Obesity and breast cancer risk for pre- and postmenopausal women among over 6 million Korean women.

PURPOSE: To examine the association between obesity measured by body mass index (BMI) and waist circumference (WC) according to menopausal status in Korean women. METHODS: We identified 6,467,388 women, using the Korean National Health Insurance System Cohort. Cox-proportional hazard models were used to generate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for breast cancer risk in relation to BMI and WC. RESULTS: In postmenopausal women, the risk of breast cancer increased with BMI. Compared to women with a BMI of 18.5-23 kg/m two, the risk of invasive breast cancer was lower in patients with BMI < 18.5 (aHR 0.82, 95% CI 0.75-0.89), while it increased linearly in those with BMI 23-25 (1.11, 1.08-1.14), BMI 25-30 (1.28, 1.25-1.32), and BMI ≥ 30 (1.54,1.47-1.62). In contrast, the risk of breast cancer decreased with BMI in premenopausal women. Compared to women with a BMI of 18.5-23, the risk of IBC was similar in those with a BMI < 18.5 (1.02, 0.94-1.11) and BMI 23-25 (1.01, 0.97-1.05), but was significantly lower in those with a BMI 25-30 (0.95, 0.91-0.98) and BMI ≥ 30 (0.90, 0.82-0.98). A relative increase with BMI was less profound for carcinoma in situ in postmenopausal women, and a relative decrease was more profound in premenopausal women. An analysis using WC showed almost identical results. CONCLUSIONS: There was a positive relationship between obesity and breast cancer in postmenopausal women, and an inverse association in premenopausal women.

Chemoradiotherapy with hyperthermia versus chemoradiotherapy alone in locally advanced cervical cancer: a systematic review and meta-analysis.

PURPOSE: Concurrent chemoradiotherapy (CCRT) is recommended as the standard treatment for locally advanced cervical cancer (LACC). However, the synergistic effect of hyperthermia (HT) with CCRT remains unclear. Therefore, we performed a meta-analysis to evaluate the effect of HT with CCRT on LACC patients. METHODS AND MATERIALS: A systematic literature search was conducted on the MEDLINE, PubMed, Embase, Cochrane library and SCOPUS databases for articles that compared CCRT with HT and CCRT alone as treatments for LACC. Hazard ratios (HRs) and risk ratios (RRs) were used to compare five-year overall survival (OS), local relapse-free survival (LRFS) and incidence of acute and chronic toxicity between the two treatments. RESULTS: Two articles out of 2860 were finally selected for analysis. A total of 536 patients were evaluated (CCRT with HT group: 268, CCRT group: 268). FIGO stages I-II and III-IV were found in 295 (55.0%) and 241 patients (45.0%), respectively. The CCRT with HT group had significantly better five-year OS than the CCRT group (HR 0.67, 95% confidence interval [CI] 0.47-0.96, p = 0.03). LRFS of patients was superior in the CCRT with HT group than in the CCRT group, but without significance (HR 0.74, 95% CI 0.49-1.12; p = 0.16). Moreover, there was no difference between the two groups regarding acute and chronic toxicity. CONCLUSION: This systematic review and meta-analysis showed that CCRT with HT significantly improved OS in LACC patients without increasing acute and chronic toxicity. Therefore, tri-modality treatment could be a feasible approach for patients with LACC.

Credé maneuver to adjust tape tension during trans-obturator tape mid-urethral sling in mixed urinary incontinence.

INTRODUCTION AND HYPOTHESIS: To evaluate the efficacy of intraoperative extrinsic manual bladder compression (Credé maneuver) for trans-obturator tape adjustment during mid-urethral sling surgery in women with stress urinary incontinence and those with mixed urinary incontinence. METHODS: The study included 148 randomly selected women who underwent mid-urethral sling surgery with trans-obturator tape for stress urinary incontinence between January 2016 and May 2017. Subgroup analysis of 66 women with mixed urinary incontinence included 43 patients from the Credé maneuver group and 23 from the non-Credé maneuver group. In the Credé maneuver group, the pattern of urine leakage was determined during the Credé maneuver, and tape tension was adjusted according to the pattern. RESULTS: The cure rate was 86.6% and improved rate was 11.9% in the Credé maneuver patients. The cure rate was 50.6% and improved rate was 38.3% in the non-Credé maneuver patients. The success rate was significantly higher in the Credé than in the non-Credé maneuver group (p = 0.023). In subgroup analysis of patients with mixed urinary incontinence, the cure rate was 81.4% and improved rate was 16.3% in the Credé maneuver group. The cure rate was 43.5% and improved rate was 47.8% in the non-Credé maneuver group. The cure rate was significantly higher in the Credé maneuver group (p = 0.007). CONCLUSIONS: Intraoperative trans-obturator tape adjustment using the Credé maneuver to identify the leaking pattern significantly improved the success rate in women with mixed urinary incontinence, and Credé maneuver-directed adjustment significantly improved the cure rate.

Effect of dietary supplementation with brewer's yeast hydrolysate on growth performance, faecal microbial counts, diarrhoea score, blood profile, rectal temperature in weanling pigs challenged with lipopolysaccharide.

The objective of this study was to determine the effects of brewer's yeast hydrolysate (BYH) supplementation on growth performance, blood profile, diarrhoea score, faecal microbial and rectal temperature in lipopolysaccharide (LPS) challenged in weanling pigs. A total of 40 cross-bred weanling pigs [(Yorkshire × Landrace) × Duroc] with an average body weight of 8.15 ± 0.87 kg were used in a 6 weeks experiment. Pigs were randomly allotted to the following four dietary treatments (five pigs/two replicate/treatment) according to their initial body weight and gender. Treatments were as follows: CON, basal diet + Saline injection; NC, basal diet + LPS challenge; PC1, basal diet + 1.0% BYH + saline injection; and PC2, basal diet + 1.0% BYH + LPS challenge. Our results demonstrated pig fed diets with BYH had higher (p < .05) average daily feed intake (ADFI) during week 2-4 as well as gain:feed (G:F) during the whole experimental period than pigs fed diets without BYH. At the end of experiment, faecal Escherichia coli counts in pigs with an LPS injection tended to increase (p = .08). Meanwhile, the rectal temperature concentration of IgM and lymphocyte percentage in pigs with an LPS injection increase (p = .05) at 6 and 12 hr. In conclusion, the supplementation of 1.0% BYH can improve ADFI and G:F, as well as may reduce the diarrhoea in weanling pigs.

Effect of supplementation with brewer's yeast hydrolysate on growth performance, nutrients digestibility, blood profiles and meat quality in growing to finishing pigs.

Objective: This study was aimed to investigate the effects of brewer's yeast hydrolysate (YH) on growth performance, nutrients digestibility, blood profiles and meat quality of growing pigs. Methods: A total of 200 growing pigs [(Landrace × Yorkshire) × Duroc] (initial BW, 25.31 ± 1.29 kg) were allotted to 5 treatments as follow: CON: basic diet, and YH treatment: CON + 0.05%, 0.1%, 0.5%, and 1.0% of YH, respectively. Results: On wk11, 16 and overall phase, pigs fed YH diet showed linear improvement in average daily body gain (ADG) and G/F (p<0.05). The pigs received YH linearly increased the digestibility of dry matter (DM), nitrogen (N), and energy (E) on wk 11 and 16. The concentration of serum urea nitrogen(SUN) was linearly increased in YH treatments on wk 16. Meanwhile, the carcass weight, back fat and lean muscle percentage of pigs received YH diet have no significant change. Besides, no difference was observed in creatinine and total protein in the blood among treatment (p > 0.05). Conclusion: The pigs fed graded YH diet could improve the growth performance and nutrients digestibility of growing pigs, meanwhile, the yeast hydr olysate could increase the serum urea nitrogen in the growing pigs.

Predictors of adverse pathologic features after radical prostatectomy in low-risk prostate cancer.

BACKGROUND: Prostate-specific antigen (PSA) screening more frequently detects early stage prostate cancer (PC). However, adverse pathologic features (APFs) after radical prostatectomy (RP) in low-risk PC occur. Previous related studies had utilized outdated staging criteria or small sample cohorts. In this study, we analyzed predictors of APFs after RP in low-risk PC using classification under the current criteria. MATERIALS AND METHODS: We retrospectively reviewed medical records of 546 low-risk PC patients who had undergone RP. Low-risk PC was defined as PC with clinical T1-T2a, Gleason score ≤ 6, and PSA levels < 10 ng/mL. Clinical and pathological parameters were analyzed to predict APFs. APFs were defined as extracapsular extension (ECE), seminal vesicle invasion (SVI), or positive surgical margins (PSM). We analyzed our data using univariable and multivariable logistic regression analyses, as well as receiver operator characteristics to predict APFs. RESULTS: Among 546 patients, ECE, SVI, and PSM were present in 199 (36.4%), 8 (1.5%), and 179 cases (32.8%), respectively. PSM had a significant correlation with preoperative high PSA levels and number of positive cores obtained. ECE/SVI was also significantly correlated with PSA levels and number of positive cores. As a result, presence of APFs after RP was associated with high PSA levels and large number of positive cores. PSA > 4.5 ng/mL and number of positive cores > 2 in low-risk PC were significantly associated with APFs, and suggested as cut-off values for predicting APFs. CONCLUSIONS: PSA > 4.5 ng/mL and number of positive cores > 2 in low-risk PC were associated with presence of APFs and patients with such records should be considered carefully to provide active surveillance.

Efficacy of ß-mannanase supplementation to corn-soya bean meal-based diets on growth performance, nutrient digestibility, blood urea nitrogen, faecal coliform and lactic acid bacteria and faecal noxious gas emission in growing pigs.

A study was conducted to determine the efficacy of ß-mannanase supplementation to a diet based on corn and soya bean meal (SBM) on growth performance, nutrient digestibility, blood urea nitrogen (BUN), faecal coliforms and lactic acid bacteria, and noxious gas emission in growing pigs. A total of 140 pigs [(Landrace × Yorkshire) × Duroc; average body weight 25 ± 3 kg] were randomly allotted to a 2 × 2 factorial arrangement with dietary treatments consisting of hulled or dehulled SBM without or with supplementation of 400 U ß-mannanase/kg. During the 6 weeks of experimental feeding, ß-mannanase supplementation had no effect on body weight gain, feed intake and gain:feed (G:F) ratio. Compared with dehulled SBM, feeding hulled SBM caused an increased feed intake of pigs in the entire trial (p = 0.05). The G:F ratio was improved in pigs receiving dehulled SBM (p < 0.05). Dietary treatments did not influence the total tract digestibility of dry matter, nitrogen and gross energy. Enzyme supplementation reduced (p < 0.05) the population of faecal coliforms and tended to reduce the NH3 concentration after 24 h of fermentation in a closed box containing faecal slurry. Feeding hulled SBM tended to reduce NH3 emission on days 3 and 5 of fermentation. In conclusion, mannanase supplementation had no influence on growth performance and nutrient digestibility but showed a positive effect on reducing coliform population and tended to reduce NH3 emission. Dehulled SBM increased G:F ratio and hulled SBM tended to reduce NH3 emission.

Evaluating the Efficacy of Machine Performance Checks as an Alternative to Winston-Lutz Quality Assurance Testing in the TrueBeam Linear Accelerator with HyperArc.

HyperArc is a preferred technique for treating brain metastases, employing a single isocenter for multiple lesions. Geometrical isocentricity in the TrueBeam linear accelerator with HyperArc is crucial. We evaluated machine performance checks (MPCs) as an alternative to the Winston-Lutz (WL) test to verify the treatment isocenter. Between January and July 2023, we assessed 53 data points using MPC and Winston-Lutz tests. The isocenter size obtained from the MPC and its sum, including the rotation-induced couch shift, were compared with the maximum total delta value from the Winston-Lutz test. The maximum total delta was 0.68 ± 0.10 mm, while the isocenter size was 0.28 ± 0.02 mm. The sum of the isocenter size and rotation-induced couch shift measured by MPC was 0.61 ± 0.03 mm. During the Winston-Lutz test (without couch rotation), the maximum total delta value was 0.56 ± 0.13 mm. A t-test analysis revealed a significant difference in the isocenter size averages between the Winston-Lutz and MPC outcomes, whereas the Pearson's correlation coefficient yielded no correlation. Our study highlights the necessity for separate MPC and Winston-Lutz tests for isocenter verification. Therefore, the Winston-Lutz test should precede stereotactic radiosurgery for isocenter verification.

Surveillance spilled Chironomidae (Diptera) larvae from drinking water treatment plants in South Korea using morphogenetic species analysis and eDNA metabarcoding.

Chironomid larvae (Diptera: Chironomidae) are tremendous indicator species that can tolerate a broad range of environmental conditions, from polluted to unimpaired water ecosystems. These species are ubiquitously observed in all bioregions and can even be found in drinking water treatment plants (DWTPs). Detection of chironomid larvae in DWTPs is a critical issue because their presence may be indicative of the water quality in the supply of tap water for human consumption. Therefore, the aim of the present study was to identify the chironomid communities that reflect the water quality of DWTPs and develop a biomonitoring tool to detect biological contamination of the chironomids in DWTPs. To do so, we investigated the identity and distribution of chironomid larvae in seven DWTP areas using morphological identification, DNA barcoding, and sediment environmental DNA (eDNA) analysis. A total of 7924 chironomid individuals encompassing three subfamilies and 25 species of 19 genera were identified in 33 sites within the DWTPs. The Gongchon and Bupyeong DWTPs were dominated by Chironomus spp. larvae, which were correlated with low levels of dissolved oxygen in the water. In the Samgye DWTP and Hwajeong DWTP, Chironomus spp. were almost absent, and instead, Tanytarsus spp. were abundant. Additionally, the Gangjeong DWTP was dominated by a Microtendipes sp., and two species of Orthocladiinae (a Parametriocnemus sp. and a Paratrichocladius sp.) were found only in the Jeju DWTP. We also identified the eight most abundant Chironomidae larvae found in the DWTPs. Furthermore, eDNA metabarcoding of DWTP sediment indicated the presence of different eukaryotic fauna and confirmed the presence of chironomids in DWTPs. These data provide useful morphological and genetic information regarding chironomid larvae that can be used for the water quality biomonitoring of DWTPs to support the supply of clean drinking water.

DEVELOPMENT OF SAFETY ASSESSMENT CODE FOR DECOMMISSIONING WASTE RECYCLING AND DISPOSAL.

In Korea, 10 units of nuclear power plants are projected for decommissioning by 2030, which will consequently generate a large amount of decommissioning waste. It could bring about a lack in the capacity of the radioactive waste disposal facility. In this paper, a computational code, REcycling and DIsposal Safety Assessment has been developed for the safety assessment regarding the recycling and disposal of the decommissioning waste. It is composed of two modules: dose assessment module and maximum allowance concentration estimation module. The dose assessment module is intended to evaluate the exposure doses from radioactive nuclides in the wastes for each recycling or disposal scenario. The maximum allowance concentration estimation module has the function to translate the nuclides concentrations in the wastes from the exposure doses received by the end user for each scenario. The concentration of each nuclide provides the basis for the development of the technical criteria in accordance with the annual dose limit.

Circulating Tumor DNA Analysis on Metastatic Prostate Cancer with Disease Progression.

The positivity rate of circulating tumor DNA (ctDNA) next-generation sequencing (NGS) varies among patients with metastatic prostate cancer (mPC), complicating its incorporation into regular practice. This retrospective study analyzed the ctDNA sequencing results of 100 mPC patients from May 2021 to March 2023 to identify the factors associated with positive ctDNA. Three custom gene panels were used for sequencing. Overall, 63% of the patients exhibited tier I/II somatic alterations, while 12% had pathogenic/likely pathogenic germline alterations. The key genes that were altered included AR, TP53, RB1, PTEN, and APC. Mutations in BRCA1/2, either germline or somatic, were observed in 21% of the patients. Among the metastatic castration-resistant prostate cancer (mCRPC) patients, the ctDNA-positive samples generally showed higher median prostate-specific antigen (PSA) levels and were more likely to be at the radiographic and clinical progressive disease stages, although they were not significantly associated with PSA progression. Our results suggest that ctDNA analysis could detect meaningful genetic changes in mPC patients, especially during disease progression.

Genetic polymorphism and natural selection in the C-terminal 42 kDa region of merozoite surface protein-1 among Plasmodium vivax Korean isolates.

BACKGROUND: The carboxy-terminal 42 kDa region of Plasmodium vivax merozoite surface protein-1 (PvMSP-142) is a leading candidate antigen for blood stage vaccine development. However, this region has been observed to be highly polymorphic among filed isolates of P. vivax. Therefore it is important to analyse the existing diversity of this antigen in the field isolates of P. vivax. In this study, the genetic diversity and natural selection in PvMSP-142 among P. vivax Korean isolates were analysed. METHODS: A total of 149 P. vivax-infected blood samples collected from patients in Korea were used. The region flanking PvMSP-142 was amplified by PCR, cloned into Escherichia coli, and then sequenced. The polymorphic characteristic and natural selection of PvMSP-142 were analysed using the DNASTAR, MEGA4 and DnaSP programs. RESULTS: A total of 11 distinct haplotypes of PvMSP-142 with 40 amino acid changes, as compared to the reference Sal I sequence, were identified in the Korean P. vivax isolates. Most of the mutations were concentrated in the 33 kDa fragment (PvMSP-133), but a novel mutation was found in the 19 kDa fragment (PvMSP-119). PvMSP-142 of Korean isolates appeared to be under balancing selection. Recombination may also play a role in the resulting genetic diversity of PvMSP-142. CONCLUSIONS: PvMSP-142 of Korean P. vivax isolates displayed allelic polymorphisms caused by mutation, recombination and balancing selection. These results will be useful for understanding the nature of the P. vivax population in Korea and for development of a PvMSP-142 based vaccine against P. vivax.

Quantitative determination of Plasmodium parasitemia by flow cytometry and microscopy.

The traditional light microscopy has limitations for precise growth assays of malaria parasites in culture or for assessment of new compounds for antimalarial activity; the speed and high reproducibility of flow cytometry can overcome these limitations. A flow cytometric method using PicoGreen, a DNA-binding fluorochrome, was developed with optimal precision suitable for performing growth assays of low-parasitemia field isolates. In addition, intra- and inter-person reproducibility of the flow cytometric and the microscopic method were compared in order to quantitatively demonstrate the improved precision. RNase treatment contributed to the precision of the flow cytometric measurements by enhancing the signal-to-noise ratios. Coefficients of variation of the method were smaller than 10% for 0.1% or higher parasitemia samples. The intra- and inter-person coefficients of variation of the flow cytometric method were three to six times smaller than those of the microscopic method. The flow cytometric method developed in this study yielded substantially more precise results than the microscopic method, allowing determination of parasitemia levels of 0.1% or higher, with coefficients of variation smaller than 10%. Thus, the PicoGreen method could be a reliable high sensitivity assay for analysis of low parasitemia samples and might be applied to a high throughput system testing antimalarial drug activity.

Effects of Potato Protein Isolated Using Ethanol on the Gelation and Anti-Proteolytic Properties in Pacific Whiting Surimi.

Pacific whiting is a primary species utilized for surimi processing in the Pacific Northwest of the US. However, endogenous protease in Pacific whiting surimi deteriorates the quality during slow cooking. The demand for clean-labeled and economically competitive protease inhibitors has been increasing. In the present study, the anti-proteolytic effect of potato protein isolate (PPI), a by-product from the potato starch industry, prepared using 20% ethanol on the endogenous protease activity of Pacific whiting (PW) surimi was investigated. The ohmic heating method was carried out for a better assessment of the anti-proteolytic activity of inhibitors. A factorial design was carried out in which the independent variables were the four types of inhibitors and their concentration (0, 0.5, 1, 2, and 3% w/w) at two heating conditions. The heating condition was used as a blocking factor. All experiments were randomized within each block. The addition of 2% PPI which demonstrated the highest anti-proteolytic activity among five different concentrations significantly increased the breaking force, penetration distance, and water retention ability of PW surimi gel as the endogenous proteases were effectively inhibited when heated ohmically at 60 °C for 30 min prior to heating up to 90 °C. In addition, SDS-PAGE disclosed that PPI successfully retained the intensity of myofibrillar heavy chain (MHC) protein of PW surimi gels even under the condition at which proteases could be activated at 60 °C. The whiteness of gels was not negatively affected by the addition of PPI. Comparing all samples, a denser and more ordered microstructure was obtained when PPI was added. A similar trend was found from the fractal dimension (Df) of the PPI-added gel's microstructure. Therefore, PPI could be an effective and non-allergenic protease inhibitor in PW surimi leading to retaining the integrity of high gel quality.

Setup uncertainties and appropriate setup margins in the head-tilted supine position of whole-brain radiotherapy (WBRT).

Various applications of head-tilting techniques in whole-brain radiotherapy (WBRT) have been introduced. However, a study on the setup uncertainties and margins in head-tilting techniques has not been reported. This study evaluated the setup uncertainties and determined the appropriate planning target volume (PTV) margins for patients treated in the head-tilted supine (ht-SP) and conventional supine position (c-SP) in WBRT. Thirty patients who received WBRT at our institution between October 2020 and May 2021 in the c-SP and ht-SP were investigated. The DUON head mask (60124, Orfit Industries, Wijnegem, Belgium) was used in the c-SP, and a thermoplastic U-Frame Mask (R420U, Klarity Medical & Equipment Co. Ltd., Lan Yu, China) was used in the ht-SP. Daily setup verification using planning computed tomography (CT) and cone-beam CT was corrected for translational (lateral, longitudinal, and vertical) and rotational (yaw) errors. In the c-SP, the means of systematic errors were -0.80, 0.79, and 0.37 mm and random errors were 0.27, 0.54, and 0.39 mm in the lateral, longitudinal, and vertical translational dimensions, respectively. Whereas, for the ht-SP, the means of systematic errors were -0.07, 0.73, and -0.63 mm, and random errors were 0.75, 1.39, 1.02 mm in the lateral, longitudinal, and vertical translational dimensions, respectively. The PTV margins were calculated using Stroom et al.'s [2Σ+0.7σ] and van Herk et al.'s recipe [2.5Σ+0.7σ]. Appropriate PTV margins with van Herk et al.'s recipe in WBRT were <2 mm and 1.5° in the c-SP and <3 mm and 2° in the ht-SP in the translational and rotational directions, respectively. Although the head tilt in the supine position requires more margin, it can be applied as a sufficiently stable and effective position in radiotherapy.

Identification of Bacterial Communities in Laboratory-Adapted Glyptotendipes tokunagai and Wild-Stream-Inhabiting Chironomus flaviplumus.

Chironomidae (chironomid) are one of the dominant families in freshwater ecosystems, and they plays an important role in the food web. They have been used as an indicator for water quality assessment, as they are resistant to diverse environmental pollutants. In this study, we identified the microbiomes of two chironomid species to see if there are any endogenous bacterial groups which could contribute to the host survival. The studied species are Glyptotendipes tokunagai, a model species cultivated in a laboratory-controlled environment, and Chironomus flaviplumus captured in a field stream in Yeosu, Korea. DNAs were extracted from the whole body of the individual species, and the 16S rRNA gene was amplified. The amplified products were sequenced using an Illumina MiSeq platform. The microbiomes of G. tokunagai were homogeneous, having 20% of the core amplicon sequence variants overlapping between replicates sampled from different water tanks. In contrast, none of the core amplicon sequence variants overlapped in C.flaviplumus. In both chironomid groups, potential symbionts were identified. Dysgonomonas, which can degrade complex carbon sources, was found in more than half of the total microbiomes of G. tokunagai. Tyzzerella and Dechloromonas, which have been suggested to detoxify environmental pollutants, were identified in the microbiome of C.flaviplumus. This study can help elucidate the life strategies of chironomids in polluted or organic-rich environments.

Efficacy of an Integrated Mobile Application System for Patients with Radiation Therapy: A Pilot Study.

The use of IT applications for patients undergoing radiotherapy is limited. This study aimed to develop an integrated system for communication between patients and radiation oncologists using IT technology and report the first test results for the system "Assisted Radiation Oncology Mobile Application" (AROMA). This system consisted of a manager program, a server running on a PC, and a mobile application on a smartphone. A prospective survey was conducted to evaluate the usefulness of this system from October 2020 to January 2021. The survey consisted of a specific questionnaire on basic information and application use by the patients. The management program was designed such that the user (doctor) edits the treatment schedule, member (patient and doctor) information, self-management, disease information, and side effect questionnaire. The mobile application for patients consisted of the current schedule, treatment schedule calendar, side effect questionnaire, side effect management method, and disease information entered by the doctor. A total of 41 patients were enrolled in this study. The mean adverse event response time was 4.4 days. In the survey, the mobile application received positive views (8.6/10 points). Most responses related to the side effect reporting function (94%) and communication using the application (91%) were positive. Satisfaction with the application design and each menu item was high, with an average of ≥8 and ≥8.5 points in most cases, respectively. The survey showed good satisfaction with the design, operability, and reporting system. Therefore, the system can facilitate communication between patients and radiation oncologists in the future.

Optimized Adaptive Radiotherapy with Individualized Plan Library for Muscle-Invasive Bladder Cancer Using Internal Target Volume Generation.

The bladder is subject to filling variation, which poses a challenge to radiotherapy (RT) delivery. We aimed to assess feasibility and clinical outcomes in patients with bladder cancer treated with adaptive RT (ART) using individualized plan libraries. We retrospectively analyzed 19 patients who underwent RT for muscle-invasive bladder cancer (MIBC) in 2015-2021. Four planning computed tomography (CT) scans were acquired at 15-min intervals, and a library of three intensity-modulated RT plans were generated using internal target volumes (ITVs). A post-treatment cone-beam CT (CBCT) scan was acquired daily to assess intra-fraction filling and coverage. All patients completed the treatment, with 408 post-treatment CBCT scans. The bladder was out of the planning target volume (PTV) range in 12 scans. The volumes of the evaluated PTV plans were significantly smaller than those of conventional PTV. The 1-year and 2-year overall survival rates were 88.2% and 63.7%, respectively. Of eight cases that experienced recurrence, only two developed MIBC. There were no grade 3 or higher RT-related adverse events. ART using plan libraries and ITVs demonstrated good survival outcomes with a high local control rate. Irradiated normal tissue volume and treatment margins may be reduced through this approach, potentially resulting in lower toxicity rates.

Fabrication of 3D printed head phantom using plaster mixed with polylactic acid powder for patient-specific QA in intensity-modulated radiotherapy.

This study aimed to fabricate a heterogeneous phantom replicating the commercial Rando phantom by mixing plaster powder and polylactic acid (PLA) powder. Producing a heterogeneous phantom using Plaster and PLA is cheaper because it can be easily obtained in the commercial market. Additionally, patient-specific Quality Assurance can be easily performed because the phantom can be produced based on the patient's CT image. PLA has been well studied in the field of radiation therapy and was found to be safe and effective. To match the mean Hounsfield unit (HU) values of the Rando phantom, the bone tissue was changed using plaster and 0-35% PLA powder until an appropriate HU value was obtained, and soft tissue was changed using the PLA infill value until an appropriate HU value was obtained. Bone tissue (200 HU or higher), soft issue (- 500 to 200 HU), and air cavity (less than - 500 HU) were modeled based on the HU values on the computed tomography (CT) image. The bone tissue was modeled as a cavity, and after three-dimensional (3D) printing, a solution containing a mixture of plaster and PLA powder was poured. To evaluate the bone implementation of the phantom obtained by the mixture of plaster and PLA powder, the HU profile of the CT images of the 3D-printed phantom using only PLA and the Rando phantom printed using only PLA was evaluated. The mean HU value for soft tissue in the Rando phantom (- 22.5 HU) showed the greatest similarity to the result obtained with an infill value of 82% (- 20 HU). The mean HU value for bone tissue (669 HU) showed the greatest similarity to the value obtained with 15% PLA powder (680 HU). Thus, for the phantom composed of plaster mixed with PLA powder, soft tissue was fabricated using a 3D printer with an infill value of 82%, and bone tissue was fabricated with a mixture containing 15% PLA powder. In the HU profile, this phantom showed a mean difference of 61 HU for soft tissue and 109 HU for bone tissue in comparison with the Rando phantom. The ratio of PLA powder and plaster can be adjusted to achieve an HU value similar to bone tissue. A simple combination of PLA powder and plaster enabled the creation of a custom phantom that showed similarities to the Rando phantom in both soft tissue and bone tissue.

Clinical performance of FractionLab in patient-specific quality assurance for intensity-modulated radiotherapy: a retrospective study.

BACKGRUOUND: This study was aimed at comparing and analyzing the results of FractionLab (Varian/Mobius Medical System) with those of portal dosimetry that uses an electronic portal imaging device. Portal dosimetry is extensively used for patient-specific quality assurance (QA) in intensity-modulated radiotherapy (IMRT). METHODS: The study includes 29 patients who underwent IMRT on a Novalis-Tx linear accelerator (Varian Medical System and BrainLAB) between June 2019 and March 2021. We analyzed the multileaf collimator (MLC) DynaLog files generated after portal dosimetry to evaluate the same condition using FractionLab. The results of the recently launched FractionLab at various gamma indices (0.1%/0.1 mm-1%/1 mm) are analyzed and compared with those of portal dosimetry (3%/3 mm). RESULTS: The average gamma passing rates of portal dosimetry (3%/3 mm) and FractionLab are 98.1 (95.5%-100%) and 97.5% (92.3%-99.7%) at 0.6%/0.6 mm, respectively. The results of portal dosimetry (3%/3 mm) are statistically comparable with the QA results of FractionLab (0.6%/0.6 mm-0.9%/0.9 mm). CONCLUSION: This paper presents the clinical performance of FractionLab by the comparison of the QA results of FractionLab using portal dosimetry with various gamma indexes when performing patient-specific QA in IMRT treatment. Further, the appropriate gamma index when performing patient-specific QA with FractionLab is provided.