Multi-Institutional Study of End-to-End Dose Delivery Quality Assurance Testing for Image-Guided Brachytherapy Using a Gel Dosimeter.

PURPOSE: To quantify dose delivery errors for high-dose-rate image-guided brachytherapy (HDR-IGBT) using an independent end-to-end dose delivery quality assurance test at multiple institutions. The novelty of our study is that this is the first multi-institutional end-to-end dose delivery study in the world. MATERIALS AND METHODS: The postal audit used a polymer gel dosimeter in a cylindrical acrylic container for the afterloading system. Image acquisition using computed tomography, treatment planning, and irradiation were performed at each institution. Dose distribution comparison between the plan and gel measurement was performed. The percentage of pixels satisfying the absolute-dose gamma criterion was reviewed. RESULTS: Thirty-five institutions participated in this study. The dose uncertainty was 3.6% ± 2.3% (mean ± 1.96σ). The geometric uncertainty with a coverage factor of k = 2 was 3.5 mm. The tolerance level was set to the gamma passing rate of 95% with the agreement criterion of 5% (global)/3 mm, which was determined from the uncertainty estimation. The percentage of pixels satisfying the gamma criterion was 90.4% ± 32.2% (mean ± 1.96σ). Sixty-six percent (23/35) of the institutions passed the verification. Of the institutions that failed the verification, 75% (9/12) had incorrect inputs of the offset between the catheter tip and indexer length in treatment planning and 17% (2/12) had incorrect catheter reconstruction in treatment planning. CONCLUSIONS: The methodology should be useful for comprehensively checking the accuracy of HDR-IGBT dose delivery and credentialing clinical studies. The results of our study highlight the high risk of large source positional errors while delivering dose for HDR-IGBT in clinical practices.

Comparison with Magnetic Resonance Three-Dimensional Sequence for Lumbar Nerve Root with Intervertebral Foramen.

STUDY DESIGN: Prospective study based on magnetic resonance (MR) imaging of the lumbar spinal root of the intervertebral foramen. PURPOSE: This study was to compare MR three-dimensional (3D) sequences for the evaluation of the lumbar spinal root of the intervertebral foramen. OVERVIEW OF LITERATURE: The diagnosis of spinal disorders by MR imaging is commonly performed using two-dimensional T1- and T2-weighted images, whereas 3D MR images can be used for acquiring further detailed data using thin slices with multi-planar reconstruction. METHODS: On twenty healthy volunteers, we investigated the contrast-to-noise ratio (CNR) of the lumbar spinal root of the intervertebral foramen with a 3D balanced sequence. The sequences used were the fast imaging employing steady state acquisition and the coherent oscillatory state acquisition for the manipulation of image contrast (COSMIC). COSMIC can be used with or without fat suppression (FS). We compared these sequence to determine the optimized visualization sequence for the lumbar spinal root of the intervertebral foramen. RESULTS: For the CNR between the nerve root and the peripheral tissue, these were no significant differences between the sequences at the entry of foramen. There was a significant difference and the highest CNR was seen with COSMIC-FS for the intra- and extra-foramen. CONCLUSIONS: In this study, the findings suggest that the COSMIC-FS sequences should be used for the internal or external foramen for spinal root disorders.

Effect of ankle flexion on the quantification of MRS for intramyocellular lipids of the tibialis anterior and the medial gastrocnemius.

Muscle proton magnetic resonance spectroscopy (MRS) has been developed for non-invasive measurement of intramyocellular lipid (IMCL) levels. The majority of previous studies measuring IMCL with MRS have been performed on the calf muscle. The appearance of muscle MRS is influenced by bulk magnetic susceptibility and residual dipolar couplings, which depend on the angle between the muscle fibers and the main magnetic field. Our objective in this study was to evaluate the effect of ankle flexion and of the pennation angle on IMCL quantification in the calf muscle using proton MRS. The subjects comprised ten healthy male volunteers. In proton MRS, the ankle flexion angle was changed, and the pennation angle was measured from the tibialis anterior (TA) and the medial gastrocnemius (MG), respectively. We considered the relationship between the quantification of IMCL with (1)H MRS and the pennation angle by ankle flexion angle. The pennation angle of the TA and MG changed with the ankle flexion angle. The IMCL on the TA decreased significantly with plantar flexion (p < 0.05). However, the IMCL on the MG demonstrated no significant difference. The MR spectrum and IMCL quantitation changed with the pennation angle. Therefore, when spectra of individual subjects in longitudinal studies or between subjects are compared in cross-sectional studies, the foot position or calf muscle orientation must be considered.

Investigation of intervertebral disc and facet joint in lumbar spondylolisthesis using T2 mapping.

PURPOSE: We measured T2 relaxation time of the intervertebral discs (IVD) and facet joints (FJ) in patients with degenerative spondylolisthesis (DS) and no spondylolisthesis (NS) and investigated the characteristics of these parts in DS. METHODS: In 40 patients with DS and 40 patients with NS, we measured T2 relaxation time of the IVD and FJ and compared them between groups. In the group with DS, we also examined the relationship between the degree of slippage using Meyerding grade and T2 relaxation of each part in the IVD and FJ. RESULTS: T2 relaxation time of the IVD tended to be lower in the DS than NS group and differed significantly (P < 0.01) within the anterior annulus fibrosus. T2 relaxation time in the FJ was significantly higher in the DS than NS group. T2 relaxation time in the FJ was significantly higher for those assessed Meyerding Grade II than Grade I, although we observed no significant differences in T2 relaxation time in any area of the IVD. CONCLUSION: T2 relaxation time decreased in the anterior annulus fibrosus of the IVD and increased in the FJ in patients with DS, suggesting an association of IVD and FJ degeneration with the development of lumbar DS.

Visualization of the foramen intervertebral nerve root of cervical spine with 3.0 tesla magnetic resonance imaging: a comparison of three-dimensional acquisition techniques.

Identification of the compression factor in cervical disc herniation and cervical spondylotic radioculopathy is often problematic when using two-dimensional magnetic resonance imaging (MRI). This prompted us to compare and examined three-dimensional sequences, coherent oscillatory state acquisition for the manipulation of image contrast (COSMIC), fast imaging employing steady state acquisition (FIESTA) and T2 star weighted MR angiography (SWAN) with 3.0-Tesla (T) MRI to visualize the foramen intervertebral nerve root for the cervical spine. Fat-suppressed COSMIC (FS-COSMIC) sequence gave the highest signal intensity ratio (1.85 ± 0.06) of the nerve root and vertebral arch. A significant difference in signal intensity ratio of the nerve root was found between FS-COSMIC and FIESTA sequences. No significant difference was found between the FS-COSMIC and FIESTA sequences in the cerebrospinal fluid and the spinal cord. The FS-COSMIC sequence proved to be the most suitable sequence for intra and extra dura matter.

[Optimized magnetic resonance sequences and parameters with operative assisted images for radical prostatectomy at 3 tesla-magnetic resonance image].

The objective of our study was to optimize magnetic resonance image (MRI) sequences and parameters using operative assisted images (three-dimensional images) for radical prostatectomy at 3 tesla (T) MRI. Five healthy volunteers underwent MRI on the 3.0 T scanner. Various sequences and parameters [Cube (TE/TR = 18, 50, 90 ms/2000 ms), FIESTA (TE/TR/FA = 2.4 ms/5 ms/40 degrees, 90 degrees), fSPGR (TE/TR/FA = 2.3 ms/11.2 ms/20 degrees), slice thickness = 1.2 mm, matrix = 192 x 160] were respectively compared. Several structures of the pelvis (the central zones and transition zones of the prostate, the peripheral zones of the prostate, seminal vesicles, rectum wall, bladder, muscle and fat) were determined. The signal intensities of these structures were measured on reformatted axial images and compared against several structures of the pelvis. Correlation with various sequences and parameters was based on the signal-to-noise ratio (SNR), the contrast ratio (CR) and the presence of artifacts. Student's t-test was used for statistical analysis. With Cube (TE/TR = 50 ms/2000 ms), the average value of visual evaluation with artifacts was high, and SNR and CR were higher than for other sequence and parameters. Optimized MRI sequences and parameters were Cube (TE/TR = 50 ms/2000 ms) which provides improved SNR and CR and the presence of artifacts with operative assisted images for radical prostatectomy. These operative assisted images obtained from Cube (TE/TR = 50 ms/2000 ms) are likely to be useful for surgery.

Impaired myocardial blood flow reserve in subjects with metabolic syndrome analyzed using positron emission tomography and N-13 labeled ammonia.

PURPOSE: Coronary vasomotor response might be impaired in metabolic syndrome (MS); however, the precise abnormality has not been elucidated. The aim of this study was to assess coronary-vasomotor response in MS subjects using N-13 labeled ammonia and positron emission tomography. METHODS AND RESULTS: Myocardial blood flow (MBF) was measured at rest and during adenosine infusion in MS subjects (n = 13, MS group) with no definite evidence of heart disease and in subjects without MS (n = 14, non-MS group). Coronary vascular resistance (CVR) was calculated by dividing the mean aortic blood pressure by MBF. Myocardial blood flow reserve (MFR) was calculated as the ratio of the MBF during adenosine infusion to that during rest. Blood chemical parameters were measured to evaluate their relationship with MFR. During adenosine infusion, MBF was lower (p = 0.0085) and CVR higher (p = 0.0128) in the MS group than in the non-MS group and MFR was significantly lower in the MS group than in the non-MS group (2.13 +/- 0.99 vs. 3.38 +/- 0.95, p = 0.0027). Multivariate analysis demonstrated that the homeostasis model assessment-insulin resistance (p < 0.05) and the presence of hypertension (p < 0.05) were independent determinants of MFR. CONCLUSIONS: The results indicate that MFR was impaired in MS subjects, suggesting that an abnormal coronary microvascular response occurred in these subjects. This abnormality may have been partially due to insulin resistance and hypertension.

[Examination of bed overlaps in 18F-FDG PET/CT 3D data acquisition].

The purpose of this study was to determine the best bed overlaps in PET/CT 3D acquisition to reconstruct a transverse image with uniform quality not depending on axial slice position. First, the value of the image contrast ratio, non-uniformity (NU) value, and coefficient of variation (COV) were examined in the image of a cylindrical phantom at each slice position. The image-contrast ratio was almost constant in all slice images, and the NU value and COV were also constant in the slice images up to 13 and 19 slices from the center, respectively, but these values increased with closeness to the edge of the detector. Secondly, COV and image contrast ratios at different sizes of (18)F-FDG concentration (phi 19 mm, phi 16 mm, phi 13 mm, phi 10 mm) were examined in the case of overlapping the bed frame with 11, 15, and 21 slices in acquiring data in 3D mode. In 21 and 15 slices overlapping in acquisition, the image contrast ratios for all concentrations were greater than 0.13, which was the threshold image contrast ratio needed to identify FDG concentration from the background image with naked eye scanning under our conditions. However, in 11 slices with overlapping acquisition, the image-contrast ratio for a phi 10 mm concentration were close to or less than 0.13 in the all slice images. As a result, 15 overlapping slices was a reasonable minimum number of slices to identify a phi 10 mm (18)F-FDG concentration while maintaining the image quality in PET/CT 3D acquisition in our institution.