Cyclotron and linear accelerator generated scanning proton beams for lung cancer SBRT: Interplay effects and mitigations.

BACKGROUND: Pencil beam scanning (PBS) proton therapy for moving targets is known to be impacted by interplay effects between the scanning beam and organ motion. While respiratory motion in the thoracic region is the major cause for organ motion, interplay effects depend on the delivery characteristics of proton accelerators. PURPOSE: To evaluate the impact of different types of PBS proton accelerators and spot sizes on interplay effects, mitigations, and plan quality for Stereotactic Body Radiation Therapy (SBRT) treatment of non-small cell lung cancer (NSCLC). METHODS: Twenty NSCLC patients treated with photon SBRT were selected to represent varying tumor volumes and respiratory motion amplitudes (median: 0.6 cm with abdominal compression) for this retrospective study. For each patient, plans were created using: (1) cyclotron-generated proton beams (CPB) with spot sizes of σ = 2.7-7.0 mm; (2) linear accelerator proton beams (LPB) (σ = 2.9-5.5 mm); and (3) linear accelerator proton minibeams (LPMB) (σ = 0.9-3.9 mm). The energy switching time is one second for CPB, and 0.005 s for LPMB and LPB. Plans were robustly optimized on the gross tumor volume (GTV) using each individual phase of four-dimensional computed tomography (4DCT) scans. Initially, single-field optimization (SFO) plans were evaluated; if the plan quality did not meet the dosimetric requirement, multi-field optimization (MFO) was used. MFO plans were created for all patients for comparisons. For each patient, all plans were normalized to have the same dose received by 99% of the GTV. Interplay effects were evaluated by computing the dose on 10 breathing phases, based on the spot distribution. Volumetric repainting (VR) was performed 2-6 times for each plan. We compared volume receiving 100% of the prescribed dose (V100%RX) of the GTV, and normal lung V20Gy. RESULTS: Twelve of 20 plans can be optimized sufficiently with SFO. SFO plans were less sensitive to the interplay effect compared to MFO plans in terms of target coverage for both LPB and LPMB. The following comparisons showed results utilizing the MFO technique. In the interplay evaluation without repainting, the mean V100%RX of the GTV were 99.42 ± 0.6%, 97.52 ± 3.9%, and 94.49 ± 7.3% for CPB, LPB, and LPMB plans, respectively. Following VR (2 × for CPB; 3 × for LPB; 5 × for LPMB), V100%RX of the GTV were improved (on average) by 0.13%, 1.84%, and 4.63%, respectively, achieving the acceptance criteria of V100%RX > 95%. Because of fast energy switch in linear accelerator proton machines, the delivery time for VR plans was the lowest for LPB plans, while delivery time for LPMB was on average 1 min longer than CPB plans. The advantage of small spot machines was better sparing in normal lung V20Gy, even when VR was applied. CONCLUSION: In the absence of repainting, proton machines with large spot sizes generated more robust plans against interplay effects. The number of VR increased with decreasing spot sizes to achieve the acceptance criteria. VR improved the plan robustness against interplay effects for modalities with small spot sizes and fast energy changes, preserving the low dose sparing aspect of the LPMB, even when motion is included.

The dosimetric impact of titanium implants in spinal SBRT using four commercial treatment planning algorithms.

To evaluate the dosimetric impact of titanium implants in spine SBRT using four dose calculation algorithms. Twenty patients with titanium implants in the spine treated with SBRT without density override (DO) were selected. The clinical plan for each patient was created in Pinnacle and subsequently imported into Eclipse (AAA and AcurosXB) and Raystation (CC) for dose evaluation with and without DO to the titanium implant. We renormalized all plans such that 90% of the tumor volume received the prescription dose and subsequently evaluated the following dose metrics: (1) the maximum dose to 0.03 cc (Dmax), dose to 99% (D99%) and 90% (D90%) of the tumor volume; (2) Dmax and volumetric metrics of the spinal cord. For the same algorithm, plans with and without DO had similar dose distributions. Differences in Dmax, D99% and D90% of the tumor were on average <2% with slightly larger variations up to 5.58% in Dmax using AcurosXB. Dmax of the spinal cord for plans calculated with DO increased but the differences were clinically insignificant for all algorithms (mean: 0.36% ± 0.7%). Comparing to the clinical plans, the relative differences for all algorithms had an average of 1.73% (-10.36%-13.21%) for the tumor metrics and -0.93% (-9.87%-10.95%) for Dmax of the spinal cord. A few cases with small tumor and spinal cord volumes, dose differences of >10% in both D99% and Dmax of the tumor, and Dmax of the spinal cord were observed. For all algorithms, the presence of titanium implants in the spine for most patients had minimal impact on dose distributions with and without DO. For the same plan calculated with different algorithms, larger differences in volumetric metrics of >10% could be observed, impacted by dose gradient at the plan normalization volume, tumor volumes, plan complexity, and partial voxel volume interpolation.

Anomalous High-Temperature Magnetoresistance in a Dilute 2D Hole System.

We report an unusual magnetoresistance that strengthens with the temperature in a dilute two-dimensional (2D) hole system in GaAs/AlGaAs quantum wells with densities p=1.98-0.99×10^{10}/cm^{2} where r_{s}, the ratio between Coulomb energy and Fermi energy, is as large as 20-30. We show that, while the system exhibits a negative parabolic magnetoresistance at low temperatures (≲0.4 K) characteristic of an interacting Fermi liquid, a positive magnetoresistance emerges unexpectedly at higher temperatures, and grows with increasing temperature even in the regime T∼E_{F}, close to the Fermi energy. This unusual positive magnetoresistance at high temperatures can be attributed to the viscous transport of 2D hole fluid in the hydrodynamic regime where holes scatter frequently with each other. These findings give insight into the collective transport of strongly interacting carriers in the r_{s}≫1 regime and new routes toward magnetoresistance at high temperatures.

Using feasibility dose-volume histograms to reduce intercampus plan quality variability for head-and-neck cancer.

The purpose of this work is to objectively assess variability of intercampus plan quality for head-and-neck (HN) cancer and to test utility of a priori feasibility dose-volume histograms (FDVHs) as planning dose goals. In this study, 109 plans treated from 2017 to 2019 were selected, with 52 from the main campus and 57 from various regional centers. For each patient, the planning computed tomography images and contours were imported into a commercial program to generate FDVHs with a feasibility value (f-value) ranging from 0.0 to 0.5. For 10 selected organs-at-risk (OARs), we used the Dice similarity coefficient (DSC) to quantify the overlaps between FDVH and clinically achieved DVH of each OAR and determined the f-value associated with the maximum DSC (labeled as f-max). Subsequently, 10 HN plans from the regional centers were replanned with planning dose goals guided by FDVHs. The clinical and feasibility-guided auto-planning (FgAP) plans were evaluated using our institutional criteria. Among plans from the main campus and regional centers, the median f-max values were statistically significantly different (p < 0.05) for all OARs except for the left parotid (p = 0.622), oral cavity (p = 0.057), and mandible (p = 0.237). For the 10 FgAP plans, the median values of f-max were 0.21, compared to 0.37 from the clinical plans. With comparable dose coverage to the tumor volumes, the significant differences (p < 0.05) in the median f-max and corresponding dose reduction (shown in parenthesis) for the spinal cord, larynx, supraglottis, trachea, and esophagus were 0.27 (8.5 Gy), 0.3 (7.6 Gy), 0.19 (5.9 Gy), 0.19 (8.9 Gy), and 0.12 (4.0 Gy), respectively. In conclusion, the FDVH prediction is an objective quality assurance tool to evaluate the intercampus plan variability. This tool can also provide guideline in planning dose goals to further improve plan quality.

Is adaptive planning necessary for patients with large tumor position displacements observed on daily image guidance during lung SBRT?

For patients undergoing stereotactic body radiation therapy for lung cancer, their tumor positions may vary due to anatomical changes. This study is to investigate whether adaptive re-planning is necessary for patients with large tumor position displacements observed from daily kV-cone-beam computed tomography (kV-CBCT). We selected 16 fractions from 16 patients with recorded treatment couch shifts greater than 1.5 cm under kV-CBCT guidance. The treatment positions for these patients were manually restored in kV-CBCTs via bone-to-bone alignments (B2B) and tumor-to-tumor alignments (T2T) with corresponding planning CTs. The tumor volumes, including PTVs, ITVs, and GTVs, were transferred from the planning CTs to these kV-CBCTs. With the planned beam configurations and treatment isocenters, kV-CBCTs were imported into the treatment planning system for dose recalculations. To minimize uncertainties of the Hounsfield Unit (HU) in kV-CBCTs, uniformed HU values were assigned to the externals, ITVs, and lungs. The percentage volumes of GTVs, ITVs, and PTVs receiving the prescription dose (VRx) and the dose to the normal structures were analyzed. Seven out of the 16 patients were identified with >5mm tumor position displacements after subtracting the recorded couch shifts from the shifts of B2B alignment. For T2T alignments, 9 out of 16 (56.3%) patients had VRx of PTV <95% (the planning goal) with 91.4% as the lowest, while VRx of the GTV and ITV remained 100% for all 16 patients. For B2B alignments, 14 out of 16 (87.5%) patients have VRx of PTV <95%; 5 patients (31.3%) had VRx of ITV <95%; and 4 patients (25.0%) had VRx of GTV <99%. T2T alignment with 5 mm PTV margin was found superior to B2B alignment, resulting in adequate dose coverage to the ITVs, even for tumors with large positional changes. Adaptive re-planning may not be necessary under these scenarios.

Is there a volume threshold of brain metastases for Linac-based stereotactic radiotherapy?

PURPOSE: To investigate whether there is a volume threshold in target volume of brain metastases below which a small cone size and sharp penumbra in Gamma Knife (GK) may provide improved plan quality when compared to Volumetric Modulated Arc Therapy (VMAT)-based stereotactic radiosurgery (SRS). METHODS: For patients treated on GK SRS for brain metastases in 2018-2019 in our institution, 121 patients with two and three targets were identified. Twenty-six patients with two or three brain metastases (total of 76 lesions) were selected for this study. Two VMAT plans, SmartArc (Pinnacle) and HyperArc (Eclipse), were generated retrospectively for each patient. Plan quality was evaluated based on RTOG conformity index (CI), Paddick gradient index (GI), normal tissue (NT) V12Gy and V4.5Gy. By using the receiver operating characteristic (ROC) curve for both VMAT plans (SmartArc and HyperArc) and metrics of RTOG CI and NT V12Gy, we compared GK plans to SmartArc and HyperArc plans separately to determine the threshold volume. RESULTS: For SmartArc plans, both ROC curve analyses showed a threshold volume of 0.4 cc for both CI and NT V12Gy. For HyperArc plans, the threshold volumes were 0.2 cc for the CI and 0.5 cc for NT V12Gy. GK plans produced improved dose distribution compared to VMAT for targets ≤0.4 cc, but HyperArc was found to have competing results with GK in terms of CI and NT V12Gy. For targets > 0.4 cc, both SmartArc and HyperArc showed better plan quality when compared to the GK plans. CONCLUSIONS: Target volumes ≤0.4 cc may require a small cone size and sharp penumbra in GK while for target volumes >0.4 cc, VMAT-based SRS can provide improved overall plan quality and faster treatment delivery.

Development of topological insulator and topological crystalline insulator nanostructures.

Topological insulators (TIs), a class of quantum materials with time reversal symmetry protected gapless Dirac-surface states, have attracted intensive research interests due to their exotic electronic properties. Topological crystalline insulators (TCIs), whose gapless surface states are protected by the crystal symmetry, have recently been proposed and experimentally verified as a new class of TIs. With high surface-to-volume ratio, nanoscale TI and TCI materials such as nanowires and nanoribbons can have significantly enhanced contribution from surface states in carrier transport and are thus ideally suited for the fundamental studies of topologically protected surface state transport and nanodevice fabrication. This article will review the synthesis and transport device measurements of TIs and TCIs nanostructures.

Manetoresistance of Ultralow-Hole-Density Monolayer Epitaxial Graphene Grown on SiC.

Silicon carbide (SiC) has already found useful applications in high-power electronic devices and light-emitting diodes (LEDs). Interestingly, SiC is a suitable substrate for growing monolayer epitaxial graphene and GaN-based devices. Therefore, it provides the opportunity for integration of high-power devices, LEDs, atomically thin electronics, and high-frequency devices, all of which can be prepared on the same SiC substrate. In this paper, we concentrate on detailed measurements on ultralow-density p-type monolayer epitaxial graphene, which has yet to be extensively studied. The measured resistivity ρxx shows insulating behavior in the sense that ρxx decreases with increasing temperature T over a wide range of T (1.5 K ≤ T ≤ 300 K). The crossover from negative magnetoresistivity (MR) to positive magnetoresistivity at T = 40 K in the low-field regime is ascribed to a transition from low-T quantum transport to high-T classical transport. For T ≥ 120 K, the measured positive MR ratio [ρxx(B) - ρxx(B = 0)]/ρxx(B = 0) at B = 2 T decreases with increasing T, but the positive MR persists up to room temperature. Our experimental results suggest that the large MR ratio (~100% at B = 9 T) is an intrinsic property of ultralow-charge-density graphene, regardless of the carrier type. This effect may find applications in magnetic sensors and magnetoresistance devices.

Non-Drude Magneto-Transport Behavior in a Topological Crystalline Insulator/Band Insulator Heterostructure.

The Drude model is one of the most fundamental models used to understand the electronic carrier transport in materials, including recently discovered topological materials. Here, we present a magneto-transport study revealing the non-Drude transport behavior in a heterostructure of topological crystalline insulator (TCI) SnTe and band insulator PbTe which exhibits a nonsaturating linear magneto-resistance (MR) effect, a novel phenomenon widely observed in topological materials with gapless dispersion. It is shown that in the van der Pauw geometry in which the longitudinal and transverse magneto-resistances are measured to extract the magneto-conductivity, the two-band Drude model is not sufficient to self-consistently describe both the longitudinal and transverse magneto-conductivities. Furthermore, in the Corbino geometry, which directly measures the longitudinal magneto-conductivity σ xx( B) for a straightforward comparison with the Drude model, the MR, 1/σ xx( B), still reveals a large linear MR effect, in direct discrepancy with the Drude model. While shining further light on the multiple-carrier transport in TCI, this study highlights an unusual magneto-transport character of topological materials that challenges the standard Drude picture of electron transport.

Epitaxial graphene homogeneity and quantum Hall effect in millimeter-scale devices.

Quantized magnetotransport is observed in 5.6 × 5.6 mm2 epitaxial graphene devices, grown using highly constrained sublimation on the Si-face of SiC(0001) at high temperature (1900 °C). The precise quantized Hall resistance of [Formula: see text] is maintained up to record level of critical current Ixx = 0.72 mA at T = 3.1 K and 9 T in a device where Raman microscopy reveals low and homogeneous strain. Adsorption-induced molecular doping in a second device reduced the carrier concentration close to the Dirac point (n ≈ 1010 cm-2), where mobility of 18760 cm2/V is measured over an area of 10 mm2. Atomic force, confocal optical, and Raman microscopies are used to characterize the large-scale devices, and reveal improved SiC terrace topography and the structure of the graphene layer. Our results show that the structural uniformity of epitaxial graphene produced by face-to-graphite processing contributes to millimeter-scale transport homogeneity, and will prove useful for scientific and commercial applications.

Temperature dependence of electron density and electron-electron interactions in monolayer epitaxial graphene grown on SiC.

We report carrier density measurements and electron-electron (e-e) interactions in monolayer epitaxial graphene grown on SiC. The temperature (T)-independent carrier density determined from the Shubnikov-de Haas (SdH) oscillations clearly demonstrates that the observed logarithmic temperature dependence of Hall slope in our system must be due to e-e interactions. Since the electron density determined from conventional SdH measurements does not depend on e-e interactions based on Kohn's theorem, SdH experiments appear to be more reliable compared with the classical Hall effect when one studies the T dependence of the carrier density in the low T regime. On the other hand, the logarithmic T dependence of the Hall slope δRxy/δB can be used to probe e-e interactions even when the conventional conductivity method is not applicable due to strong electron-phonon scattering.

Hot carriers in epitaxial graphene sheets with and without hydrogen intercalation: role of substrate coupling.

The development of graphene electronic devices produced by industry relies on efficient control of heat transfer from the graphene sheet to its environment. In nanoscale devices, heat is one of the major obstacles to the operation of such devices at high frequencies. Here we have studied the transport of hot carriers in epitaxial graphene sheets on 6H-SiC (0001) substrates with and without hydrogen intercalation by driving the device into the non-equilibrium regime. Interestingly, we have demonstrated that the energy relaxation time of the device without hydrogen intercalation is two orders of magnitude shorter than that with hydrogen intercalation, suggesting application of epitaxial graphene in high-frequency devices which require outstanding heat exchange with an outside cooling source.

Professional knowledge of child support staff: evidence from the New Jersey child support training program.

Child support enforcement (CSE) has experienced dramatic changes in the last decade; however, it is not clear whether child support staff is fully aware of the development. Using data from the New Jersey child support training program (n = 530), this article aims to evaluate the professional knowledge of child support staff. The results show that participants answered 55% of the questions on CSE correctly in the pretraining assessment. After the training, the participants answered 77% of all questions correctly. The findings reveal an urgent need for training for child support staff in a rapidly changing profession.