Image quality characterization of an ultra-high-speed kilovoltage cone-beam computed tomography imaging system on an O-ring linear accelerator.

PURPOSE: The quality of on-board imaging systems, including cone-beam computed tomography (CBCT), plays a vital role in image-guided radiation therapy (IGRT) and adaptive radiotherapy. Recently, there has been an upgrade of the CBCT systems fused in the O-ring linear accelerators called HyperSight, featuring a high imaging performance. As the characterization of a new imaging system is essential, we evaluated the image quality of the HyperSight system by comparing it with Halcyon 3.0 CBCT and providing benchmark data for routine imaging quality assurance. METHODS: The HyperSight features ultra-fast scan time, a larger kilovoltage (kV) detector, a more substantial kV tube, and an advanced reconstruction algorithm. Imaging protocols in the two modes of operation, treatment mode with IGRT and the CBCT for planning (CBCTp) mode were evaluated and compared with Halcyon 3.0 CBCT. Image quality metrics, including spatial resolution, contrast resolution, uniformity, noise, computed tomography (CT) number linearity, and calibration error, were assessed using a Catphan and an electron density phantom and analyzed with TotalQA software. RESULTS: HyperSight demonstrated substantial improvements in contrast-to-noise ratio and noise in both IGRT and CBCTp modes compared to Halcyon 3.0 CBCT. CT number calibration error of HyperSight CBCTp mode (1.06%) closely matches that of a full CT scanner (0.72%), making it suitable for adaptive planning. In addition, the advanced hardware of HyperSight, such as ultra-fast scan time (5.9 s) or 2.5 times larger heat unit capacity, enhanced the clinical efficiency in our experience. CONCLUSIONS: HyperSight represented a significant advancement in CBCT imaging. With its image quality, CT number accuracy, and ultra-fast scans, HyperSight has a potential to transform patient care and treatment outcomes. The enhanced scan speed and image quality of HyperSight are expected to significantly improve the quality and efficiency of treatment, particularly benefiting patients.

Bioactivities of Phenolic Compounds from Kiwifruit and Persimmon.

Fruit used in the common human diet in general, and kiwifruit and persimmon particularly, displays health properties in the prevention of heart disease. This study describes a combination of bioactivity, multivariate data analyses and fluorescence measurements for the differentiating of kiwifruit and persimmon, their quenching and antioxidant properties. The metabolic differences are shown, as well in the results of bioactivities and antioxidant capacities determined by ABTS, FRAP, CUPRAC and DPPH assays. To complement the bioactivity of these fruits, the quenching properties between extracted polyphenols and human serum proteins were determined by 3D-fluorescence spectroscopy studies. These properties of the extracted polyphenols in interaction with the main serum proteins in the human metabolism (human serum albumin (HSA), α-ß-globulin (α-ß G) and fibrinogen (Fgn)), showed that kiwifruit was more reactive than persimmon. There was a direct correlation between the quenching properties of the polyphenols of the investigated fruits with serum human proteins, their relative quantification and bioactivity. The results of metabolites and fluorescence quenching show that these fruits possess multiple properties that have a great potential to be used in industry with emphasis on the formulation of functional foods and in the pharmaceutical industry. Based on the quenching properties of human serum proteins with polyphenols and recent reports in vivo on human studies, we hypothesize that HSA, α-ß G and Fgn will be predictors of coronary artery disease (CAD).

Surface guided motion management in glottic larynx stereotactic body radiation therapy.

BACKGROUND AND PURPOSE: Involuntary motion due to swallowing cause inaccurate dose delivery during larynx radiotherapy, a deviation that may be particularly problematic during stereotactic body radiation therapy (SBRT). The goal of this study was to develop a motion management solution for larynx SBRT using surface imaging. MATERIAL AND METHODS: Ten patients were recently treated on a phase II study of larynx SBRT on a LINAC equipped with a surface guidance system. A small region of the immobilization mask was manually cut open to allow surface tracking. Pre-treatment and intra-fractional CBCTs were acquired to verify internal anatomy. Patients were verbally instructed not to swallow during treatment. During treatment delivery, beam hold was initiated by the Motion Management Interface if surface motion exceeded a patient-specific threshold. Patient motion was recorded in log files and analyzed. We also performed phantom studies to assess the theoretical impact of gating on dose delivery. RESULTS: The frequency (6.5 ± 5.2 times per fraction) and duration (3.9 ± 2.5 seconds per swallow) of swallowing varied both between patients and fractions. The magnitude of each swallow showed mean peak amplitude at 5.8 ± 3.8 mm above baseline, mostly in the longitudinal direction. Beam duty cycle was 95.0% ± 7.0% (absolute range: 76-100%), with inefficiency most prominent in the early fractions. The 95th percentile residual motion was reduced from 3.4 mm to 2.3 mm with both verbal instruction and gating. Phantom studies confirmed dose delivery accuracy represented by gamma pass rate was improved by 5% using this approach. CONCLUSIONS: Laryngeal motion management using surface imaging is feasible and efficacious. Uncontrolled movement of the larynx was not uncommon during treatment, with gating reducing potential for unplanned dose deviations. Additional research is needed to determine the clinical benefit with this system.

Evaluation of an a priori scatter correction algorithm for cone-beam computed tomography based range and dose calculations in proton therapy.

BACKGROUND AND PURPOSE: Scatter correction of cone-beam computed tomography (CBCT) projections may enable accurate online dose-delivery estimations in photon and proton-based radiotherapy. This study aimed to evaluate the impact of scatter correction in CBCT-based proton range/dose calculations, in scans acquired in both proton and photon gantries. MATERIAL AND METHODS: CBCT projections of a Catphan and an Alderson phantom were acquired on both a proton and a photon gantry. The scatter corrected CBCTs (corrCBCTs) and the clinical reconstructions (stdCBCTs) were compared against CTs rigidly registered to the CBCTs (rigidCTs). The CBCTs of the Catphan phantom were segmented by materials for CT number analysis. Water equivalent path length (WEPL) maps were calculated through the Alderson phantom while proton plans optimized on the rigidCT and recalculated on all CBCTs were compared in a gamma analysis. RESULTS: In medium and high-density materials, the corrCBCT CT numbers were much closer to those of the rigidCT than the stdCBCTs. E.g. in the 50% bone segmentations the differences were reduced from above 300 HU (with stdCBCT) to around 60-70 HU (with corrCBCT). Differences in WEPL from the rigidCT were typically well below 5 mm for the corrCBCTs, compared to well above 10 mm for the stdCBCTs with the largest deviations in the head and thorax regions. Gamma pass rates (2%/2mm) when comparing CBCT-based dose re-calculations to rigidCT calculations were improved from around 80% (with stdCBCT) to mostly above 90% (with corrCBCT). CONCLUSION: Scatter correction leads to substantial artefact reductions, improving accuracy of CBCT-based proton range/dose calculations.

Beam angle optimization using angular dependency of range variation assessed via water equivalent path length (WEPL) calculation for head and neck proton therapy.

PURPOSE: To investigate angular sensitivity of proton range variation due to anatomic change in patients and patient setup error via water equivalent path length (WEPL) calculations. METHODS: Proton range was estimated by calculating WEPL to the distal edge of target volume using planning CT (pCT) and weekly scatter-corrected cone-beam CT (CBCT) images of 11 head and neck patients. Range variation was estimated as the difference between the distal WEPLs calculated on pCT and scatter-corrected CBCT (cCBCT). This WEPL analysis was performed every five degrees ipsilaterally to the target. Statistics of the distal WEPL difference were calculated over the distal area to compare between different beam angles. Physician-defined contours were used for the WEPL calculation on both pCT and cCBCT, not considering local deformation of target volume. It was also tested if a couch kick (10°) can mitigate the range variation due to anatomic change and patient setup error. RESULTS: For most of the patients considered, median, 75% quantile, and 95% quantile of the distal WEPL difference were largest for posterior oblique angles, indicating a higher chance of overdosing normal tissues at distal edge with these angles. Using a couch kick resulted in decrease in the WEPL difference for some posterior oblique angles. CONCLUSIONS: It was demonstrated that the WEPL change has angular dependency for the cohort of head and neck cancer patients. Selecting beam configuration robust to anatomic change in patient and patient setup error may improve the treatment outcome of head and neck proton therapy.

Microstructural Control for Characteristics of Biomedical Ti-39Nb-6Zr-0.45Al Alloy.

Ti-39Nb-6Zr-0.45Al alloy was developed for biological applications as exchangeable hard tissue. This alloy has very low elastic modulus, but lower strength than Ti-6Al-4V alloy. This study was performed for improving the strength by various heat treatments and microstructural characteristics and mechanical properties of Ti-39Nb-6Zr-0.45Al alloy were investigated. Heat treatments were conducted at 350 °C, 400 °C, 450 °C, 500 °C, 550 °C and 600 °C, followed by water quenching. Microstructures of Ti-39Nb-6Zr-0.45Al alloy showed two types of different features. One of the features was not visible for grains at low temperature heat conditions (350 °C, 400 °C and 450 °C), because of the effect of cold swaging. On the contrast, at high temperature conditions (500 °C, 550 °C and 600 °C), the grains were visible. Tensile properties had similar tendency to hardness properties under all low temperature conditions. The samples showed high strength and low elongation under low temperatures, but showed the opposite results under high temperature conditions. These results were due to thermal ω phases and secondary α phases inside the matrix of this alloy. ω phases, which were precipitated under low temperature heat treatments, induce high strength and low elongation. In case of high temperature conditions, ω phases disappeared into the matrix and secondary α phases with fine size appeared. γoung's moduli of the samples under all the conditions were lower (about 60 GPa) than those of the as-swaged (about 70 GPa). Consequently, the heattreated Ti-39Nb-6Zr-0.45Al alloy had high strength and very low elastic modulus for biomedical applications.

Kilovoltage projection streaming-based tracking application (KiPSTA): First clinical implementation during spine stereotactic radiation surgery.

PURPOSE: This study aimed to develop a linac-mounted kilovoltage (kV) projection streaming-based tracking method for vertebral targets during spine stereotactic radiation surgery and evaluate the clinical feasibility of the proposed spine tracking method. METHODS AND MATERIALS: Using real-time kV projection streaming within XVI (Elekta XVI), kV-projection-based tracking was applied to the target vertebral bodies. Two-dimensional in-plane patient translation was calculated via an image registration between digitally reconstructed radiographs (DRRs) and kV projections. DRR was generated from the cone beam computed tomography (CBCT) scan, which was obtained immediately before the tracking session. During a tracking session, each kV projection was streamed for an intensity gradient-based image with similar metric-based registration to the offset DRR. The ground truth displacement for each kV beam angle was calculated at the beam isocenter using the 6 degrees-of-freedom transformation that was obtained by a CBCT-CBCT rigid registration. The resulting translation by the DRR-projection registration was compared with the ground truth displacement. The proposed tracking method was evaluated retrospectively and online, using 7 and 5 spine patients, respectively. RESULTS: The accuracy and precision of spine tracking for in-plane patient motion were 0.5 ± 0.2 and 0.2 ± 0.1 mm. The magnitude of patient motion that was estimated using the CBCT-CBCT rigid registration was (0.5 ± 0.4, 0.4 ± 0.3, 0.3 ± 0.3) mm and (0.3 ± 0.4, 0.2 ± 0.2, 0.5 ± 0.6) mm for all tracking sessions. The intrafraction motion was within 2 mm for all CBCT scans considered. CONCLUSIONS: This study demonstrated that the proposed spine tracking method can track intrafraction motion with sub-millimeter accuracy and precision, and sub-second latency.

A Mobile Outside-in Technique of Transforaminal Lumbar Endoscopy for Lumbar Disc Herniations.

Percutaneous endoscopic transforaminal lumbar discectomy (PETLD) has now become a standard of care for the management of lumbar disc disease. There are two techniques for the introduction of a working cannula with respect to disc-outside-in and inside-out. The aim of this prospective study is to describe the technical aspects of a novel mobile outside-in method in dealing with different types of disc prolapse. A total of 184 consecutive patients with unilateral lower limb radiculopathy due to lumbar disc prolapse were operated on with the mobile outside-in technique of PETLD. Their clinical outcomes were evaluated based on the type of disc prolapse they had, a visual analog scale (VAS) leg pain score, the Oswestry Disability Index (ODI), and the Macnab criteria. The completeness of the decompression was documented with a postoperative magnetic resonance imaging. The mean age of the patients was 50 ± 16 years and the male/female ratio was 2:1. The mean follow-up was 19 ± 6 months. A total of 190 lumbar levels were operated on (L1-L2: n = 4, L2-L3: n = 17, L3-L4: n = 27, L4-5: n = 123, and L5-S1: n = 19). Divided into types, the patient distribution was central: n = 14, paracentral: n = 74, foraminal: n = 28, far lateral: n = 13, superior-migrated: n = 8, inferior migrated: n = 38, and high canal compromise: n = 9. The mean operative time was 35 ± 12 (25 - 56) min and the mean hospital stay was 1.2 ± 0.5 (1-3) days. The VAS score for leg pain improved from 7.5 ± 1 to 1.7 ± 0.9. The ODI improved from 70 ± 8.3 to 23 ± 5. According to the Macnab criteria, 75 patients (40.8%) had excellent results, 104 patients (56.5%) had good results, and 5 patients (2.7%) had fair results. Recurrence (including early and late) was seen in 15 out of the 190 levels that were operated on (7.89%). This article presents a novel outside-in approach that relies on a precise landing within the foramen in a mobile manner and does not solely depend upon the enlargement of the foramen. It is more versatile in application and useful in the management of all types of disc prolapse, even in severe canal compromise and high migration.

1H NMR and antioxidant profiles of polar and non-polar extracts of persimmon (Diospyros kaki L.) - Metabolomics study based on cultivars and origins.

Persimmon (Diospyros kaki L.) is one of the most important fruits that has been consumed for its medicinal properties due to the presence of some active metabolites, particularly polyphenols and carotenoids. Previously described methods, including HPLC, were limited in the determination of metabolites in different persimmon varieties. The present study shows the evaluation and the differences among persimmon polar and non-polar extracts by 1H NMR-based metabolomics approach. The hierarchical clustering analysis (HCA) based on score values of principal component analysis (PCA) model was used to analyze the important compounds in investigated fruits. The 1H NMR spectrum of persimmon chloroform (CDCl3) extracts showed different types of compounds as compared to polar methanol-water (CD3OD-D2O) ones. Persimmons growing in Israel were clustered different from those growing in Korea with the abundance of phenolic compounds (gallic, caffeic and protocathecuic acids), carotenoids (ß-cryptoxanthin, lutein, and zeaxanthin), amino acids (alanine), maltose, uridine, and fatty acids (myristic and palmitoleic acids). Glucose, choline and formic acid were more prominent in persimmon growing in Korea. In CD3OD-D2O and CDCl3 persimmon extracts, 43 metabolites were identified. The metabolic differences were shown as well on the results of bioactivities and antioxidant capacities determined by ABTS, FRAP, CUPRAC and DPPH assays. The presented methods can be widely used for quantitation of multiple compounds in many plant and biological samples especially in vegetables and fruits.

Short-term microcurrent electrical neuromuscular stimulation to improve muscle function in the elderly: A randomized, double-blinded, sham-controlled clinical trial.

BACKGROUND: Microcurrent electrical neuromuscular stimulation (MENS) has been suggested to improve muscle function and restore damaged muscle. However, current evidence is insufficient to determine the effectiveness of this therapy in age-dependent muscle weakness. Therefore, a prospective, randomized, double-blinded, sham-controlled clinical trial was designed to evaluate the effects of short-term MENS on muscle function in the elderly. METHODS: A total of 38 healthy elderly participants aged 65 years and above were enrolled and randomly divided into 2 stimulation groups: real or sham MENS group. Real or sham MENS were applied to the 8 anatomical points of the dominant arm and leg during the course of 40 minutes. We performed muscle function tests at baseline and after the intervention: the handgrip strength tests (HGS, kg), the root mean square values (RMS, µV), and the single leg heel-rise tests (HRT) to determine changes in the strength, activity, and endurance of the elderly muscle, respectively. RESULTS: In the real MENS group, the mean values of the HGS and the number of plantar flexions were significantly increased, but the RMS value of the electromyography signal was significantly decreased after the real intervention (P < .05). However, the sham MENS group showed a significant decrease in the number of plantar flexions and the total time for HRT after the sham stimulation (P < .05). The mean difference in the RMS value was significantly lower, but the number of plantar flexions and the total time for HRT was significantly higher in the real MENS group than in the sham MENS group (P < .05). CONCLUSION: The findings suggest that short-term application of MENS may play a partial role in enhancing physical activities of the elderly, as it can improve some muscle function.

Water equivalent path length calculations using scatter-corrected head and neck CBCT images to evaluate patients for adaptive proton therapy.

Proton therapy has dosimetric advantages due to the well-defined range of the proton beam over photon radiotherapy. When the proton beams, however, are delivered to the patient in fractionated radiation treatment, the treatment outcome is affected by delivery uncertainties such as anatomic change in the patient and daily patient setup error. This study aims at establishing a method to evaluate the dosimetric impact of the anatomic change and patient setup error during head and neck proton therapy. Range variations due to the delivery uncertainties were assessed by calculating water equivalent path length (WEPL) to the distal edge of tumor volume using planning CT and weekly treatment cone-beam CT (CBCT) images. Specifically, mean difference and root mean squared deviation (RMSD) of the distal WEPLs were calculated as the weekly range variations. To accurately calculate the distal WEPLs, an existing CBCT scatter correction algorithm was used. An automatic rigid registration was used to align the planning CT and treatment CBCT images, simulating a six degree-of-freedom couch correction at treatments. The authors conclude that the dosimetric impact of the anatomic change and patient setup error was reasonably captured in the differences of the distal WEPL variation with a range calculation uncertainty of 2%. The proposed method to calculate the distal WEPL using the scatter-corrected CBCT images can be an essential tool to decide the necessity of re-planning in adaptive proton therapy.

Investigating deformable image registration and scatter correction for CBCT-based dose calculation in adaptive IMPT.

PURPOSE: This work aims at investigating intensity corrected cone-beam x-ray computed tomography (CBCT) images for accurate dose calculation in adaptive intensity modulated proton therapy (IMPT) for prostate and head and neck (H&N) cancer. A deformable image registration (DIR)-based method and a scatter correction approach using the image data obtained from DIR as prior are characterized and compared on the basis of the same clinical patient cohort for the first time. METHODS: Planning CT (pCT) and daily CBCT data (reconstructed images and measured projections) of four H&N and four prostate cancer patients have been considered in this study. A previously validated Morphons algorithm was used for DIR of the planning CT to the current CBCT image, yielding a so-called virtual CT (vCT). For the first time, this approach was translated from H&N to prostate cancer cases in the scope of proton therapy. The warped pCT images were also used as prior for scatter correction of the CBCT projections for both tumor sites. Single field uniform dose and IMPT (only for H&N cases) treatment plans have been generated with a research version of a commercial planning system. Dose calculations on vCT and scatter corrected CBCT (CBCTcor) were compared by means of the proton range and a gamma-index analysis. For the H&N cases, an additional diagnostic replanning CT (rpCT) acquired within three days of the CBCT served as additional reference. For the prostate patients, a comprehensive contour comparison of CBCT and vCT, using a trained physician's delineation, was performed. RESULTS: A high agreement of vCT and CBCTcor was found in terms of the proton range and gamma-index analysis. For all patients and indications between 95% and 100% of the proton dose profiles in beam's eye view showed a range agreement of better than 3 mm. The pass rate in a (2%,2 mm) gamma-comparison was between 96% and 100%. For H&N patients, an equivalent agreement of vCT and CBCTcor to the reference rpCT was observed. However, for the prostate cases, an insufficient accuracy of the vCT contours retrieved from DIR was found, while the CBCTcor contours showed very high agreement to the contours delineated on the raw CBCT. CONCLUSIONS: For H&N patients, no considerable differences of vCT and CBCTcor were found. For prostate cases, despite the high dosimetric agreement, the DIR yields incorrect contours, probably due to the more pronounced anatomical changes in the abdomen and the reduced soft-tissue contrast in the CBCT. Using the vCT as prior, these inaccuracies can be overcome and images suitable for accurate delineation and dose calculation in CBCT-based adaptive IMPT can be retrieved from scatter correction of the CBCT projections.

Impact of Cultivation Conditions, Ethylene Treatment, and Postharvest Storage on Selected Quality and Bioactivity Parameters of Kiwifruit "Hayward" Evaluated by Analytical and Chemometric Methods.

Organic, semiorganic, and conventional "Hayward" kiwifruits, treated with ethylene for 24 h and stored during 10 days, were assessed by UV spectrometry, fluorometry, and chemometrical analysis for changes in selected characteristics of quality (firmness, dry matter and soluble solid contents, pH, and acidity) and bioactivity (concentration of polyphenols via Folin-Ciocalteu and p-hydroxybenzoic acid assays). All of the monitored qualitative parameters and characteristics related to bioactivity were affected either by cultivation practices or by ethylene treatment and storage. Results obtained, supported by statistical evaluation (Friedman two-way ANOVA) and chemometric analysis, clearly proved that the most significant impact on the majority of the evaluated parameters of quality and bioactivity of "Hayward" kiwifruit had the ethylene treatment followed by the cultivation practices and the postharvest storage. Total concentration of polyphenols expressed via p-hydroxybenzoic acid assay exhibited the most significant sensitivity to all three evaluated parameters, reaching a 16.5% increase for fresh organic compared to a conventional control sample. As a result of postharvest storage coupled with ethylene treatment, the difference increased to 26.3%. Three-dimensional fluorescence showed differences in the position of the main peaks and their fluorescence intensity for conventional, semiorganic, and organic kiwifruits in comparison with ethylene nontreated samples.

Investigation of cone-beam CT image quality trade-off for image-guided radiation therapy.

It is well-known that projections acquired over an angular range slightly over 180° (so-called short scan) are sufficient for fan-beam reconstruction. However, due to practical imaging conditions (projection data and reconstruction image discretization, physical factors, and data noise), the short-scan reconstructions may have different appearances and properties from the full-scan (scans over 360°) reconstructions. Nevertheless, short-scan configurations have been used in applications such as cone-beam CT (CBCT) for head-neck-cancer image-guided radiation therapy (IGRT) that only requires a small field of view due to the potential reduced imaging time and dose. In this work, we studied the image quality trade-off for full, short, and full/short scan configurations with both conventional filtered-backprojection (FBP) reconstruction and iterative reconstruction algorithms based on total-variation (TV) minimization for head-neck-cancer IGRT. Anthropomorphic and Catphan phantoms were scanned at different exposure levels with a clinical scanner used in IGRT. Both visualization- and numerical-metric-based evaluation studies were performed. The results indicate that the optimal exposure level and number of views are in the middle range for both FBP and TV-based iterative algorithms and the optimization is object-dependent and task-dependent. The optimal view numbers decrease with the total exposure levels for both FBP and TV-based algorithms. The results also indicate there are slight differences between FBP and TV-based iterative algorithms for the image quality trade-off: FBP seems to be more in favor of larger number of views while the TV-based algorithm is more robust to different data conditions (number of views and exposure levels) than the FBP algorithm. The studies can provide a general guideline for image-quality optimization for CBCT used in IGRT and other applications.

Gain Correction for an X-ray Imaging System With a Movable Flat Panel Detector and Intrinsic Localization Crosshair.

Gain calibration for X-ray imaging systems with a movable flat panel detector and an intrinsic crosshair is a challenge due to the geometry-dependent heel effect and crosshair artifact. This study aims to develop a gain correction method for such systems by implementing the Multi-Acquisition Gain Image Correction technique. Flood field images containing crosshair and heel effect were acquired in 4 different flat panel detector positions at fixed exposure parameters. The crosshair region was automatically detected using common image processing algorithms and removed by a simple interpolation procedure, resulting in a crosshair-removed image. A large kernel-based correction was then used to remove the heel effect. Mask filters corresponding to each crosshair region were applied to the resultant heel effect-removed images to invalidate the pixels of the original crosshair region. Finally, a seamless gain map was composed with corresponding valid pixels from the processed images either by the sequential replacement or by the selective averaging techniques developed in this study. Quantitative evaluation was performed based on normalized noise power spectrum and detective quantum efficiency improvement factor for the flood field images corrected by the Multi-Acquisition Gain Image Correction-based gain maps. For comparison purposes, a single crosshair-removed gain map was also tested. As a result, it was demonstrated that the Multi-Acquisition Gain Image Correction technique achieved better image quality than the crosshair-removed technique, showing lower normalized noise power spectrum values over most of spatial frequencies. The improvement was more obvious at the priori-crosshair region of the gain map. The mean detective quantum efficiency improvement factor was 1.09 ± 0.06, 2.46 ± 0.32, and 3.34 ± 0.36 in the priori-crosshair region and 2.35 ± 0.31, 2.33 ± 0.31, and 3.09 ± 0.34 in the normal region, for crosshair-removed, Multi-Acquisition Gain Image Correction-sequential replacement, and Multi-Acquisition Gain Image Correction-selective averaging techniques, respectively. Therefore, this study indicates that the introduced Multi-Acquisition Gain Image Correction technique is an appropriate method for gain calibration of an imaging system associated with a moving flat panel detector and an intrinsic crosshair.

Antihypertensive Effects of Artemisia scoparia Waldst in Spontaneously Hypertensive Rats and Identification of Angiotensin I Converting Enzyme Inhibitors.

We investigated the antihypertensive effects of Artemisia scoparia (AS) in spontaneously hypertensive rats (SHR). The rats were fed diets containing 2% (w/w) hot water extracts of AS aerial parts for 6 weeks. The AS group had significantly lower systolic and diastolic blood pressure levels than the control group. The AS group also had lower angiotensin I converting enzyme (ACE) activity and angiotensin II content in serum compared to the control group. The AS group showed higher vascular endothelial growth factor and lower ras homolog gene family member A expression levels in kidney compared to the control group. The AS group had significantly lower levels of plasma lipid oxidation and protein carbonyls than the control group. One new and six known compounds were isolated from AS by guided purification. The new compound was determined to be 4'-O-ß-D-glucopyranoyl (E)-4-hydroxy-3-methylbut-2-enyl benzoate, based on its nuclear magnetic resonance and electrospray ionization-mass spectroscopy data.

Proton dose calculation on scatter-corrected CBCT image: Feasibility study for adaptive proton therapy.

PURPOSE: To demonstrate the feasibility of proton dose calculation on scatter-corrected cone-beam computed tomographic (CBCT) images for the purpose of adaptive proton therapy. METHODS: CBCT projection images were acquired from anthropomorphic phantoms and a prostate patient using an on-board imaging system of an Elekta infinity linear accelerator. Two previously introduced techniques were used to correct the scattered x-rays in the raw projection images: uniform scatter correction (CBCTus) and a priori CT-based scatter correction (CBCTap). CBCT images were reconstructed using a standard FDK algorithm and GPU-based reconstruction toolkit. Soft tissue ROI-based HU shifting was used to improve HU accuracy of the uncorrected CBCT images and CBCTus, while no HU change was applied to the CBCTap. The degree of equivalence of the corrected CBCT images with respect to the reference CT image (CTref) was evaluated by using angular profiles of water equivalent path length (WEPL) and passively scattered proton treatment plans. The CBCTap was further evaluated in more realistic scenarios such as rectal filling and weight loss to assess the effect of mismatched prior information on the corrected images. RESULTS: The uncorrected CBCT and CBCTus images demonstrated substantial WEPL discrepancies (7.3 ± 5.3 mm and 11.1 ± 6.6 mm, respectively) with respect to the CTref, while the CBCTap images showed substantially reduced WEPL errors (2.4 ± 2.0 mm). Similarly, the CBCTap-based treatment plans demonstrated a high pass rate (96.0% ± 2.5% in 2 mm/2% criteria) in a 3D gamma analysis. CONCLUSIONS: A priori CT-based scatter correction technique was shown to be promising for adaptive proton therapy, as it achieved equivalent proton dose distributions and water equivalent path lengths compared to those of a reference CT in a selection of anthropomorphic phantoms.

Multileaf collimator tongue-and-groove effect on depth and off-axis doses: a comparison of treatment planning data with measurements and Monte Carlo calculations.

To investigate how accurately treatment planning systems (TPSs) account for the tongue-and-groove (TG) effect, Monte Carlo (MC) simulations and radiochromic film (RCF) measurements were performed for comparison with TPS results. Two commercial TPSs computed the TG effect for Varian Millennium 120 multileaf collimator (MLC). The TG effect on off-axis dose profile at 3 depths of solid water was estimated as the maximum depth and the full width at half maximum (FWHM) of the dose dip at an interleaf position. When compared with the off-axis dose of open field, the maximum depth of the dose dip for MC and RCF ranged from 10.1% to 20.6%; the maximum depth of the dose dip gradually decreased by up to 8.7% with increasing depths of 1.5 to 10cm and also by up to 4.1% with increasing off-axis distances of 0 to 13cm. However, TPS results showed at most a 2.7% decrease for the same depth range and a negligible variation for the same off-axis distances. The FWHM of the dose dip was approximately 0.19cm for MC and 0.17cm for RCF, but 0.30cm for Eclipse TPS and 0.45cm for Pinnacle TPS. Accordingly, the integrated value of TG dose dip for TPS was larger than that for MC and RCF and almost invariant along the depths and off-axis distances. We concluded that the TG dependence on depth and off-axis doses shown in the MC and RCF results could not be appropriately modeled by the TPS versions in this study.

In vitro antioxidative and binding properties of phenolics in traditional, citrus and exotic fruits.

Many polyphenols bind proteins, therefore our research was focused on the potential of protein binding to polyphenols of investigated fruits and their health-related effects. The contents of polyphenols and related antioxidant activities of traditional, citrus and exotic fruits were compared. The presence of polyphenols (flavonoids and phenolic acids) in the investigated samples and their interaction with human serum albumin (HSA) was studied by HPLC, Fourier Transform Infrared (FT-IR) and three dimensional fluorescence spectroscopy (3D-FL). The highest levels of polyphenols, antioxidant and binding capacities were found in red and blond grapefruits (citrus group), followed by strawberries and apples (traditional group) and mangosteen and kiwi fruit (exotic fruit), which also contained the highest levels of protocatechuic, p-coumaric, ferulic acids and quercetin. In conclusion, for the first time, the interaction of the polyphenols with human serum albumin was evaluated by fluorometry/FTIR. The obtained binding profiles allowed the comparison of three different groups of fruits. A mixture of these fruits can be recommended for consumption.

Incidence, impact, and risk factors of adverse events in thoracic and lumbar spine fractures: an ambispective cohort analysis of 390 patients.

BACKGROUND CONTEXT: Adverse events (AEs) in thoracic and lumbar spine fractures are common, but little is known about the type of AEs that are specific to this population. Furthermore, very little is known about the incidence and clinical impact of these AEs on patients in the presence of traumatic spinal cord injury and whether they are treated operatively or nonoperatively. PURPOSE: The purpose of this study was to determine primarily the incidence of AEs in patients with thoracic or lumbar spine fractures treated both operatively and nonoperatively and their impact on length of stay (LOS) and secondarily the difference in the incidence of AEs in both neurologically intact and compromised patients. STUDY DESIGN/SETTING: This is an ambispective cohort study at a quaternary referral center. PATIENT SAMPLE: Patients admitted at our institution with thoracic or lumbar fractures from January 2009 to December 2013 were identified. Patients with full Spine Adverse Events Severity System (SAVES) data were included. OUTCOME MEASURES: Number and type of AEs collected from SAVES were assessed. Impact of AE on acute LOS was also determined. METHODS: Data on intraoperative, preoperative, and postoperative AEs were prospectively collected using the SAVES data collection. Logistic regression was used to model the likelihood of experiencing at least one AE based on the patient characteristics. The impact of the total number of AEs experienced by a patient and that of each of the most common AEs on LOS was determined using Poisson regression. RESULTS: Three hundred and ninety patients were included in the final analysis. Two hundred and seventy-six patients (70.8%) were treated operatively. One hundred and forty patients (36%) experienced neurologic deficit as a result of their initial injury. Adverse events occurred 56% of the time in the operatively treated patients and only 13% of the time in the nonoperative group. The presence of neurologic deficit increased the risk of AEs especially in high thoracic (T1-T6) trauma increasing the odds of having an AE by 12.1 (p<.0001). The most common AEs were urinary tract infections (19.7%), neuropathic pain (12.3%), pneumonias (11.8%), delirium (10.5%), and ileus (6.2%). Length of hospital stay increased significantly with pneumonia (p<.0001) and delirium (p=.0001). CONCLUSIONS: The presence of neurologic injury and the need for operative fixation of thoracic or lumbar injuries lead to a greater risk of AEs. Only pneumonia and delirium consistently increase LOS.