Technical Note: Radiation properties of tissue- and water-equivalent materials formulated using the stoichiometric analysis method in charged particle therapy.

PURPOSE: Five tissue- and water-equivalent materials (TEMs) mimicking ICRU real tissues have been formulated using a previously established stoichiometric analysis method (SAM) to be applied in charged particle therapy. The purpose of this study was an experimental verification of the TEMs-SAM against charged particle beam measurements and for different computed tomography (CT) scanners. The potential of the TEMs-SAM to be employed in the dosimetry was also investigated. METHODS: Experimental verification with three CT scanners was carried out to validate the calculated Hounsfield units (HUs) of the TEMs. Water-equivalent path lengths (WEPLs) of the TEMs for proton (106.8 MeV/u), helium (107.93 MeV/u), and carbon (200.3 MeV/u) ions were measured to be compared with the computed relative stopping powers. HU calibration curves were also generated. RESULTS: Differences between the measured HUs of the TEMs and the calculated HUs of the ICRU real tissues for all CT scanners were smaller than 4 HU except for the skeletal tissues which deviated up to 21 HU. The measured WEPLs verified the calculated WEPLs of the TEMs (maximum deviation was 0.17 mm) and were in good agreement with the calculated WEPLs of the ICRU real tissues (maximum deviation was 0.23 mm). Moreover, the relative stopping powers converted from the measured WEPLs differed less than 0.8% and 1.3% from the calculated values of the SAM and the ICRU, respectively. Regarding the relative nonelastic cross section per unit of volume for 200 MeV protons, the ICRU real tissues were generally well represented by the TEMs except for adipose which differed 3.8%. Further, the HU calibration curves yielded the mean and the standard deviation of the errors not larger than 0.5% and 1.9%, respectively. CONCLUSIONS: The results of this investigation implied the potential of the TEMs formulated using the SAM to be employed for both, beam dosimetry and HU calibration in charged particle therapy.

Fourier power spectrum characteristics of face photographs: attractiveness perception depends on low-level image properties.

We investigated whether low-level processed image properties that are shared by natural scenes and artworks - but not veridical face photographs - affect the perception of facial attractiveness and age. Specifically, we considered the slope of the radially averaged Fourier power spectrum in a log-log plot. This slope is a measure of the distribution of special frequency power in an image. Images of natural scenes and artworks possess - compared to face images - a relatively shallow slope (i.e., increased high spatial frequency power). Since aesthetic perception might be based on the efficient processing of images with natural scene statistics, we assumed that the perception of facial attractiveness might also be affected by these properties. We calculated Fourier slope and other beauty-associated measurements in face images and correlated them with ratings of attractiveness and age of the depicted persons (Study 1). We found that Fourier slope - in contrast to the other tested image properties - did not predict attractiveness ratings when we controlled for age. In Study 2A, we overlaid face images with random-phase patterns with different statistics. Patterns with a slope similar to those in natural scenes and artworks resulted in lower attractiveness and higher age ratings. In Studies 2B and 2C, we directly manipulated the Fourier slope of face images and found that images with shallower slopes were rated as more attractive. Additionally, attractiveness of unaltered faces was affected by the Fourier slope of a random-phase background (Study 3). Faces in front of backgrounds with statistics similar to natural scenes and faces were rated as more attractive. We conclude that facial attractiveness ratings are affected by specific image properties. An explanation might be the efficient coding hypothesis.

Unprotected left main percutaneous coronary intervention in acute coronary syndromes with extracorporeal life support backup.

Background. Left main PCI is superior to coronary bypass surgery in selected patients. Registry data, however, suggest significant early adverse event rates associated with unprotected left main PCI. We aimed to evaluate safety of an extracorporeal life support (ECLS) as backup system during PCI. Methods. We report a registry study of 16 high-risk patients presenting with acute coronary syndromes undergoing unprotected left main PCI with an ECLS backup. Results. Seven patients (43.8%) presented with an acute myocardial infarction while 9 patients (56.3%) had unstable angina. Unprotected left main PCI could be successfully performed in all 16 patients. Mortality or thromboembolic event rates were zero within the index hospital stay. General anesthesia was necessary only in 5 patients (31.3%). Access site bleeding requiring transfusion was encountered in 4 patients (25.0%). Three patients (18.8%) developed access site complications requiring surgical intervention. All patients were ECLS-free after 96 hours. Conclusions. Unprotected left main PCI could be safely and effectively performed after ECLS implantation as backup in acute coronary syndromes in our patient collectively. Vascular access site complications however need to be considered when applying ECLS as backup system.

Socially anxious individuals discriminate better between angry and neutral faces, particularly when using low spatial frequency information.

BACKGROUND AND OBJECTIVES: Social anxiety is associated with biased processing of threatening faces. Earlier research indicated that socially anxious individuals are biased towards processing low spatial frequency (LSF) information when judging facial expressions. However, it remains unclear whether this bias reflects better performance for LSF-information, worse performance for high spatial frequency (HSF) information that needs to be compensated for, or both. METHODS: To answer this question, we used frequency-filtered neutral and angry face stimuli in a speeded classification task to compare the performance of socially anxious and non-anxious individuals for different spatial frequency bands. RESULTS: Across all spatial frequency bands, socially anxious individuals were faster in judging facial expressions. Importantly, this performance advantage was larger for LSF-filtered stimuli and most pronounced for those stimuli with the lowest frequency band. Analyzing inverse efficiency scores showed the same pattern, ruling out speed-accuracy trade-off differences between groups. LIMITATIONS: The study uses rather artificial (bandpass-filtered) stimuli and is limited towards contrasting the discrimination of neutral and angry faces. Further, only participants with subclinical anxiety were part of the study, so clinical relevance remains to be shown. CONCLUSIONS: Our results show that social anxiety is not characterized by deficits in judging emotions from HSF-information, but by advantages when processing LSF-information.

Intrusive images and voluntary memory for affective pictures: contextualization and dual-task interference.

BACKGROUND AND OBJECTIVES: The present study addressed the role of context information and dual-task interference during the encoding of negative pictures on intrusion development and voluntary recall. METHODS: Healthy participants were shown negative pictures with or without context information. Pictures were either viewed alone or concurrently with a visuospatial or verbal task. Participants reported their intrusive images of the pictures in a diary. At follow-up, perceptual and contextual memory was tested. RESULTS: Participants in the context group reported more intrusive images and perceptual voluntary memory than participants in the no context group. No effects of the concurrent tasks were found on intrusive image frequency, but perceptual and contextual memory was affected according to the cognitive load of the task. LIMITATIONS: The analogue method cannot be generalized to real-life trauma and the secondary tasks may differ in cognitive load. CONCLUSIONS: The findings challenge a dual memory model of PTSD but support an account in which retrieval strategy, rather than encoding processes, accounts for the experience of involuntary versus voluntary recall.

Validating the truth of propositions: behavioral and ERP indicators of truth evaluation processes.

We investigated processes of truth validation during reading. Participants responded to 'true' and 'false' probes after reading simple true or false sentences. Compatible sentence/probe combinations (true/'true', false/'false') facilitated responding compared with incompatible combinations (true/'false', false/'true'), indicating truth validation. Evidence for truth validation was obtained after inducing an evaluative mindset but not after inducing a non-evaluative mindset, using additional intermixed tasks requiring true/false decisions or sentence comparisons, respectively. Event-related potentials revealed an increased late negativity (500-1000 ms after onset of the last word of sentences) for false compared with true sentences. Paralleling behavioral results, this electroencephalographic marker only obtained in the evaluative mindset condition. Further, mere semantic mismatches between subject and object of sentences led to an elevated N400 for both mindset conditions. Taken together, our findings suggest that truth validation is a conditionally automatic process that is dependent on the current task demands and resulting mindset, whereas the processing of word meaning and semantic relations between words proceeds in an unconditionally automatic fashion.

Higher sensitivity for low spatial frequency expressions in social anxiety: evident in indirect but not direct tasks?

We tested whether socially anxious individuals perform better in processing facial information with low spatial frequencies (LSFs). For this, we presented socially anxious and nonanxious participants with hybrid face stimuli that contained independent facial expressions in high (HSF) and LSF bands. In two tasks, participants either rated the images according to "angriness" or had to learn how hybrid facial expressions predicted the location of an upcoming target. We found mostly additive effects of LSF and HSF information in the rating task for both groups. In contrast, socially anxious participants showed better prediction performance for LSF expressions in the implicit learning task. We conclude that socially anxious participants are more sensitive to facial information within LSFs, but this higher sensitivity may become mostly evident in indirect tasks.

A formulation of tissue- and water-equivalent materials using the stoichiometric analysis method for CT-number calibration in radiotherapy treatment planning.

Tissue- and water-equivalent materials (TEMs) are widely used in quality assurance and calibration procedures, both in radiodiagnostics and radiotherapy. In radiotherapy, particularly, the TEMs are often used for computed tomography (CT) number calibration in treatment planning systems. However, currently available TEMs may not be very accurate in the determination of the calibration curves due to their limitation in mimicking radiation characteristics of the corresponding real tissues in both low- and high-energy ranges. Therefore, we are proposing a new formulation of TEMs using a stoichiometric analysis method to obtain TEMs for the calibration purposes. We combined the stoichiometric calibration and the basic data method to compose base materials to develop TEMs matching standard real tissues from ICRU Report 44 and 46. First, the CT numbers of six materials with known elemental compositions were measured to get constants for the stoichiometric calibration. The results of the stoichiometric calibration were used together with the basic data method to formulate new TEMs. These new TEMs were scanned to validate their CT numbers. The electron density and the stopping power calibration curves were also generated. The absolute differences of the measured CT numbers of the new TEMs were less than 4 HU for the soft tissues and less than 22 HU for the bone compared to the ICRU real tissues. Furthermore, the calculated relative electron density and electron and proton stopping powers of the new TEMs differed by less than 2% from the corresponding ICRU real tissues. The new TEMs which were formulated using the proposed technique increase the simplicity of the calibration process and preserve the accuracy of the stoichiometric calibration simultaneously.

Task-irrelevant spider associations affect categorization performance.

In two studies, the Single Target Implicit Association Test (STIAT) was used to investigate automatic associations toward spiders. In both experiments, we measured the strength of associations between pictures of spiders and either threat-related words or pleasant words. Unlike previous studies, we administered a STIAT version in which stimulus contents was task-irrelevant: The target spider pictures were categorized according to the label picture, irrespective of what they showed. In Study 1, spider-fearful individuals versus non-fearful controls were tested, Study 2 compared spider enthusiasts to non-fearful controls. Results revealed that the novel STIAT version was sensitive to group differences in automatic associations toward spiders. In Study 1, it successfully distinguished between spider-fearful individuals and non-fearful controls. Moreover, STIAT scores predicted automatic fear responses best, whereas controlled avoidance behavior was best predicted by the FAS (German translation of the Fear of Spiders Questionnaire). The results of Study 2 demonstrated that the novel STIAT version was also able to differentiate between spider enthusiasts and non-fearful controls.

Face value: eye movements and the evaluation of facial crowds in social anxiety.

Scientific evidence is equivocal on whether Social Anxiety Disorder (SAD) is characterized by a biased negative evaluation of (grouped) facial expressions, even though it is assumed that such a bias plays a crucial role in the maintenance of the disorder. To shed light on the underlying mechanisms of face evaluation in social anxiety, the eye movements of 22 highly socially anxious (SAs) and 21 non-anxious controls (NACs) were recorded while they rated the degree of friendliness of neutral-angry and smiling-angry face combinations. While the Crowd Rating Task data showed no significant differences between SAs and NACs, the resultant eye-movement patterns revealed that SAs, compared to NACs, looked away faster when the face first fixated was angry. Additionally, in SAs the proportion of fixated angry faces was significantly higher than for other expressions. Independent of social anxiety, these fixated angry faces were the best predictor of subsequent affect ratings for either group. Angry faces influence attentional processes such as eye movements in SAs and by doing so reflect biased evaluations. As these processes do not correlate with explicit ratings of faces, however, it remains unclear at what point implicit attentional behaviors lead to anxiety-prone behaviors and the maintenance of SAD. The relevance of these findings is discussed in the light of the current theories.

Effects of adaptive section collimation on patient radiation dose in multisection spiral CT.

PURPOSE: To evaluate the potential effectiveness of adaptive collimation in reducing computed tomographic (CT) radiation dose owing to z-overscanning by using dose measurements and Monte Carlo (MC) dose simulations. MATERIALS AND METHODS: Institutional review board approval was not necessary. Dose profiles were measured with thermoluminescent dosimeters in CT dose index phantoms and in an Alderson-Rando phantom without and with adaptive section collimation for spiral cardiac and chest CT protocols and were compared with the MC simulated dose profiles. Additional dose measurements were performed with an ionization chamber for scan ranges of 5-50 cm and pitch factors of 0.5-1.5. RESULTS: The measured and simulated dose profiles agreed to within 3%. By using adaptive section collimation, a substantial dose reduction of up to 10% was achieved for cardiac and chest CT when measurements were performed free in air and of 7% on average when measurements were performed in phantoms. For scan ranges smaller than 12 cm, ionization chamber measurements and simulations indicated a dose reduction of up to 38%. CONCLUSION: Adaptive section collimation allows substantial reduction of unnecessary exposure owing to z-overscanning in spiral CT. It can be combined in synergy with other means of dose reduction, such as spectral optimization and automatic exposure control.

Social anxiety and anger identification: bubbles reveal differential use of facial information with low spatial frequencies.

We investigated the facial information that socially anxious and nonanxious individuals utilize to judge emotions. Using a reversed-correlation technique, we presented participants with face images that were masked with random bubble patterns. These patterns determined which parts of the face were visible in specific spatial-frequency bands. This masking allowed us to establish which locations and spatial frequencies were helping participants to successfully discriminate angry faces from neutral ones. Although socially anxious individuals performed as well as nonanxious individuals on the emotion-discrimination task, they did not utilize the same facial information for the task. The fine details (high spatial frequencies) around the eyes were discriminative for both groups, but only socially anxious participants additionally processed rough configural information (low spatial frequencies).

Modulation transfer function-based assessment of temporal resolution: validation for single- and dual-source CT.

The purpose of this study was to determine a manufacturer-independent quality assurance measurement for temporal resolution with a three-dimensional cardiac motion robot; validation was with single-source (SS) and dual-source (DS) computed tomography (CT). Image acquisition was performed by using standard cardiac protocols. Image contrast-based modulation transfer function (MTF) was assessed as function of time. For motion frequency of 60 beats per minute, MTF slightly decreased by 14% and 6% for SS CT and DS CT, respectively. For higher frequencies, a stronger decrease of MTF (eg, by 50% [SS CT] and 18% [DS CT] at 120 beats per minute) was detected. Effect of manufacturer's adaptive bisegment algorithm for SS CT and corresponding resonance effects of rotation time and heart rate were quantified. The robot-based approach is a reproducible, objective way to assess temporal resolution; it allows practical measurement of temporal resolution and comparison of CT scanners and protocols.

Concepts for dose determination in flat-detector CT.

Flat-detector computed tomography (FD-CT) scanners provide large irradiation fields of typically 200 mm in the cranio-caudal direction. In consequence, dose assessment according to the current definition of the computed tomography dose index CTDI(L=100 mm), where L is the integration length, would demand larger ionization chambers and phantoms which do not appear practical. We investigated the usefulness of the CTDI concept and practical dosimetry approaches for FD-CT by measurements and Monte Carlo (MC) simulations. An MC simulation tool (ImpactMC, VAMP GmbH, Erlangen, Germany) was used to assess the dose characteristics and was calibrated with measurements of air kerma. For validation purposes measurements were performed on an Axiom Artis C-arm system (Siemens Medical Solutions, Forchheim, Germany) equipped with a flat detector of 40 cm x 30 cm. The dose was assessed for 70 kV and 125 kV in cylindrical PMMA phantoms of 160 mm and 320 mm diameter with a varying phantom length from 150 to 900 mm. MC simulation results were compared to the values obtained with a calibrated ionization chambers of 100 mm and 250 mm length and to thermoluminesence (TLD) dose profiles. The MCs simulations were used to calculate the efficiency of the CTDI(L) determination with respect to the desired CTDI(infinity). Both the MC simulation results and the dose distributions obtained by MC simulation were in very good agreement with the CTDI measurements and with the reference TLD profiles, respectively, to within 5%. Standard CTDI phantoms which have a z-extent of 150 mm underestimate the dose at the center by up to 55%, whereas a z-extent of 600 mm appears to be sufficient for FD-CT; the baseline value of the respective profile was within 1% to the reference baseline. As expected, the measurements with ionization chambers of 100 mm and 250 mm offer a limited accuracy, whereas an increased integration length of 600 mm appeared to be necessary to approximate CTDI(infinity) in within 1%. MC simulations appear to offer a practical and accurate way of assessing conversion factors for arbitrary dosimetry setups using a standard pencil chamber to provide estimates of CTDI(infinity). This would eliminate the need for extra-long phantoms and ionization chambers or excessive amounts of TLDs.

Technical approaches to the optimisation of CT.

This paper reviews current technical approaches to the optimisation of CT practice, i.e. approaches to reduce patient dose to the necessary minimum. The most important step towards this goal appears to be the technology of tube current modulation (TCM), which came into practice in the early 2000s and has become the standard approach recently. Anatomy- or attenuation-based TCM allows for a dose reduction between 10 and 60% as compared to scans with constant tube current. Automatic exposure control (AEC) approaches are the next step; based on TCM technology, AEC adapts the tube current both with the rotation angle alpha (alpha-modulation) and along the z-axis (z-modulation) to achieve a pre-selected image quality level at minimal dose. To pre-select the image quality level, i.e. primarily the pixel noise level, tools for simulation are important to investigate the necessary noise levels pro- and retrospectively for given cases and diagnostic tasks. Respective "dose tutor" approaches have become available recently and are presented. The most recent technical innovation which may lead to substantial dose reduction is the investigation of optimal spectra taking the type of contrast and 3D dose distributions into account. A high potential has been shown especially for pediatric CT and for thoracic CT where dose reduction of a factor of 2 and more is possible when using reduced tube voltages.