Geological sketch map and implications for ice flow of Thwaites Glacier, West Antarctica, from integrated aerogeophysical observations.

The geology beneath Thwaites Glacier, the Antarctic glacial catchment most vulnerable to climate change, is unknown. Thwaites Glacier lies within the West Antarctic Rift System, but details of the subglacial geology relevant to glacial flow, including sediment availability, underlying lithology, and heat flux, are lacking. We present the first sketch map of the subglacial geology of Thwaites Glacier, interpreted from maps of airborne gravity, magnetic and radar data, supported by 2D models and 3D inversion of subsurface properties, and the regional geological context. A zone of Cretaceous mafic magmatism extending ~200 km inland from the coast is interpreted, while sedimentary basins are restricted to a region 150 to 200 km inboard of the coast, underlying just 20% of the catchment. Several granitic subglacial highlands are identified, forming long-lived topographic highs. Our geological interpretation places constraints on the basal properties of Thwaites Glacier, laying the foundation for both improved predictions of ice sheet change and studies of West Antarctic tectonics.

Clinical validation and benchmarking of knowledge-based IMRT and VMAT treatment planning in pelvic anatomy.

PURPOSE: The aim of this work was to determine whether a commercial knowledge-based treatment planning (KBP) module can efficiently produce IMRT and VMAT plans in the pelvic region (prostate & cervical cancer), and to assess sensitivity of plan quality to training data and model parameters. METHODS: Initial benchmarking of KBP was performed using prostate cancer cases. Structures and dose distributions from 40 patients previously treated using a 5-field IMRT technique were used for model training. Two types of model were created: one excluded statistical outliers (as identified by RapidPlan guidelines) and the other had no exclusions. A separate model for cervix uteri cancer cases was subsequently developed using 37 clinical patients treated for cervical cancer using RapidArc™ VMAT, with no exclusions. The resulting models were then used to generate plans for ten patients from each patient group who had not been included in the modelling process. Comparisons of generated RapidPlans with the corresponding clinical plans were carried out to indicate the required modifications to the models. Model parameters were then iteratively adjusted until plan quality converged with that obtained by experienced planners without KBP. RESULTS: Initial automated model generation settings led to poor conformity, coverage and efficiency compared to clinical plans. Therefore a number of changes to the initial KBP models were required. Before model optimisation, it was found that the PTV coverage was slightly reduced in the superior and inferior directions for RapidPlan compared with clinical plans and therefore PTV parameters were adjusted to improve coverage. OAR doses were similar for both RapidPlan and clinical plans (p>0.05). Excluding outliers had little effect on plan quality (p≫0.05). Manually fixing key optimisation objectives enabled production of clinically acceptable treatment plans without further planner intervention for 9 of 10 prostate test patients and all 10 cervix test patients. CONCLUSIONS: The Varian RapidPlan™ system was able to produce IMRT & VMAT treatment plans in the pelvis, in a single optimisation, that had comparable sparing and comparable or better conformity than the original clinically acceptable plans. The system allows for better consistency and efficiency in the treatment planning process and has therefore been adopted clinically within our institute with over 100 patients treated.

Feasibility of using glass-bead thermoluminescent dosimeters for radiotherapy treatment plan verification.

OBJECTIVE: To investigate the feasibility of using glass beads as novel thermoluminescent dosemeters (TLDs) for radiotherapy treatment plan verification. METHODS: Commercially available glass beads with a size of 1-mm thickness and 2-mm diameter were characterized as TLDs. Five clinical treatment plans including a conventional larynx, a conformal prostate, an intensity-modulated radiotherapy (IMRT) prostate and two stereotactic body radiation therapy (SBRT) lung plans were transferred onto a CT scan of a water-equivalent phantom (Solid Water(®), Gammex, Middleton, WI) and the dose distribution recalculated. The number of monitor units was maintained from the clinical plan and delivered accordingly. The doses determined by the glass beads were compared with those measured by a graphite-walled ionization chamber, and the respective expected doses were determined by the treatment-planning system (TPS) calculation. RESULTS: The mean percentage difference between measured dose with the glass beads and TPS was found to be 0.3%, -0.1%, 0.4%, 1.8% and 1.7% for the conventional larynx, conformal prostate, IMRT prostate and each of the SBRT delivery techniques, respectively. The percentage difference between measured dose with the ionization chamber and glass bead was found to be -1.2%, -1.4%, -0.1%, -0.9% and 2.4% for the above-mentioned plans, respectively. The results of measured doses with the glass beads and ionization chamber in comparison with expected doses from the TPS were analysed using a two-sided paired t-test, and there was no significant difference at p < 0.05. CONCLUSION: It is feasible to use glass-bead TLDs as dosemeters in a range of clinical plan verifications. ADVANCES IN KNOWLEDGE: Commercial glass beads are utilized as low-cost novel TLDs for treatment-plan verification.

Volumetric-modulated arc therapy (RapidArc) vs. conventional fixed-field intensity-modulated radiotherapy for ¹8F-FDG-PET-guided dose escalation in oropharyngeal cancer: a planning study.

UNLABELLED: Fluorine-18-fluorodeoxyglucose-positron emission tomography (¹8F-FDG-PET)-guided focal dose escalation in oropharyngeal cancer may potentially improve local control. We evaluated the feasibility of this approach using volumetric-modulated arc therapy (RapidArc) and compared these plans with fixed-field intensity-modulated radiotherapy (IMRT) focal dose escalation plans. MATERIALS AND METHODS: An initial study of 20 patients compared RapidArc with fixed-field IMRT using standard dose prescriptions. From this cohort, 10 were included in a dose escalation planning study. Dose escalation was applied to ¹8F-FDG-PET-positive regions in the primary tumor at dose levels of 5% (DL1), 10% (DL2), and 15% (DL3) above standard radical dose (65 Gy in 30 fractions). Fixed-field IMRT and double-arc RapidArc plans were generated for each dataset. Dose-volume histograms were used for plan evaluation and comparison. The Paddick conformity index (CI(Paddick)) and monitor units (MU) for each plan were recorded and compared. Both IMRT and RapidArc produced clinically acceptable plans and achieved planning objectives for target volumes. Dose conformity was significantly better in the RapidArc plans, with lower CI(Paddick) scores in both primary (PTV1) and elective (PTV2) planning target volumes (largest difference in PTV1 at DL3; 0.81 ± 0.03 [RapidArc] vs. 0.77 ± 0.07 [IMRT], p = 0.04). Maximum dose constraints for spinal cord and brainstem were not exceeded in both RapidArc and IMRT plans, but mean doses were higher with RapidArc (by 2.7 ± 1 Gy for spinal cord and 1.9 ± 1 Gy for brainstem). Contralateral parotid mean dose was lower with RapidArc, which was statistically significant at DL1 (29.0 vs. 29.9 Gy, p = 0.01) and DL2 (29.3 vs. 30.3 Gy, p = 0.03). MU were reduced by 39.8-49.2% with RapidArc (largest difference at DL3, 641 ± 94 vs. 1261 ± 118, p < 0.01). ¹8F-FDG-PET-guided focal dose escalation in oropharyngeal cancer is feasible with RapidArc. Compared with conventional fixed-field IMRT, RapidArc can achieve better dose conformity, improve contralateral parotid sparing, and uses fewer MU.

East Antarctic rifting triggers uplift of the Gamburtsev Mountains.

The Gamburtsev Subglacial Mountains are the least understood tectonic feature on Earth, because they are completely hidden beneath the East Antarctic Ice Sheet. Their high elevation and youthful Alpine topography, combined with their location on the East Antarctic craton, creates a paradox that has puzzled researchers since the mountains were discovered in 1958. The preservation of Alpine topography in the Gamburtsevs may reflect extremely low long-term erosion rates beneath the ice sheet, but the mountains' origin remains problematic. Here we present the first comprehensive view of the crustal architecture and uplift mechanisms for the Gamburtsevs, derived from radar, gravity and magnetic data. The geophysical data define a 2,500-km-long rift system in East Antarctica surrounding the Gamburtsevs, and a thick crustal root beneath the range. We propose that the root formed during the Proterozoic assembly of interior East Antarctica (possibly about 1 Gyr ago), was preserved as in some old orogens and was rejuvenated during much later Permian (roughly 250 Myr ago) and Cretaceous (roughly 100 Myr ago) rifting. Much like East Africa, the interior of East Antarctica is a mosaic of Precambrian provinces affected by rifting processes. Our models show that the combination of rift-flank uplift, root buoyancy and the isostatic response to fluvial and glacial erosion explains the high elevation and relief of the Gamburtsevs. The evolution of the Gamburtsevs demonstrates that rifting and preserved orogenic roots can produce broad regions of high topography in continental interiors without significantly modifying the underlying Precambrian lithosphere.

Transverse femoral implant prominence: four cases demonstrating a preventable complication for ACL reconstruction.

Anterior cruciate ligament (ACL) tear is a commonly occurring injury that often demands surgical reconstruction. Although the utility of this operation is widely accepted, many specific components, including graft fixation technique, remain controversial. Many clinicians favor transverse femoral implant fixation for soft tissue ACL grafts. This technique can be accomplished successfully; however, in a minority of the cases, the femoral implant can be excessively prominent, leading to iatrogenic postoperative iliotibial band syndrome. This article presents 4 patients that developed postoperative iliotibial band syndrome resulting from transverse femoral implant prominence. Despite achievement of knee ligamentous stability, implant prominence compromised final clinical results following ACL reconstruction. Through change in Lysholm value, we reviewed the clinical outcomes of these patients following femoral implant hardware removal for treatment of iliotibial band syndrome. On hardware removal, all patients demonstrated complete symptomatic improvement, mirroring an average Lysholm value increase of 38. We believe transverse femoral implant prominence is avoidable, and subsequent iliotibial band syndrome is a preventable postoperative complication.