Clinical validation of artificial intelligence-based preoperative virtual reduction for Neer 3- or 4-part proximal humerus fractures.

BACKGROUND: If reduction images of fractures can be provided in advance with artificial-intelligence (AI)-based technology, it can assist with preoperative surgical planning. Recently, we developed the AI-based preoperative virtual reduction model for orthopedic trauma, which can provide an automatic segmentation and reduction of fractured fragments. The purpose of this study was to validate a quality of reduction model of Neer 3- or 4-part proximal humerus fractures established by AI-based technology. METHODS: To develop the AI-based preoperative virtual reduction model, deep learning performed the segmentation of fracture fragments, and a Monte Carlo simulation completed the virtual reduction to determine the best model. A total of 20 pre/postoperative three-dimensional computed tomography (CT) scans of proximal humerus fracture were prepared. The preoperative CT scans were employed as the input of AI-based automated reduction (AI-R) to deduce the reduction models of fracture fragments, meanwhile, the manual reduction (MR) was conducted using the same CT images. Dice similarity coefficient (DSC) and intersection over union (IoU) between the reduction model from the AI-R/MR and postoperative CT scans were evaluated. Working times were compared between the two groups. Clinical validity agreement (CVA) and reduction quality score (RQS) were investigated for clinical validation outcomes by 20 orthopedic surgeons. RESULTS: The mean DSC and IoU were better when using AI-R that when using MR (0.78 ± 0.13 vs. 0.69 ± 0.16, p < 0.001 and 0.65 ± 0.16 vs. 0.55 ± 0.18, p < 0.001, respectively). The working time of AI-R was, on average, 1.41% of that of MR. The mean CVA of all cases was 81%±14.7% (AI-R, 82.25%±14.27%; MR, 76.75%±14.17%, p = 0.06). The mean RQS was significantly higher when AI-R compared with MR was used (91.47 ± 1.12 vs. 89.30 ± 1.62, p = 0.045). CONCLUSION: The AI-based preoperative virtual reduction model showed good performance in the reduction model in proximal humerus fractures with faster working times. Beyond diagnosis, classification, and outcome prediction, the AI-based technology can change the paradigm of preoperative surgical planning in orthopedic surgery. LEVEL OF EVIDENCE: Level IV.

Mechanical properties of human tumour tissues and their implications for cancer development.

The mechanical properties of cells and tissues help determine their architecture, composition and function. Alterations to these properties are associated with many diseases, including cancer. Tensional, compressive, adhesive, elastic and viscous properties of individual cells and multicellular tissues are mostly regulated by reorganization of the actomyosin and microtubule cytoskeletons and extracellular glycocalyx, which in turn drive many pathophysiological processes, including cancer progression. This Review provides an in-depth collection of quantitative data on diverse mechanical properties of living human cancer cells and tissues. Additionally, the implications of mechanical property changes for cancer development are discussed. An increased knowledge of the mechanical properties of the tumour microenvironment, as collected using biomechanical approaches capable of multi-timescale and multiparametric analyses, will provide a better understanding of the complex mechanical determinants of cancer organization and progression. This information can lead to a further understanding of resistance mechanisms to chemotherapies and immunotherapies and the metastatic cascade.

A Preliminary Diagnostic Model for Forward Head Posture among Adolescents Using Forward Neck Tilt Angle and Radiographic Sagittal Alignment Parameters.

Despite numerous attempts to correct forward head posture (FHP), definitive evidence-based screening and diagnostic methods remain elusive. This study proposes a preliminary diagnostic methodology for FHP, utilizing a noninvasive body angle measurement system as a screening test for FHP and incorporating radiological parameters for sagittal alignment. We enrolled 145 adolescents for FHP screening. The forward neck tilt angle (FNTA), defined as the angle between the vertical line and the line connecting the participant's acromion and tragus, was measured using the POM-Checker (a noninvasive depth sensor-based body angle measurement system). A whole-spine standing lateral radiograph was obtained, and eight sagittal alignment parameters were measured. Statistical analyses of the association between the FNTA and eight sagittal alignment parameters were conducted. We used 70% of the participant data to establish a preliminary diagnostic model for FHP based on FNTA and each sagittal alignment parameter. The accuracy of the model was evaluated using the remaining 30% of the participant data. All radiological parameters of sagittal alignment showed weak statistical significance with respect to FNTA (best case: r = 0.16, p = 0.0500; cranial tilt). The proposed preliminary diagnostic model for FHP demonstrated 95.35% agreement. Notably, the model using FNTA without radiological parameters accurately identified (100%) participants who required radiographic scanning for FHP diagnosis. Owing to the weak statistical significance of the association between radiological parameters and external body angle, both factors must be considered for accurate FHP diagnosis. When a clear and severe angle variation is observed in an external body angle check, medical professionals should perform radiographic scanning for an accurate FHP diagnosis. In conclusion, FNTA assessment of FNTA through the proposed preliminary diagnostic model is a significant screening factor for selecting participants who must undergo radiographic scanning so that a diagnosis of FHP can be obtained.

Automatic segmentation of inconstant fractured fragments for tibia/fibula from CT images using deep learning.

Orthopaedic surgeons need to correctly identify bone fragments using 2D/3D CT images before trauma surgery. Advances in deep learning technology provide good insights into trauma surgery over manual diagnosis. This study demonstrates the application of the DeepLab v3+ -based deep learning model for the automatic segmentation of fragments of the fractured tibia and fibula from CT images and the results of the evaluation of the performance of the automatic segmentation. The deep learning model, which was trained using over 11 million images, showed good performance with a global accuracy of 98.92%, a weighted intersection over the union of 0.9841, and a mean boundary F1 score of 0.8921. Moreover, deep learning performed 5-8 times faster than the experts' recognition performed manually, which is comparatively inefficient, with almost the same significance. This study will play an important role in preoperative surgical planning for trauma surgery with convenience and speed.

Structural analysis of customized 3D printed plate for pelvic bone by comparison with conventional plate based on bending process.

Pelvic bone fracture is highly complex, and its anatomical reduction is difficult. Therefore, patient-specific customized plates have been developed using three-dimensional (3D) printing technology and are being increasingly used. In this study, the reduction status in five representative pelvic fracture models was compared between two groups: the 3D printing plate (3DP) group using a patient-specific 3D printed plate after virtual reduction and the conventional plate (CP) group using a conventional plate by manual bending. The 3DP and CP groups included 10 and 5 cases, respectively. The fractured models were reduced virtually and their non-locking metal plates were customized using 3D printing. The process of contouring the conventional plates to fit the contact surface of the bone with the bending tool was conducted by an experienced pelvic bone trauma surgeon. The reduction and fixation achieved using the two different plate groups was compared, and the significance of differences in the results was analyzed using paired t-tests, after verifying the normality of data distribution. The vertex distances between the surface of the bone and the contact surface of the plate were significantly lower in the 3DP group than in the CP group (0.407 ± 0.342 and 2.195 ± 1.643, respectively, P = 0.008). Length and angular variations, which are measurements of the reduction state, were also lower in the 3DP group than in the CP group (length variation: 3.211 ± 2.497 and 5.493 ± 3.609, respectively, P = 0.051; angular variation: 2.958 ± 1.977 and 4.352 ± 1.947, respectively, P = 0.037). The customized 3D printed plate in the virtual reduction model provided a highly accurate reduction of pelvic bone fractures, suggesting that the customized 3D printed plate may help ensure easy and accurate reduction.

Deep Learning Model Based on You Only Look Once Algorithm for Detection and Visualization of Fracture Areas in Three-Dimensional Skeletal Images.

Utilizing "You only look once" (YOLO) v4 AI offers valuable support in fracture detection and diagnostic decision-making. The purpose of this study was to help doctors to detect and diagnose fractures more accurately and intuitively, with fewer errors. The data accepted into the backbone are diversified through CSPDarkNet-53. Feature maps are extracted using Spatial Pyramid Pooling and a Path Aggregation Network in the neck part. The head part aggregates and generates the final output. All bounding boxes by the YOLO v4 are mapped onto the 3D reconstructed bone images after being resized to match the same region as shown in the 2D CT images. The YOLO v4-based AI model was evaluated through precision-recall (PR) curves and the intersection over union (IoU). Our proposed system facilitated an intuitive display of the fractured area through a distinctive red mask overlaid on the 3D reconstructed bone images. The high average precision values (>0.60) were reported as 0.71 and 0.81 from the PR curves of the tibia and elbow, respectively. The IoU values were calculated as 0.6327 (tibia) and 0.6638 (elbow). When utilized by orthopedic surgeons in real clinical scenarios, this AI-powered 3D diagnosis support system could enable a quick and accurate trauma diagnosis.

Does a Customized 3D Printing Plate Based on Virtual Reduction Facilitate the Restoration of Original Anatomy in Fractures?

The purpose of this study was to evaluate the restoration of original anatomy after fixation of sawbone fractures using case-specific 3D printing plates based on virtual reduction (VR). Three-dimensional models of 28 tibia sawbones with cortical marking holes were obtained. The sawbones were fractured at various locations of the shaft and 3D models were obtained. The fractured models were reduced virtually and customized non-locking metal plates that fit the reduced model were produced via 3D printing. The fractured sawbones were actually fixed to the customized plate with nonlocking screws and 3D models were generated. With the proximal fragments of the 3D models overlapped, the changes in length, 3D angulation, and rotation of the distal fragment were evaluated. Compared to the intact model (IN), the virtual reduction model (VR) and the actual fixation model (AF) showed no significant differences in length. Compared to the IN, the VR and the AF had mean 3D angulations of 0.39° and 0.64°, respectively. Compared to the IN model, the VR and the AF showed mean rotations of 0.89° and 1.51°, respectively. A customized plate based on VR facilitates the restoration of near-original anatomy in fractures of tibial sawbone shaft.

Quantitative Assessment of the Restoration of Original Anatomy after 3D Virtual Reduction of Long Bone Fractures.

Background: The purpose of this study was to demonstrate the usefulness of 3D image-based virtual reduction by validating the evaluation criteria according to guidelines suggested by the AO Surgery Reference. Methods: For this experiment, 19 intact radial ORTHObones (ORTHObones radius, 3B Scientific, Germany, Hamburg) without any fractures were prepared. All ORTHObones with six cortical marking holes (three points on the distal part and three points on the proximal part) were scanned using a CT scanner twice (before/after intentional fracture of the ORTHObone). After the virtual reduction of all 19 ORTHObones, accuracy evaluations using the four criteria (length variation, apposition variation, alignment variation, Rotation Variation) suggested in the AO Surgery Reference were performed. Results: The mean (M) length variation was 0.42 mm, with 0.01 mm standard deviation (SD). The M apposition variation was 0.48 mm, with 0.40 mm SD. The M AP angulation variation (for alignment variation) was 3.24°, with 2.95° SD. The M lateral angulation variation (for alignment variation) was 0.09°, with 0.13° SD. The M angle of axial rotation was 1.27° with SD: 1.19°. Conclusions: The method of accuracy evaluation used in this study can be helpful in establishing a reliable plan.

Patient-Derived Nasopharyngeal Cancer Organoids for Disease Modeling and Radiation Dose Optimization.

Effective radiation treatment (RT) for recurrent nasopharyngeal cancers (NPC), featuring an intrinsic hypoxic sub-volume, remains a clinical challenge. Lack of disease-specific in-vitro models of NPC, together with difficulties in establishing patient derived xenograft (PDX) models, have further hindered development of personalized therapeutic options. Herein, we established two NPC organoid lines from recurrent NPC PDX models and further characterized and compared these models with original patient tumors using RNA sequencing analysis. Organoids were cultured in hypoxic conditions to examine the effects of hypoxia and radioresistance. These models were then utilized to determine the radiobiological parameters, such as α/ß ratio and oxygen enhancement ratio (OER), characteristic to radiosensitive normoxic and radioresistant hypoxic NPC, using simple dose-survival data analytic tools. The results were further validated in-vitro and in-vivo, to determine the optimal boost dose and fractionation regimen required to achieve effective NPC tumor regression. Despite the differences in tumor microenvironment due to the lack of human stroma, RNA sequencing analysis revealed good correlation of NPC PDX and organoid models with patient tumors. Additionally, the established models also mimicked inter-tumoral heterogeneity. Hypoxic NPC organoids were highly radioresistant and had high α/ß ratio compared to its normoxic counterparts. In-vitro and in-vivo fractionation studies showed that hypoxic NPC was less sensitive to RT fractionation scheme and required a large bolus dose or 1.4 times of the fractionated dose that was effective against normoxic cells in order to compensate for oxygen deficiency. This study is the first direct experimental evidence to predict optimal RT boost dose required to cause sufficient damage to recurrent hypoxic NPC tumor cells, which can be further used to develop dose-painting algorithms in clinical practice.

Simplified sigmoidal curve fitting for a 6 MV FFF photon beam of the Halcyon to determine the field size for beam commissioning and quality assurance.

BACKGROUND: An O-ring gantry-type linear accelerator (LINAC) with a 6-MV flattening filter-free (FFF) photon beam, Halcyon, includes a reference beam that contains representative information such as the percent depth dose, profile and output factor for commissioning and quality assurance. However, because it does not provide information about the field size, we proposed a method to determine all field sizes according to all depths for radiation therapy using simplified sigmoidal curve fitting (SCF). METHODS: After mathematical definition of the SCF using four coefficients, the defined curves were fitted to both the reference data (RD) and the measured data (MD). For good agreement between the fitting curve and the profiles in each data set, the field sizes were determined by identifying the maximum point along the third derivative of the fitting curve. The curve fitting included the field sizes for beam profiles of 2 × 2, 4 × 4, 6 × 6, 8 × 8, 10 × 10, 20 × 20 and 28 × 28 cm2 as a function of depth (at 1.3, 5, 10 and 20 cm). The field size results from the RD were compared with the results from the MD using the same condition. RESULTS: All fitting curves show goodness of fit, R2, values that are greater than 0.99. The differences in field size between the RD and the MD were within the range of 0 to 0.2 cm. The smallest difference in the field sizes at a depth of 10 cm, which is a surface-to-axis distance, was reported. CONCLUSION: Application of the SCF method has been proven to accurately capture the field size of the preconfigured RD and the measured FFF photon beam data for the Halcyon system. The current work can be useful for beam commissioning as a countercheck methodology to determine the field size from RD in the treatment planning system of a newly installed Halcyon system and for routine quality assurance to ascertain the correctness of field sizes for clinical use of the Halcyon system.

Fabrication of piezoelectric poly(L-lactic acid)/BaTiO3 fibre by the melt-spinning process.

Poly(L-lactic acid) (PLLA) based piezoelectric polymers are gradually becoming the substitute for the conventional piezoelectric ceramic and polymeric materials due to their low cost and biodegradable, non-toxic, piezoelectric and non-pyroelectric nature. To improve the piezoelectric properties of melt-spun poly(L-lactic acid) (PLLA)/BaTiO3, we optimized the post-processing conditions to increase the proportion of the ß crystalline phase. The α → ß phase transition behaviour was determined by two-dimensional wide-angle x-ray diffraction and differential scanning calorimetry. The piezoelectric properties of PLLA/BaTiO3 fibres were characterised in their yarn and textile form through a tapping method. From these results, we confirmed that the crystalline phase transition of PLLA/BaTiO3 fibres was significantly enhanced under the optimised post-processing conditions at a draw ratio of 3 and temperature of 120 °C during the melt-spinning process. The results indicated that PLLA/BaTiO3 fibres could be a one of the material for organic-based piezoelectric sensors for application in textile-based wearable piezoelectric devices.

A Highly Porous Nonwoven Thermoplastic Polyurethane/Polypropylene-Based Triboelectric Nanogenerator for Energy Harvesting by Human Walking.

: A highly porous nonwoven thermoplastic polyurethane (TPU)/Polypropylene (PP) triboelectric nanogenerator (N-TENG) was developed. To fabricate the triboelectric layers, the TPU nanofiber was directly electrospun onto the nonwoven PP at different basis weights (15, 30, and 50 g/m2). The surface morphologies and porosities of the nonwoven PP and TPU nanofiber mats were characterized by field-emission scanning electron microscopy and porosimetry. The triboelectric performance of the nonwoven TPU/PP based TENG was found to improve with an increase in the basis weight of nonwoven PP. The maximum output voltage and current of the TPU/PP N-TENG with 50% PP basis weight reached 110.18 ± 6.06 V and 7.28 ± 0.67 µA, respectively, due to high air volume of nonwoven without spacers. In order to demonstrate its practical application as a generator, a TPU/PP N-TENG-attached insole for footwear was fabricated. The N-TENG was used as a power source to turn on 57 light-emitting diodes through human-walking, without any charging system. Thus, owing to its excellent energy-conversion performance, simple fabrication process, and low cost, the breathable and wearable nonwoven fiber-based TENG is suitable for large-scale production, to be used in wearable devices.

Nano- And Microfiber-Based Fully Fabric Triboelectric Nanogenerator For Wearable Devices.

The combination of the triboelectric effect and static electricity as a triboelectric nanogenerator (TENG) has been extensively studied. TENGs using nanofibers have advantages such as high surface roughness, porous structure, and ease of production by electrospinning; however, their shortcomings include high-cost, limited yield, and poor mechanical properties. Microfibers are produced on mass scale at low cost; they are solvent-free, their thickness can be easily controlled, and they have relatively better mechanical properties than nanofiber webs. Herein, a nano- and micro-fiber-based TENG (NMF-TENG) was fabricated using a nylon 6 nanofiber mat and melt blown nonwoven polypropylene (PP) as triboelectric layers. Hence, the advantages of nanofibers and microfibers are maintained and mutually complemented. The NMF-TENG was manufactured by electrospinning nylon 6 on the nonwoven PP, and then attaching Ni coated fabric electrodes on the top and bottom of the triboelectric layers. The morphology, porosity, pore size distribution, and fiber diameters of the triboelectric layers were investigated. The triboelectric output performances were confirmed by controlling the pressure area and basis weight of the nonwoven PP. This study proposes a low-cost fabrication process of NMF-TENGs with high air-permeability, durability, and productivity, which makes them applicable to a variety of wearable electronics.

Comparative performance analysis for abdominal phantom ROI detectability according to CT reconstruction algorithm: ADMIRE.

PURPOSE: We compared and analyzed the detectability performance pertaining to an abdominal phantom including a region of interest (ROI) according to a computed tomography (CT) reconstruction algorithm. METHODS: Three types of reconstruction algorithms (FBP, SAFIRE, and ADMIRE) were used to evaluate the detectability performance using the abdominal phantom (phantom size: 25 × 18 × 28 cm3 ). The vendor default settings for routine multi-detector computed tomography abdominal scans were used. As the quantitative evaluation method, the contrast-to-noise ratio (CNR), difference in coefficient of variation (COV) with the normalization based on the FBP data, and the noise power spectrum (NPS) were measured. RESULTS: The characteristic of the ADMIRE-3 reconstructed image was higher than those of the FBP and SAFIRE-3 reconstructed images. The CNR values of the SAFIRE and ADMIRE images were much higher than the corresponding values of the FBP images. The difference in COV values for the ADMIRE images was ~1.2 times lower than the corresponding values of the SAFIRE images. CONCLUSION: The comparative analysis of the abdominal phantom low-contrast resolution differences for each CT exposure parameters showed that ADMIRE demonstrated better results than SAFIRE and FBP in terms of contrast, CNR, COV difference, and 1D NPS. This indicates that ADMIRE can provide a clearer observation even with the same number of contrast objects as compared to SAFIRE and FBP owing to its better contrast resolution in the central part of the contrast hole at low kV.

Estimation of radiation shielding ability in electron therapy and brachytherapy with real time variable shape tungsten rubber.

PURPOSE: To clarify the physical characteristics of a newly developed real time variable shape rubber containing tungsten (STR) with changes in heat and estimate its shielding abilities against electron beams and γ-rays from 192Ir. METHODS: Dynamic mechanical analysis for the STR (density = 7.3 g/cm3) was conducted at a frequency of 1.0 Hz in the temperature range of -60 °C to 60 °C. We evaluated tanδ, defined as the ratio (E″/E') between the storage modulus (E') and loss modulus (E″). The transmission rates were measured against 6- and 12-MeV electron beams and the percentage depth dose and lateral dose profile were compared with low-melting alloy (LMA). For the shielding rate of 192Ir against γ-rays, measurement data and Monte Carlo simulation data were obtained with STR thickness ranging from 1.0 mm to 16.0 mm. RESULTS: At 36 °C, the tanδ value was 0.520, while at 60 °C, this value was 1.016. For 6- and 12-MeV electron beams, the transmission rates decreased with increasing STR thickness and reached plateaus at approximately 1.0% and 4.0% with STR thickness of >7.0 and >12.0 mm, respectively. The dose distributions were almost equal to those for LMA. Against γ-rays, the thickness of STR that obtained a 50% attenuation rate for 192Ir was 5.804 mm. The Monte Carlo calculation results were 2.6% higher on average than the measurement results. CONCLUSION: The STR can be changed shape in real time at 60 °C and maintains its shape at body temperatures. It has adequate shielding abilities against megavoltage electron beams and γ-rays from 192Ir.

Mechanical performance of a commercial knowledge-based VMAT planning for prostate cancer.

BACKGROUND: This study clarified the mechanical performance of volumetric modulated arc therapy (VMAT) plans for prostate cancer generated with a commercial knowledge-based treatment planning (KBP) and whether KBP system could be applied clinically without any major problems with mechanical performance. METHODS: Thirty consecutive prostate cancer patients who underwent VMAT using extant clinical plans were evaluated. The mechanical performance and dosimetric accuracy of the single optimized KBPs, which were trained with other 51 clinical plans, were compared with the clinical plans. The mechanical performance metrics were mean field area (MFA), mean asymmetry distance (MAD), cross-axis score (CAS), closed leaf score (CLS), small aperture score (SAS), leaf travel (LT), modulation complexity score (MCSv), and monitor unit (MU). The γ passing rates were evaluated with ArcCheck and EBT3 film. RESULTS: The mean mechanical performance metrics (clinical plan vs. KBP) were as follows: 18.28 cm2 vs. 17.25 cm2 (MFA), 21.08 mm vs. 20.47 mm (MAD), 0.54 vs. 0.55 (CAS), 0.040 vs. 0.051 (CLS), 0.20 vs. 0.23 (SAS5mm), 458.5 mm vs. 418.8 mm (LT), 0.27 vs. 0.27 (MCSv), and 618.2 vs. 622.1 (MU), respectively. Significant differences were observed for CLS and LT. The average γ passing rates (clinical plan vs. KBP) were as follows: 99.0% vs. 99.1% (3%/3 mm) and 92.4% vs. 92.5% (2%/2 mm) with ArcCHeck, and 99.5% vs. 99.4% (3%/3 mm) and 95.2% vs. 95.4% (2%/2 mm) with EBT3 film, respectively. CONCLUSIONS: The KBP used lower multileaf collimator (MLC) travel and more closed or small MLC apertures than the clinical plan. The KBP system of VMAT for the prostate cancer was acceptable for clinical use without any major problems.

Quantitative analysis of prompt gamma ray imaging during proton boron fusion therapy according to boron concentration.

The purpose of this study is to evaluate the prompt gamma ray imaging technique according to the clinical boron concentration range during proton boron fusion therapy (PBFT). To acquire a prompt gamma ray image from 32 projections, we simulated four head single photon emission computed tomography and a proton beam nozzle using a Monte Carlo simulation. We used modified ordered subset expectation maximization reconstruction algorithm with a graphic processing unit for fast image acquisition. Boron concentration was set as 20 to 100 µg at intervals of 20 µg. For quantitative analysis of the prompt gamma ray image, we acquired an image profile drawn through two boron uptake regions (BURs) and calculated the contrast value, signal-to-noise ratio (SNR), and difference between the physical target volume and volume of the prompt gamma ray image. The relative counts of prompt gamma rays were noticeably increased with increasing boron concentration. Although the intensities on the image profiles showed a similar tendency according to the boron concentration, the SNR and contrast value were improved with increasing boron concentration. This study suggests that a tumor monitoring technique using prompt gamma ray detection can be clinically applicable even if the boron concentration is relatively low.

Digital Imaging and Communications in Medicine (DICOM) information conversion procedure for SUV calculation of PET scanners with different DICOM header information.

PURPOSE: In nuclear medicine, the standardized uptake value (SUV) obtained using positron emission tomography with 2-deoxy-2-fluoro-D-glucose (FDG-PET) is widely used as a semi-quantitative diagnosis factor. We found that the header file of the Philips Allegro PET scanner using the Digital Imaging and Communications in Medicine (DICOM) standard was stored differently than with other scanners. Thus, the purpose of this study was to develop a DICOM header information conversion program to ensure compatibility between Allegro and other equipment. METHODS AND RESULTS: The NEMA IEC Body phantom was scanned using the Allegro PET scanner. We conducted measurements and performed calculations by using commercial software and the proposed self-developed program, respectively, to compare the SUVs by using conversion data. The program consists of three parts: an input part that can load data regardless of the number of DICOM images, and conversion and output parts that can be used to convert the DICOM header information and store it in the order of slices. The results of the calculation are in good agreement with the data measured at 12 circular regions of interest. The percent difference was lower than the 20%. CONCLUSION: In conclusion, this study suggested a simple and convenient method to solve the incompatibility through conversion of the DICOM header information. This study thus provides physicians more accurate information for diagnosis and treatment.

Comparison between proton boron fusion therapy (PBFT) and boron neutron capture therapy (BNCT): a monte carlo study.

The aim of this study is to compare between proton boron fusion therapy (PBFT) and boron neutron capture therapy (BNCT) and to analyze dose escalation using a Monte Carlo simulation. We simulated a proton beam passing through the water with a boron uptake region (BUR) in MCNPX. To estimate the interaction between neutrons/protons and borons by the alpha particle, the simulation yielded with a variation of the center of the BUR location and proton energies. The variation and influence about the alpha particle were observed from the percent depth dose (PDD) and cross-plane dose profile of both the neutron and proton beams. The peak value of the maximum dose level when the boron particle was accurately labeled at the region was 192.4% among the energies. In all, we confirmed that prompt gamma rays of 478 keV and 719 keV were generated by the nuclear reactions in PBFT and BNCT, respectively. We validated the dramatic effectiveness of the alpha particle, especially in PBFT. The utility of PBFT was verified using the simulation and it has a potential for application in radiotherapy.