Controlling cantilevered adaptive X-ray mirrors.

Modeling the behavior of a prototype cantilevered X-ray adaptive mirror (held from one end) demonstrates its potential for use on high-performance X-ray beamlines. Similar adaptive mirrors are used on X-ray beamlines to compensate optical aberrations, control wavefronts and tune mirror focal distances at will. Controlled by 1D arrays of piezoceramic actuators, these glancing-incidence mirrors can provide nanometre-scale surface shape adjustment capabilities. However, significant engineering challenges remain for mounting them with low distortion and low environmental sensitivity. Finite-element analysis is used to predict the micron-scale full actuation surface shape from each channel and then linear modeling is applied to investigate the mirrors' ability to reach target profiles. Using either uniform or arbitrary spatial weighting, actuator voltages are optimized using a Moore-Penrose matrix inverse, or pseudoinverse, revealing a spatial dependence on the shape fitting with increasing fidelity farther from the mount.

Direct MRI-guided In-Bore Targeted Biopsy of the Prostate: A Step-by-Step How To and Lessons Learned.

Multiparametric MRI-the most accurate imaging technique for detection of prostate cancer-has transformed the landscape of prostate cancer diagnosis by enabling targeted biopsies. In a targeted biopsy, tissue samples are obtained from suspicious regions identified at prebiopsy diagnostic MRI. The authors briefly compare the different strategies available for targeting an MRI-visible suspicious lesion, followed by a step-by-step description of the direct MRI-guided in-bore approach and an illustrated review of its application in challenging clinical scenarios. In this technique, direct visualization of the needle, needle guide, and needle trajectory during the procedure provides a precise and versatile strategy to accurately sample suspicious lesions, improving detection of clinically significant cancers. Published under a CC BY 4.0 license Test Your Knowledge questions for this article are available in the supplemental material.

Off-axis representation of hyperbolic mirror shapes for X-ray beamlines.

Mirror-centered, closed-form expressions for hyperbolic surfaces used in X-ray beamlines have been derived. Hyperbolic mirrors create a virtual focus or source point and can be used to lengthen or shorten the effective focal distance of a compound optical system. The derivations here express off-axis segments of a hyperbolic surface in terms of the real and virtual focal distances and the incident glancing angle at the center of the mirror. Conventional mathematical expressions of hyperbolic shapes describe the surfaces in Cartesian or polar coordinates centered on an axis of symmetry, necessitating cumbersome rotation and translation to mirror-centered coordinates. The representation presented here, with zero slope and the origin at the central point, is most convenient for modeling, metrology, aberration correction, and general surface analysis of off-axis configurations. The direct derivation avoids the need for nested coordinate transforms. A series expansion provides a helpful approximation; the coefficients of the implicit equation are also provided.

Data-driven modeling and control of an X-ray bimorph adaptive mirror.

Adaptive X-ray mirrors are being adopted on high-coherent-flux synchrotron and X-ray free-electron laser beamlines where dynamic phase control and aberration compensation are necessary to preserve wavefront quality from source to sample, yet challenging to achieve. Additional difficulties arise from the inability to continuously probe the wavefront in this context, which demands methods of control that require little to no feedback. In this work, a data-driven approach to the control of adaptive X-ray optics with piezo-bimorph actuators is demonstrated. This approach approximates the non-linear system dynamics with a discrete-time model using random mirror shapes and interferometric measurements as training data. For mirrors of this type, prior states and voltage inputs affect the shape-change trajectory, and therefore must be included in the model. Without the need for assumed physical models of the mirror's behavior, the generality of the neural network structure accommodates drift, creep and hysteresis, and enables a control algorithm that achieves shape control and stability below 2 nm RMS. Using a prototype mirror and ex situ metrology, it is shown that the accuracy of our trained model enables open-loop shape control across a diverse set of states and that the control algorithm achieves shape error magnitudes that fall within diffraction-limited performance.

Real-time machine-learning-driven control system of a deformable mirror for achieving aberration-free X-ray wavefronts.

A neural-network machine learning model is developed to control a bimorph adaptive mirror to achieve and preserve aberration-free coherent X-ray wavefronts at synchrotron radiation and free electron laser beamlines. The controller is trained on a mirror actuator response directly measured at a beamline with a real-time single-shot wavefront sensor, which uses a coded mask and wavelet-transform analysis. The system has been successfully tested on a bimorph deformable mirror at the 28-ID IDEA beamline of the Advanced Photon Source at Argonne National Laboratory. It achieved a response time of a few seconds and maintained desired wavefront shapes (e.g., a spherical wavefront) with sub-wavelength accuracy at 20 keV of X-ray energy. This result is significantly better than what can be obtained using a linear model of the mirror's response. The developed system has not been tailored to a specific mirror and can be applied, in principle, to different kinds of bending mechanisms and actuators.

Analytic descriptions of parabolic X-ray mirrors.

On X-ray beamlines and telescopes, glancing-incidence mirrors with parabolic profiles are used to collimate, focus, and collect light. Here, analytic descriptions for paraboloidal, plane-parabolic, and parabolic cylindrical mirrors in several congruent geometries that are commonly used in fabrication, metrology, and modeling are provided. The exact expressions are derived directly from Fermat's principle, without coordinate transformations, in several mirror-centered coordinate systems, including one with the surface tangent to the central point of intersection. Coefficients for a sixth-order polynomial series approximation are calculated for that coordinate system.

Derivation of closed-form ellipsoidal X-ray mirror shapes from Fermat's principle.

Ellipsoidal and plane-elliptical surfaces are widely used as reflective, point-to-point focusing elements in many optical systems, including X-ray optics. Here the classical optical path function approach of Fermat is applied to derive a closed-form expression for these surfaces that are uniquely described by the object and image distances and the angle of incidence at a point on a mirror surface. A compact description facilitates design, modeling, fabrication, and testing to arbitrary accuracy. Congruent surfaces in two useful coordinate systems - a system centered on the ellipsoid's axes of symmetry and a mirror-centered or `vertex' system with the surface tangent to the xy plane at the mirror's center - are presented. Expressions for the local slope and radii of curvature are derived from the result, and the first several terms of the Maclauren series expansion are provided about the mirror center.

Simulations of applications using diaboloid mirrors.

The diaboloid is a reflecting surface that converts a spherical wave to a cylindrical wave. This complex surface may find application in new Advanced Light Source bending-magnet beamlines or in other beamlines that now use toroidal optics for astigmatic focusing. Here, the numerical implementation of diaboloid mirrors is described, and the benefit of this mirror in beamlines exploiting diffraction-limited storage rings is studied by ray tracing. The use of diaboloids becomes especially interesting for the new low-emittance storage rings because the reduction of aberration becomes essential for such small sources. The validity of the toroidal and other mirror surfaces approximating the diaboloid, and the effect of the mirror magnification, are discussed.

Diaboloidal mirrors: algebraic solution and surface shape approximations.

A new type of optical element that can focus a cylindrical wave to a point focus (or vice versa) is analytically described. Such waves are, for example, produced in a beamline where light is collimated in one direction and then doubly focused by a single optic. A classical example in X-ray optics is the collimated two-crystal monochromator, with toroidal mirror refocusing. The element here replaces the toroid, and in such a system provides completely aberration free, point-to-point imaging of rays from the on-axis source point. We present an analytic solution for the mirror shape in its laboratory coordinate system with zero slope at the centre, and approximate solutions, based on bending an oblique circular cone and a bent right circular cylinder, that may facilitate fabrication and metrology.

Final 5-Year Outcomes of the Multicenter Randomized Sham-Controlled Trial of a Water Vapor Thermal Therapy for Treatment of Moderate to Severe Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia.

PURPOSE: We present final 5-year outcomes of the multicenter randomized sham-controlled trial of a water vapor therapy (Rezum™) for treatment of moderate to severe lower urinary tract symptoms due to benign prostatic hyperplasia. MATERIALS AND METHODS: A total of 197 subjects >50 years of age with International Prostate Symptom Score ≥13, maximum flow rate ≤15 ml/second and prostate volume 30 to 80 cc were randomized and followed for 5 years. From the control arm of 61 subjects, a subset of 53 subjects requalified and after 3 months received treatment as part of the crossover group and were also followed for 5 years. The total number of vapor treatments to each lobe of the prostate was determined by length of prostatic urethra and included middle lobe treatment per physician discretion. RESULTS: Significant improvement of lower urinary tract symptoms was observed at <3 months post-thermal therapy, remaining durable through 5 years in the treatment group (International Prostate Symptom Score reduced 48%, quality of life increased 45%, maximum flow rate improved 44%, Benign Prostatic Hyperplasia Impact Index decreased 48%). Surgical re-treatment rate was 4.4% with no reports of device or procedure related sexual dysfunction or sustained de novo erectile dysfunction. Results within the crossover group were similar through 5 years. CONCLUSIONS: Minimally invasive treatment with water vapor thermal therapy provides significant and durable symptom relief as well as flow rate improvements through 5 years, with low surgical re-treatment rates and without impacting sexual function. It is a versatile therapy, providing successful treatment to obstructive lateral and middle lobes.

Pseudo-gray-scale halftone gratings for shearing and Hartmann wavefront sensors.

Now in use on x-ray beamlines worldwide, shearing interferometry and Hartmann wavefront sensing provide effective feedback for measuring and optimizing high-quality beams. Conventionally, both approaches spatially modulate the beam properties (amplitude or phase) using two-tone, binary patterns, leading to deleterious diffraction effects that must be mitigated. In shearing, the presence of multiple diffraction orders affects measurement near boundaries. In Hartmann, diffraction limits the measurement point density. We demonstrate that the use of pseudo-gray-scale halftone patterns in the diffracting elements can improve the performance of both techniques.

Impact of the Number of Cores on the Prostate Cancer Detection Rate in Men Undergoing in-Bore Magnetic Resonance Imaging-Guided Targeted Biopsies.

OBJECTIVE: To determine the incremental detection rate of clinically significant prostate cancer (csPCa) provided by sequential cores during in-bore magnetic resonance imaging (MRI)-guided prostate biopsies. METHODS: Single-center, retrospective interpretation of prospectively acquired data in men without previous diagnosis of csPCa who underwent in-bore MRI-guided prostate biopsy between May 2017 and December 2019. Endpoints included detection of csPCa (grade group [GG] ≥ 2) and rate of GG upgrade provided by additional cores. Descriptive statistics presented as mean and standard deviation for the continuous variables, and frequency and percentage for the categorical variables. RESULTS: Four hundred and forty-three men with 747 lesions met eligibility criteria. Clinically significant prostate cancer was detected in 43.1% (322/747) of the biopsied lesions and GG 2 PCa or greater was identified by the first core in 78.3% (252/322) of them. On a per-core basis, cores 2, 3, 4, and 5 found new csPCa in 6% (42/744), 4% (26/719), 1% (2/137), and 0% (0/11) of the cases. Core biopsy 2, 3, 4, and 5 resulted in GG upgrade in 12% (91/744), 7% (49/719), 7% (9/137), and 0% (0/11) of the lesions, respectively. Each additional core was associated with a mean increase of 5 minutes in the duration of the biopsy. CONCLUSIONS: In men undergoing in-bore MRI-guided prostate biopsies, 3 targeted cores per lesion provide an optimal trade-off between detection of clinically significant tumors and biopsy duration.

Binary Amplitude Reflection Gratings for X-ray Shearing and Hartmann Wavefront Sensors.

New, high-coherent-flux X-ray beamlines at synchrotron and free-electron laser light sources rely on wavefront sensors to achieve and maintain optimal alignment under dynamic operating conditions. This includes feedback to adaptive X-ray optics. We describe the design and modeling of a new class of binary-amplitude reflective gratings for shearing interferometry and Hartmann wavefront sensing. Compact arrays of deeply etched gratings illuminated at glancing incidence can withstand higher power densities than transmission membranes and can be designed to operate across a broad range of photon energies with a fixed grating-to-detector distance. Coherent wave-propagation is used to study the energy bandwidth of individual elements in an array and to set the design parameters. We observe that shearing operates well over a ±10% bandwidth, while Hartmann can be extended to ±30% or more, in our configuration. We apply this methodology to the design of a wavefront sensor for a soft X-ray beamline operating from 230 eV to 1400 eV and model shearing and Hartmann tests in the presence of varying wavefront aberration types and magnitudes.

Compensation of heat load deformations using adaptive optics for the ALS upgrade: a wave optics study.

A realistic wave optics simulation method has been developed to study how wavefront distortions originating from heat load deformations can be corrected using adaptive X-ray optics. Several planned soft X-ray and tender X-ray insertion-device beamlines in the Advanced Light Source upgrade rely on a common design principle. A flat, first mirror intercepts the white beam; vertical focusing is provided by a variable-line-space monochromator; and horizontal focusing comes from a single, pre-figured, adaptive mirror. A variety of scenarios to cope with thermal distortion in the first mirror are studied by finite-element analysis. The degradation of the intensity distribution at the focal plane is analyzed and the adaptive optics that correct it is modeled. The range of correctable wavefront errors across the operating range of the beamlines is reported in terms of mirror curvature and spatial frequencies. The software developed is a one-dimensional wavefront propagation package made available in the OASYS suite, an adaptable, customizable and efficient beamline modeling platform.

Adaptive shape control of wavefront-preserving X-ray mirrors with active cooling and heating.

This article describes the development and testing of a novel, water-cooled, active optic mirror system (called "REAL: Resistive Element Adjustable Length") that combines cooling with applied auxiliary heating, tailored to the spatial distribution of the thermal load generated by the incident beam. This technique is theoretically capable of sub-nanometer surface figure error control even at high power density. Tests conducted in an optical metrology laboratory and at synchrotron X-ray beamlines showed the ability to maintain the mirror profile to the level needed for the next generation storage rings and FEL mirrors.

Reflective binary amplitude grating for soft x-ray shearing and Hartmann wavefront sensing.

We demonstrate a reflective wavefront sensor grating suitable for the characterization of high-quality x-ray beamlines and optical systems with high power densities. Operating at glancing incidence angles, the optical element is deeply etched with a two-level pattern of shearing interferometry gratings and Hartmann wavefront sensor grids. Transverse features block unwanted light, enabling binary amplitude in reflection with high pattern contrast. We present surface characterization and soft x-ray reflectometry of a prototype grating array to demonstrate function prior to wavefront measurement applications. A simulation of device performance is shown.

Prospective evaluation of fexapotide triflutate injection treatment of Grade Group 1 prostate cancer: 4-year results.

PURPOSE: This study was undertaken to determine the safety and efficacy of fexapotide triflutate (FT) 2.5 mg and 15 mg for the treatment of Grade Group 1 prostate cancer. METHODS: Prospective randomized transrectal intraprostatic single injection FT 2.5 mg (n = 49), FT 15 mg (n = 48) and control active surveillance (AS) (n = 49) groups were compared in 146 patients at 28 U.S. sites, with elective AS crossover (n = 18) to FT after first follow-up biopsy at 45 days. Patients were followed for 5 years including biopsies (baseline, 45 days, and 18, 36, and 54 months thereafter), and urological evaluations with PSA every 6 months. Patients with Gleason grade increase or who elected surgical or radiotherapeutic intervention exited the study and were cumulatively included in the data analysis. Percentage of normal biopsies in baseline focus quadrant, tumor grades, and volumes; and outcomes including Gleason grade in entire prostate as well as treated prostate lobe, interventions associated with Gleason grade increase and total incidence of interventions were assessed. RESULTS: Significantly improved long-term clinical outcomes were found after 4-year follow-up, with percentages of patients progressing to interventions with and without Gleason grade increase significantly reduced by FT single treatment. Results in the FT 15-mg group were superior to the FT 2.5-mg dose group. There were no drug-related serious adverse events (SAEs). CONCLUSIONS: FT showed statistically significant long-term efficacy in the treatment of Grade Group 1 patients regarding clinical and pathological progression. FT 15 mg showed superior results to FT 2.5 mg. There were no drug-related SAEs; FT injection was well tolerated.

Prospective Inclusion of Apparent Diffusion Coefficients in Multiparametric Prostate MRI Structured Reports: Discrimination of Clinically Insignificant and Significant Cancers.

OBJECTIVE: The purpose of this study was to assess the diagnostic performance of prospectively assigned mean apparent diffusion coefficient (ADC) values in multiparametric MRI (mpMRI) structured reports for discriminating clinically insignificant (International Society of Urological Pathology [ISUP] group 1) from clinically significant (ISUP groups 2-5) prostate cancer. MATERIALS AND METHODS: This single-center study included men with abnormal 3-T mpMRI findings (Prostate Imaging Reporting and Data System version 2 score, ≥ 3) who subsequently underwent radical prostatectomy or targeted biopsy with positive results. One of nine radiologists prospectively reported the mean ADC for each lesion during clinical interpretation. Lesions with ADC ≤ 0.700 mm2/s × 10-3 were flagged as concerning for clinically significant prostate cancer. The index lesion at MRI correlated with the site-concordant lesion at targeted biopsy or whole-mount histopathologic analysis. Logistic regression was used to evaluate the utility of mean ADC values for discriminating ISUP grade group 1 from groups 2-5. Diagnostic performance was assessed by ROC AUC. RESULTS: Among the 218 eligible men, those with ISUP group 2-5 lesions had lower mean ADC values than those with ISUP 1 lesions; overall, 0.598 vs 0.803 mm/s2 × 10-3 (p < 0.0001); peripheral zone (PZ), 0.597 vs 0.855 mm/s2 × 10-3 (p < 0.0001); transition zone (TZ), 0.600 vs 0.660 mm/s2 × 10-3 (p = 0.035). The AUC for the PZ was 0.91 and for the TZ was 0.70. The optimal ADC cutoff values were 0.682 mm/s2 × 10-3 for PZ lesions and 0.638 mm2/s × 10-3 for TZ lesions, resulting in sensitivity and specificity of 78% and 94% for the PZ and 72% and 67% for the TZ. CONCLUSION: ADC values estimated prospectively in a clinical setting can help differentiate clinically insignificant from clinically significant prostate cancer, facilitating prebiopsy and pretreatment risk stratification.

Fexapotide triflutate: results of long-term safety and efficacy trials of a novel injectable therapy for symptomatic prostate enlargement.

PURPOSE: These studies were undertaken to determine if fexapotide triflutate 2.5 mg transrectal injectable (FT) has significant long-term (LT) safety and efficacy for the treatment of benign prostatic hyperplasia (BPH). METHODS: Two placebo controlled double-blind randomized parallel group trials with 995 BPH patients at 72 sites treated 3:2 FT:placebo, with open-label FT crossover (CO) re-injection in 2 trials n = 344 and long-term follow-up (LF) 2-6.75 years (mean 3.58 years, median 3.67 years; FT re-injection CO mean 4.27 years, median 4.42 years) were evaluated. 12 months post-treatment patients elected no further treatment, approved oral medications, FT, or interventional treatment. Primary endpoint variable was change in Symptom Score (IPSS) at 12 months and at LF. CO primary co-endpoints were 3-year incidence of (1) surgery for BPH in FT treated CO patients versus patients crossed over to oral BPH medications and (2) surgery or acute urinary retention in FT-treated CO placebo patients versus placebo patients crossed over to oral BPH medications. 28 CO secondary endpoints assessed surgical and symptomatic outcomes in FT reinjected patients versus conventional BPH medication CO and control subgroups at 2 and 3 years. RESULTS: FT injection had no significant safety differences from placebo. LF IPSS change from baseline was higher in FT treated patients compared to placebo (median FT group improvement - 5.2 versus placebo - 3.0, p < 0.0001). LF incidence of AUR (1.08% p = 0.0058) and prostate cancer (PCa) (1.1% p = 0.0116) were both reduced in FT treated patients. LF incidence of intervention for BPH was reduced in the FT group versus oral BPH medications (8.08% versus 27.85% at 3 years, p < 0.0001). LF incidence of intervention or AUR in placebo CO group with FT versus placebo CO group with oral medications was reduced (6.07% versus 33.3% at 3 years, p < 0.0001). 28/28 secondary efficacy endpoints were reached in LF CO re-injection studies. CONCLUSIONS: FT 2.5 mg is a safe and effective transrectal injectable for LT treatment of BPH. FT treated patients also had reduced need for BPH intervention, and reduced incidence of PCa and AUR.

Convective Thermal Therapy: Durable 2-Year Results of Randomized Controlled and Prospective Crossover Studies for Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia.

PURPOSE: We report 2-year outcomes of a multicenter randomized controlled trial plus 1-year results of a crossover trial after treatment with convective radiofrequency water vapor thermal energy for lower urinary tract symptoms due to benign prostatic hyperplasia. MATERIALS AND METHODS: A total of 197 men at least 50 years old with I-PSS (International Prostate Symptom Score) 13 or greater, maximum flow rate 15 ml per second or less and prostate size 30 to 80 cc were randomized 2:1 to thermal therapy with the Rezum® System or a control group. Rigid cystoscopy with simulated active treatment sounds served as the control procedure. After unblinding at 3 months control subjects could requalify for crossover study. Convectively delivered radiofrequency thermal energy was delivered into obstructive prostate tissue, including the median lobe as needed. The primary efficacy end point was a change in severity of symptom scores. RESULTS: Convective radiofrequency thermal therapy improved urinary symptoms significantly over controls at 3 months and provided a sustained 51% reduction from baseline at 24 months (p <0.0001). This produced a 5 and 8-point or greater score decrease in 84% and 74% of subjects, respectively, at 24 months. Crossover subject symptoms, flow rate and quality of life measures were markedly improved after thermal therapy compared to after the control procedure (p = 0.024 to <0.0001). No de novo erectile dysfunction was reported. CONCLUSIONS: Convective radiofrequency water vapor thermal therapy is a minimally invasive office or outpatient procedure that provides early effective symptom relief that remains durable for 2 years and is applicable to the median lobe.