Serial 4DCT/4DPET imaging to predict and monitor response for locally-advanced non-small cell lung cancer chemo-radiotherapy.

BACKGROUND AND PURPOSE: A FDG-PET/CT image feature with optimal prognostic potential for locally-advanced non-small cell lung cancer (LA-NSCLC) patients has yet to be identified, and neither has the optimal time for FDG-PET/CT response assessment; furthermore, nodal features have been largely ignored in the literature. We propose to identify image features or imaging time point with maximal prognostic power. MATERIALS AND METHODS: Consecutive consenting patients with LA-NSCLC receiving curative intent CRT were enrolled. 4DPET/4DCT scans were acquired 0, 2, 4, and 7 weeks during IMRT treatment. Eleven image features and their rates of change were recorded for each time point and tested for each of the possible outcome 2 years post CRT using the Kaplan-Meier method. RESULTS: 32 consecutive patients were recruited, 27 completing all scans. Restricting analysis to 4DPET/4DCT features and rates of change with p < 0.005, several volume-based features and their rates of change reached significance. Image features involving nodal disease were the only ones associated with overall survival. CONCLUSIONS: Several 4DPET/CT features and rates of change can reach significant association (p < 0.005) with outcomes, including overall survival, at many time points. The optimal time for adaptive CRT is therefore not constrained uniquely on imaging.

Investigation of two linear accelerator head designs for treating brain metastases with hypofractionated volumetric-modulated arc radiotherapy.

OBJECTIVE: To investigate brain radiation dose in complex cases arising from two stereotactic linear accelerator designs and to present a method for comparing brain dose to published data. METHODS: Two head designs were considered: Beam Modulator (BM) and Agility (AG). 12 patients treated on BM were replanned with AG. Planning objectives were: minimize brain dose and satisfy target coverage and organs at risk dose constraints. Each of the 36 targets was analyzed for conformality index (CI Paddick), gradient index (GI) and homogeneity index (HI). Total volume of tissue receiving 80% (V80) of the prescription dose down to 25% (V25) was evaluated. Similarly the volume of brain minus planning target volume receiving 80% (BMP80) down to 25% (BMP25) was evaluated. The mean brain dose and BMP dose were also evaluated. System differences were statistically evaluated using Wilcoxon signed-rank test. Power-law models for total volume (V) and brain minus planning target volumes (BMP) were generated based on BM data. RESULTS: The median CI Paddick was 0.74 and 0.76 for BM and AG, respectively (p = 0.04). The median GI was 5.5 and 6.1 (p < 0.01) and the median HI was 1.17 and 1.16 for BM and AG, respectively (p < 0.01). Neither V or BMP receiving doses of 80% down to 40% exhibited statistically significant difference between the two systems, whereas the volume of brain minus PTV receiving 25% (BMP25) was weakly different (p = 0.02). AG exhibited a lower mean BMP dose (4.1 Gy) than BM (4.6 Gy) (p < 0.01). Power-law models for V/BMP showed excellent (R(2) > 0.80) agreement for the dose levels studied and comparable results with published data. CONCLUSION: Treatment plans of equivalent quality were attained with AG compared with BM. ADVANCES IN KNOWLEDGE: The AG system involves a novel collimation design. The present article demonstrates equivalent or improved brain dose for complex, multitarget cases using AG vs an older stereotactic system.

Fast B-flow imaging: a method for improving frame rate in Golay coded B-flow imaging.

A technique for Golay coded B-flow imaging, called fast B-flow imaging, has been developed. This technique improves the frame rate of Golay coded B-flow imaging. In this technique, three instead of four input pulses are used to produce each scan line. A standard Golay pulse-pair is used as two of the three inputs, and pulse compression is performed upon receive returning the echoes from stationary (tissue) objects in the image. The third input is a repetition of one of the first two inputs. Upon receive, this pulse is cross correlated with an inverted copy of its input pulse. Addition of the cross-correlated signals produced from the identical input pulses results in the cancellation of the strong tissue echoes, and enables visualization of the weaker/moving blood echoes. Combining a small fraction of the tissue echoes with the weaker blood echoes allows both to be visualized in the same gray scale image. By using three instead of four input pulses, this technique can achieve a frame rate improvement of 33% compared with standard Golay coded B-flow imaging, with some loss in signal-to-noise ratio. The impact of axial and lateral motion on these techniques is examined. A quantitative comparison of both techniques is presented.

Golay pulse encoding for microbubble contrast imaging in ultrasound.

We present a technique that uses Golay phase encoding, pulse inversion, and amplitude modulation (GPIAM) for microbubble contrast agent imaging with ultrasound. This technique improves the contrast-to-tissue ratio (CTR) by increasing the time-bandwidth product of the insonating waveforms. A nonlinear pulse compression algorithm is used to compress the signal energy upon receive. A 6.5-dB improvement in CTR was observed using an 8-chip GPIAM sequence compared to a conventional pulse-inversion amplitude-modulation sequence. The CTR improvement comes at the cost of a reduction in frame rate: GPIAM coding uses four input pulses whereas most contrast imaging sequences require two or three pulses. Our results showed that the microbubble response can be phase encoded and subsequently compressed using a nonlinear matched-filtering algorithm, in order to enhance the signal from the contrast agent, while maintaining resolution and suppressing the tissue signal.