macro program automatically controlled the QBH procedure to virtually deliver an intensity modulated radiation therapy (IMRT) plan. For each volunteer subject, three QBH maneuvers with different breath-hold times of 3, 5, and 7s (denoted as QBH3s, QBH5s, and QBH7s, respectively) and a conventional gating maneuver with 30% duty cycle (for comparison purpose) were applied. External respiration motion signals obtained during the gating window were analyzed to obtain mean absolute error (MAE) between the measured and guiding curve, mean absolute deviation (MAD) of the measured curve, and an inverse uncertainty time histogram (IUTH). RESULTS: Every volunteer successfully performed all of the four maneuvers (1 gating and 3 QBH patterns). The average treatment times were 466.8, 452.3, and 430.8 s for the QBH3s, QBH5s, and QBH7s, respectively, compared to 530.4 s for the gating technique. The mean absolute errors between measured and guiding curve during the gating window were 0.9 +/- 0.7, 0.8 +/- 0.6, 0.7 +/- 0.6, and 0.6 +/- 0.7 mm for the gating, QBH3s, QBH5s, and QBH7s, respectively. The mean absolute deviations of the measured curve during the gating window were 0.7 +/- 0.7, 0.5 +/- 0.5, 0.5 +/- 0.4, and 0.5 +/- 0.6 mm for the gating, QBH3s, QBH5s, and QBH7s, respectively. In the analysis of the IUTH during the gating window, the QBH simulations showed similar (QBH3s) or less (QBH5s and QBH7s) motion uncertainties compared to the gating simulation. CONCLUSIONS: The proposed QBH technique with personalized audio-visual biofeedback was feasible for respiratory motion management. It showed equivalent or less motion uncertainty and shorter treatment time than the conventional free-breathing-based gating technique did. The technique is expected to optimally compromise between patient comfort and treatment efficiency.

Beam angle optimization using angular dependency of range variation assessed via water equivalent path length (WEPL) calculation for head and neck proton therapy.

PURPOSE: To investigate angular sensitivity of proton range variation due to anatomic change in patients and patient setup error via water equivalent path length (WEPL) calculations. METHODS: Proton range was estimated by calculating WEPL to the distal edge of target volume using planning CT (pCT) and weekly scatter-corrected cone-beam CT (CBCT) images of 11 head and neck patients. Range variation was estimated as the difference between the distal WEPLs calculated on pCT and scatter-corrected CBCT (cCBCT). This WEPL analysis was performed every five degrees ipsilaterally to the target. Statistics of the distal WEPL difference were calculated over the distal area to compare between different beam angles. Physician-defined contours were used for the WEPL calculation on both pCT and cCBCT, not considering local deformation of target volume. It was also tested if a couch kick (10°) can mitigate the range variation due to anatomic change and patient setup error. RESULTS: For most of the patients considered, median, 75% quantile, and 95% quantile of the distal WEPL difference were largest for posterior oblique angles, indicating a higher chance of overdosing normal tissues at distal edge with these angles. Using a couch kick resulted in decrease in the WEPL difference for some posterior oblique angles. CONCLUSIONS: It was demonstrated that the WEPL change has angular dependency for the cohort of head and neck cancer patients. Selecting beam configuration robust to anatomic change in patient and patient setup error may improve the treatment outcome of head and neck proton therapy.

Surface guided motion management in glottic larynx stereotactic body radiation therapy.

BACKGROUND AND PURPOSE: Involuntary motion due to swallowing cause inaccurate dose delivery during larynx radiotherapy, a deviation that may be particularly problematic during stereotactic body radiation therapy (SBRT). The goal of this study was to develop a motion management solution for larynx SBRT using surface imaging. MATERIAL AND METHODS: Ten patients were recently treated on a phase II study of larynx SBRT on a LINAC equipped with a surface guidance system. A small region of the immobilization mask was manually cut open to allow surface tracking. Pre-treatment and intra-fractional CBCTs were acquired to verify internal anatomy. Patients were verbally instructed not to swallow during treatment. During treatment delivery, beam hold was initiated by the Motion Management Interface if surface motion exceeded a patient-specific threshold. Patient motion was recorded in log files and analyzed. We also performed phantom studies to assess the theoretical impact of gating on dose delivery. RESULTS: The frequency (6.5 ± 5.2 times per fraction) and duration (3.9 ± 2.5 seconds per swallow) of swallowing varied both between patients and fractions. The magnitude of each swallow showed mean peak amplitude at 5.8 ± 3.8 mm above baseline, mostly in the longitudinal direction. Beam duty cycle was 95.0% ± 7.0% (absolute range: 76-100%), with inefficiency most prominent in the early fractions. The 95th percentile residual motion was reduced from 3.4 mm to 2.3 mm with both verbal instruction and gating. Phantom studies confirmed dose delivery accuracy represented by gamma pass rate was improved by 5% using this approach. CONCLUSIONS: Laryngeal motion management using surface imaging is feasible and efficacious. Uncontrolled movement of the larynx was not uncommon during treatment, with gating reducing potential for unplanned dose deviations. Additional research is needed to determine the clinical benefit with this system.

Evaluation of an a priori scatter correction algorithm for cone-beam computed tomography based range and dose calculations in proton therapy.

BACKGROUND AND PURPOSE: Scatter correction of cone-beam computed tomography (CBCT) projections may enable accurate online dose-delivery estimations in photon and proton-based radiotherapy. This study aimed to evaluate the impact of scatter correction in CBCT-based proton range/dose calculations, in scans acquired in both proton and photon gantries. MATERIAL AND METHODS: CBCT projections of a Catphan and an Alderson phantom were acquired on both a proton and a photon gantry. The scatter corrected CBCTs (corrCBCTs) and the clinical reconstructions (stdCBCTs) were compared against CTs rigidly registered to the CBCTs (rigidCTs). The CBCTs of the Catphan phantom were segmented by materials for CT number analysis. Water equivalent path length (WEPL) maps were calculated through the Alderson phantom while proton plans optimized on the rigidCT and recalculated on all CBCTs were compared in a gamma analysis. RESULTS: In medium and high-density materials, the corrCBCT CT numbers were much closer to those of the rigidCT than the stdCBCTs. E.g. in the 50% bone segmentations the differences were reduced from above 300 HU (with stdCBCT) to around 60-70 HU (with corrCBCT). Differences in WEPL from the rigidCT were typically well below 5 mm for the corrCBCTs, compared to well above 10 mm for the stdCBCTs with the largest deviations in the head and thorax regions. Gamma pass rates (2%/2mm) when comparing CBCT-based dose re-calculations to rigidCT calculations were improved from around 80% (with stdCBCT) to mostly above 90% (with corrCBCT). CONCLUSION: Scatter correction leads to substantial artefact reductions, improving accuracy of CBCT-based proton range/dose calculations.

Potential use of P-32 ophthalmic applicator: Monte Carlo simulations for design and dosimetry.

Postoperative beta-irradiation after pterygium excision has been considered a valuable therapeutic procedure to reduce the recurrence rate. Recently, it was reported that beta-irradiation also substantially reduced the risk of surgical failure after glaucoma surgery. Pure beta-irradiation using a 90Sr/Y applicator has been almost exclusively used for this purpose. As an alternative to 90Sr/Y beta-irradiation, we propose treatment with betas of a 32P source. While 32P has a lower maximum energy (1.71 MeV) than 90Sr/Y (2.27 MeV), it has an average energy comparable to that of 90Sr/Y. Furthermore, it can be produced easily in a nuclear reactor by neutron activation and is considered a less hazardous material. Monte Carlo simulations for the dosimetry of proposed 32P applicators were performed using the MCNP5 code. The structure and dimension of the 32P applicators were based on those of the 90Sr/Y applicators currently available, while medical plastic encapsulation and liquid source were chosen to enhance beta-dose to the surface of the conjunctiva. The 32P applicator showed that the surface dose distribution (up to 0.75 mm depth) is very similar to that of 90Sr/Y. However, beyond 0.75 mm depth, the 32P doses decrease with depths more rapidly than 90Sr/Y doses. In order to achieve the same surface dose rate, the required 32P activity is about three times that for a 90Sr/Y applicator. We conclude that the proposed 32P applicator can deliver therapeutic doses to the target lesion while sparing the lens better than the 90Sr/Y applicator. The 32P activity required to deliver therapeutic doses can be produced in a 30 MW reactor available at the Korea Atomic Energy Research Institute.

Kilovoltage projection streaming-based tracking application (KiPSTA): First clinical implementation during spine stereotactic radiation surgery.

PURPOSE: This study aimed to develop a linac-mounted kilovoltage (kV) projection streaming-based tracking method for vertebral targets during spine stereotactic radiation surgery and evaluate the clinical feasibility of the proposed spine tracking method. METHODS AND MATERIALS: Using real-time kV projection streaming within XVI (Elekta XVI), kV-projection-based tracking was applied to the target vertebral bodies. Two-dimensional in-plane patient translation was calculated via an image registration between digitally reconstructed radiographs (DRRs) and kV projections. DRR was generated from the cone beam computed tomography (CBCT) scan, which was obtained immediately before the tracking session. During a tracking session, each kV projection was streamed for an intensity gradient-based image with similar metric-based registration to the offset DRR. The ground truth displacement for each kV beam angle was calculated at the beam isocenter using the 6 degrees-of-freedom transformation that was obtained by a CBCT-CBCT rigid registration. The resulting translation by the DRR-projection registration was compared with the ground truth displacement. The proposed tracking method was evaluated retrospectively and online, using 7 and 5 spine patients, respectively. RESULTS: The accuracy and precision of spine tracking for in-plane patient motion were 0.5 ± 0.2 and 0.2 ± 0.1 mm. The magnitude of patient motion that was estimated using the CBCT-CBCT rigid registration was (0.5 ± 0.4, 0.4 ± 0.3, 0.3 ± 0.3) mm and (0.3 ± 0.4, 0.2 ± 0.2, 0.5 ± 0.6) mm for all tracking sessions. The intrafraction motion was within 2 mm for all CBCT scans considered. CONCLUSIONS: This study demonstrated that the proposed spine tracking method can track intrafraction motion with sub-millimeter accuracy and precision, and sub-second latency.

1H NMR and antioxidant profiles of polar and non-polar extracts of persimmon (Diospyros kaki L.) - Metabolomics study based on cultivars and origins.

Persimmon (Diospyros kaki L.) is one of the most important fruits that has been consumed for its medicinal properties due to the presence of some active metabolites, particularly polyphenols and carotenoids. Previously described methods, including HPLC, were limited in the determination of metabolites in different persimmon varieties. The present study shows the evaluation and the differences among persimmon polar and non-polar extracts by 1H NMR-based metabolomics approach. The hierarchical clustering analysis (HCA) based on score values of principal component analysis (PCA) model was used to analyze the important compounds in investigated fruits. The 1H NMR spectrum of persimmon chloroform (CDCl3) extracts showed different types of compounds as compared to polar methanol-water (CD3OD-D2O) ones. Persimmons growing in Israel were clustered different from those growing in Korea with the abundance of phenolic compounds (gallic, caffeic and protocathecuic acids), carotenoids (ß-cryptoxanthin, lutein, and zeaxanthin), amino acids (alanine), maltose, uridine, and fatty acids (myristic and palmitoleic acids). Glucose, choline and formic acid were more prominent in persimmon growing in Korea. In CD3OD-D2O and CDCl3 persimmon extracts, 43 metabolites were identified. The metabolic differences were shown as well on the results of bioactivities and antioxidant capacities determined by ABTS, FRAP, CUPRAC and DPPH assays. The presented methods can be widely used for quantitation of multiple compounds in many plant and biological samples especially in vegetables and fruits.

Water equivalent path length calculations using scatter-corrected head and neck CBCT images to evaluate patients for adaptive proton therapy.

Proton therapy has dosimetric advantages due to the well-defined range of the proton beam over photon radiotherapy. When the proton beams, however, are delivered to the patient in fractionated radiation treatment, the treatment outcome is affected by delivery uncertainties such as anatomic change in the patient and daily patient setup error. This study aims at establishing a method to evaluate the dosimetric impact of the anatomic change and patient setup error during head and neck proton therapy. Range variations due to the delivery uncertainties were assessed by calculating water equivalent path length (WEPL) to the distal edge of tumor volume using planning CT and weekly treatment cone-beam CT (CBCT) images. Specifically, mean difference and root mean squared deviation (RMSD) of the distal WEPLs were calculated as the weekly range variations. To accurately calculate the distal WEPLs, an existing CBCT scatter correction algorithm was used. An automatic rigid registration was used to align the planning CT and treatment CBCT images, simulating a six degree-of-freedom couch correction at treatments. The authors conclude that the dosimetric impact of the anatomic change and patient setup error was reasonably captured in the differences of the distal WEPL variation with a range calculation uncertainty of 2%. The proposed method to calculate the distal WEPL using the scatter-corrected CBCT images can be an essential tool to decide the necessity of re-planning in adaptive proton therapy.

Gain Correction for an X-ray Imaging System With a Movable Flat Panel Detector and Intrinsic Localization Crosshair.

Gain calibration for X-ray imaging systems with a movable flat panel detector and an intrinsic crosshair is a challenge due to the geometry-dependent heel effect and crosshair artifact. This study aims to develop a gain correction method for such systems by implementing the Multi-Acquisition Gain Image Correction technique. Flood field images containing crosshair and heel effect were acquired in 4 different flat panel detector positions at fixed exposure parameters. The crosshair region was automatically detected using common image processing algorithms and removed by a simple interpolation procedure, resulting in a crosshair-removed image. A large kernel-based correction was then used to remove the heel effect. Mask filters corresponding to each crosshair region were applied to the resultant heel effect-removed images to invalidate the pixels of the original crosshair region. Finally, a seamless gain map was composed with corresponding valid pixels from the processed images either by the sequential replacement or by the selective averaging techniques developed in this study. Quantitative evaluation was performed based on normalized noise power spectrum and detective quantum efficiency improvement factor for the flood field images corrected by the Multi-Acquisition Gain Image Correction-based gain maps. For comparison purposes, a single crosshair-removed gain map was also tested. As a result, it was demonstrated that the Multi-Acquisition Gain Image Correction technique achieved better image quality than the crosshair-removed technique, showing lower normalized noise power spectrum values over most of spatial frequencies. The improvement was more obvious at the priori-crosshair region of the gain map. The mean detective quantum efficiency improvement factor was 1.09 ± 0.06, 2.46 ± 0.32, and 3.34 ± 0.36 in the priori-crosshair region and 2.35 ± 0.31, 2.33 ± 0.31, and 3.09 ± 0.34 in the normal region, for crosshair-removed, Multi-Acquisition Gain Image Correction-sequential replacement, and Multi-Acquisition Gain Image Correction-selective averaging techniques, respectively. Therefore, this study indicates that the introduced Multi-Acquisition Gain Image Correction technique is an appropriate method for gain calibration of an imaging system associated with a moving flat panel detector and an intrinsic crosshair.