Understory fuel loads and the impact factors of Quercus mongolica natural secondary forest in Hebei Pro-vince, China.

We investigated understory fuel loads of Quercus mongolica natural secondary forests in Hebei Province, China. We analyzed the effects of stand factors, topographic factors, and ground cover factors on the quantity and composition of fuel, established the dynamic models of understory fuel loads, and proposed management measures. The results showed that the understory total fuel load in Q. mongolica natural secondary forests was 11.68 t·hm-2, which exceeded the forest fire potential threshold (10 t·hm-2). The understory dead fuel load was mainly humus, and the understory living fuel load was mainly shrubs. The 1 h time-lag fuel load increased significantly with increasing canopy density, stand density, stand age, and litter thickness. The 10 h time-lag fuel load increased signi-ficantly with increasing stand density, average tree height, and litter thickness. Humus load decreased significantly with increasing altitude and increased significantly with increasing humus thickness. Herb load increased significantly with increasing sunny slope orientation and herbal coverage. Shrub load increased significantly with increasing slope degree, shrub coverage, and humus thickness. Understory total fuel load decreased significantly with increasing altitude, and increased significantly with increasing stand density, humus thickness, and litter thickness. The results of stepwise regression analysis indicated that stand density, humus thickness, and altitude could better predict the understory total fuel load (Radj2=0.775). Therefore, more attention should be paid on the control of stand density of Q. mongolica natural secondary forest in Hebei Province. Cleaning of litters and humus on the ground would help prevent forest fires scientifically and effectively.

Report of AAPM Task Group 219 on independent calculation-based dose/MU verification for IMRT.

Independent verification of the dose per monitor unit (MU) to deliver the prescribed dose to a patient has been a mainstay of radiation oncology quality assurance (QA). We discuss the role of secondary dose/MU calculation programs as part of a comprehensive QA program. This report provides guidelines on calculation-based dose/MU verification for intensity modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT) provided by various modalities. We provide a review of various algorithms for "independent/second check" of monitor unit calculations for IMRT/VMAT. The report makes recommendations on the clinical implementation of secondary dose/MU calculation programs; on commissioning and acceptance of various commercially available secondary dose/MU calculation programs; on benchmark QA and periodic QA; and on clinically reasonable action levels for agreement of secondary dose/MU calculation programs.

[Applicability of thermal dissipation probe in the determination of trunk flow of Platycladus orientalis under cyclic heating mode]. / é—´æ–­åŠ çƒ­æ¨¡å¼ä¸‹çƒ­æ‰©æ•£æŠ€æœ¯åœ¨ä¾§æŸæ ‘å¹²æ¶²æµæµ‹å®šä¸­çš„é€‚ç”¨æ€§.

To evaluate the adaptability of the cyclic heating mode in the thermal diffusion probe method (TDP) in the measurement of trunk sap flow and the accuracy of the measurement of tree transpiration water consumption, we selected Platycladus orientalis as the research object and set three different heating modes: 60 min/0 min (continuous heating mode), 30 min/30 min (cyclic heating mode with 30 min heating and 30 min cooling), 10 min/50 min (cyclic heating mode with 10 min heating and 50 min cooling). Based on the measured value of the whole tree container wei-ghing method, the temperature gradient characteristics of different heating modes were analyzed using the measurement technology of thermal diffusive trunk sap flow. The Granier's corrected formulas of cyclic heating modes were constructed, with its error being analyzed by validity verification. The results showed that sap flow rate calculated by the cyclic heating mode was consistent with the diurnal variation of the transpiration rate measured by the whole tree weighing method. The temperature of cyclic heating mode could quickly rise, fall and performed stably. The sap flow calculated by Granier's original formula was 61.3% lower than that by weighing method. The corrected Granier formula in the mode of 10 min/50 min and 30 min/30 min were Fd=0.0177K0.9457 (R2=0.88) and Fd=0.0378K1.3146(R2=0.85), respectively. The difference of sap flow rate in P. orientalis by the new formula was smaller than that measured by the whole tree weighing method, and the error of transpiration rate calculated by the 10 min/50 min correction formula was the smallest, 5.9% lower than that calculated by the weighing method, and thus could express the real flow rate. The 10 min/50 min cyclic heating mode could be used to reduce the effect of natural temperature difference, cut down power consumption, and accurately reflect the actual sap flow rate of P. orientalis.

[Response of photosynthesis and carbon/nitrogen metabolism to drought stress in Chinese chestnut 'Yanshanzaofeng' seedlings]. / æ¿æ —"燕山早丰"å¹¼è‹—å ‰åˆä¸Žç¢³æ°®ä»£è°¢å¯¹å¹²æ—±èƒè¿«çš„å“åº”.

Drought is a main factor affecting the growth and yield of Chinese chestnut trees in Yan-shan Mountains. To investigate the responses of chestnut seedlings to drought stress, the growth and physiological indices, including photosynthetic characteristics, biomass, proline, malondialdehyde, carbon and nitrogen contents were measured in roots, stems, and leaves after the Chinese chestnut 'Yanshanzaofeng' seedlings in the pots were treated by simulating drought for 22 days. The results showed that, compared with the normal irrigation, water contents in the roots, stems and leaves were decreased by 18.3%, 29.0% and 62.8%, respectively, accompanied by the considerable increases in the contents of proline (355.0%-1586.7%) and malondialdehyde except in the stems (41.1%-81.3%). The non-photochemical quenching coefficiency and net photosynthetic rate in the leaves were significantly decreased by 49.4% and 77.4%, respectively. The contents of non-structural carbohydrates were increased by 21.4% in stems and 69.5% in leaves, but that in roots did not change. The contents of nitrate were increased by 28.9% in stems and 26.8% in leaves, but that in roots did not change. Ammonium nitrogen was increased by 16.2%, 12.9% and 217.6% in roots, stems, and leaves, but being statistically significant in the leaves. These results indicated that drought stress led to serious damage to 'Yanshanzaofeng' chestnut seedlings, which inhibited photosynthetic performance, but they could improve their adaptation to drought stress by enhancing carbon and nitrogen metabolism. Our results provide a reference for the breeding and cultivation of drought resistance of the local Chinese chestnut resources.

[Responses of photosynthetic physiology and sap flow to the introduction of external dye in Populus ×euramericana cv. '74/76']. / 107æ¨å ‰åˆç”Ÿç†ä¸Žæ ‘å¹²æ¶²æµå¯¹å¤–æºæŸ“æ¶²å¯¼å ¥çš„å“åº”.

The exogenous liquid introduction technology is an effective way to produce the value-added poplar wood with excellent pattern color. This technology was used to add the various concentrated active red dyeing solution (0.2%, 0.4% and 0.6%) into target trees of six-year-old 107 poplar (Populus ×euramericana cv. '74/76'). The photosynthetic gas exchange parameter and sap flow rate were measured by Li-6400 photosynthetic instrument and TDP stem flowmeter, respectively. We analyzed the relationship between photosynthetic parameters, sap flow rate and dye absorption, and the effects of exogenous dye solution on the photosynthetic physiology and sap flow characteristics. The results showed that exogenous dyeing solution significantly inhibited flow rate of poplar trunks. The 0.2% concentrated liquid was far less effective than others (0.4% and 0.6%). The net photosynthetic rate (Pn), stomatal conductance (gs) and transpiration rate (Tr) of poplars treated with different concentrated dyeing liquids were significantly lower than the control poplar. The intercellular carbon dioxide concentration (Ci) decreased first and then increased. The inhibitory effects of 0.4% and 0.2% concentrated dyeing solutions on photosynthesis were stronger than that of 0.6%. Dye absorption decreased with increasing dye concentration. The maximum liquid flow rate, Pn, gs and Tr were significantly negatively correlated with the dye content. The contents of chlorophyll (a+b), chlorophyll a and chlorophyll b in exogenous dyeing solution treatments were significantly lower than those of the control at the later stage. The concentration of dyeing solution and introduction time determined the amount of dye absorption. The dye solution 0.4%, which was introduced for three days, could ensure the appropriate dye absorption and reduce the inhibitory effect on the physiological activities of the poplar.

[Adaptability of Granier empirical formula in sap flow measurement of Populus tomentosa based on whole tree weighing method]. / åŸºäºŽæ•´æ ‘ç§°é‡æ³•çš„Granierç»éªŒå ¬å¼å¯¹æ¯›ç™½æ¨æ ‘å¹²æ¶²æµæµ‹å®šçš„é€‚ç”¨æ€§.

We evaluated the adaptability of Granier's empirical formula in the measurement of trunk sap flow in Populus tomentosa. The thermal diffusion probe method (TDP) was used to mea-sure sap flow rate, and the whole tree weighing was simultaneously measured for each tree. We compared results from the Granier empirical formula with that from the whole tree weighing to find out whether Granier formula had any error in measuring the trunk sap flow of P. tomentosa. The transpiration rate by the whole tree weighing method and the temperature difference coefficient K by the thermal diffusion method were fitted with power exponential regression to establish a corrected Granier formula. Compared with the transpiration rate measured by the whole tree weighing method, sap flow rate calculated by the Granier empirical formula was underestimated by 67.7%. Therefore, a calibrated Granier correction formula of P. tomentosa was established: Fd=0.0135K0.6952(R2=0.77). The calculated result from this calibrated formula was only 3.4% lower than the transpiration rate estimated with the whole tree weighing method, which showed good consistency. Thus, the calculation of the P. tomentosa sap flow rate should be corrected when using the Granier empirical formula.

Beam modeling and beam model commissioning for Monte Carlo dose calculation-based radiation therapy treatment planning: Report of AAPM Task Group 157.

Dose calculation plays an important role in the accuracy of radiotherapy treatment planning and beam delivery. The Monte Carlo (MC) method is capable of achieving the highest accuracy in radiotherapy dose calculation and has been implemented in many commercial systems for radiotherapy treatment planning. The objective of this task group was to assist clinical physicists with the potentially complex task of acceptance testing and commissioning MC-based treatment planning systems (TPS) for photon and electron beam dose calculations. This report provides an overview on the general approach of clinical implementation and testing of MC-based TPS with a specific focus on models of clinical photon and electron beams. Different types of beam models are described including those that utilize MC simulation of the treatment head and those that rely on analytical methods and measurements. The trade-off between accuracy and efficiency in the various source-modeling approaches is discussed together with guidelines for acceptance testing of MC-based TPS from the clinical standpoint. Specific recommendations are given on methods and practical procedures to commission clinical beam models for MC-based TPS.

Positioning errors of metal localization devices with motion artifacts on kV and MV cone beam CT.

OBJECTIVE: To investigate motion artifacts on kV CBCT and MV CBCT images with metal localization devices for image-guided radiation therapy. METHODS: The 8 µ pelvis CBCT template for the Siemens Artiste MVision and Pelvis template for the Varian IX on-board Exact Arms kV were used to acquire CBCT images in this study. Images from both CBCT modalities were compared in CNRs, metal landmark absolute positions, and image volume distortion on three different planes of view. The images were taken on a breathing-simulated thoracic phantom in which several typical metal localization devices were implanted, including clips and wires for breast patients, gold seeds for prostate patients, and BBs as skin markers. To magnify the artifacts, a 4 cm diameter metal ball was also implanted into the thoracic phantom to mimic the metal artifacts. RESULTS: For MV CBCT, the CNR at a 4 sec breathing cycle with 1 cm breathing amplitude was 5.0, 3.4 and 4.6 for clips, gold seeds and BBs, respectively while it was 1.5, 2.0 and 1.6 for the kV CBCT. On the images, the kV CBCT showed symmetric streaking artifacts both in the transverse and longitudinal directions relative to the motion direction. The kV CBCT images predicted 89 % of the expected volume, while the MV CBCT images predicted 95 % of the expected volume. The simulated soft tissue observed in the MVCT could not be detected in the kV CBCT. CONCLUSION: The MV CBCT images showed better volume prediction, less streaking effects and better CNRs of a moving metal target, i.e. clips, BBs, gold seeds and metal balls than on the kV CBCT images. The MV CBCT was more advantageous compared to the kV CBCT with less motion artifacts for metal localization devices. ADVANCES IN KNOWLEDGE: This study would benefit clinicians to prescribe MV CBCT as localization modality for radiation treatment with moving target when metal markers are implanted.

Tissue TGF-ß expression following conventional radiotherapy and pulsed low-dose-rate radiation.

The release of inflammatory cytokines has been implicated in the toxicity of conventional radiotherapy (CRT). Transforming growth factor ß (TGF-ß) has been suggested to be a risk marker for pulmonary toxicity following radiotherapy. Pulsed low-dose rate radiotherapy (PLDR) is a technique that involves spreading out a conventional radiotherapy dose into short pulses of dose with breaks in between to reduce toxicities. We hypothesized that the more tolerable toxicity profile of PLDR compared with CRT may be related to differential expression of inflammatory cytokines such as TGF-ß in normal tissues. To address this, we analyzed tissues from mice that had been subjected to lethal doses of CRT and PLDR by histology and immunohistochemistry (IHC). Equivalent physical doses of CRT triggered more cellular atrophy in the bone marrow, intestine, and pancreas when compared with PLDR as indicated by hematoxylin and eosin staining. IHC data indicates that TGF-ß expression is increased in the bone marrow, intestine, and lungs of mice subjected to CRT as compared with tissues from mice subjected to PLDR. Our in vivo data suggest that differential expression of inflammatory cytokines such as TGF-ß may play a role in the more favorable normal tissue late response following treatment with PLDR.

Dosimetric and delivery efficiency investigation for treating hepatic lesions with a MLC-equipped robotic radiosurgery-radiotherapy combined system.

PURPOSE: The CyberKnife M6 (CK-M6) Series introduced a multileaf collimator (MLC) for extending its capability from stereotactic radiosurgery/stereotactic radiotherapy (SBRT) to conventionally fractionated radiotherapy. This work is to investigate the dosimetric quality of plans that are generated using MLC-shaped beams on the CK-M6, as well as their delivery time, via comparisons with the intensity modulated radiotherapy plans that were clinically used on a Varian Linac for treating hepatic lesions. METHODS: Nine patient cases were selected and divided into three groups with three patients in each group: (1) the group-one patients were treated conventionally (25 fractions); (2) the group-two patients were treated with SBRT-like hypofractionation (5 fractions); and (3) the group-three patients were treated similar to group-one patients, but with two planning target volumes (PTVs) and two different prescription dose levels correspondingly. The clinically used plans were generated on the eclipse treatment planning system (TPS) and delivered on a Varian Linac (E-V plans). The multiplan (MP) TPS was used to replan these clinical cases with the MLC as the beam device for the CK-M6 (C-M plans). After plans were normalized to the same PTV dose coverage, comparisons between the C-M and E-V plans were performed based on D(99%) (percentage of prescription dose received by 99% of the PTV), D(0.1cm(3)) (the percentage of prescription dose to 0.1 cm(3) of the PTV), and doses received by critical structures. Then, the delivery times for the C-M plans will be obtained, which are the MP TPS generated estimations assuming having an imaging interval of 60 s. RESULTS: The difference in D(99%) between C-M and E-V plans is +0.6% on average (+ or - indicating a higher or lower dose from C-M plans than from E-V plans) with a range from -4.1% to +3.8%, and the difference in D(0.1cm(3)) was -1.0% on average with a range from -5.1% to +2.9%. The PTV conformity index (CI) for the C-M plans ranges from 1.07 to 1.29 with a mean of 1.19, slightly inferior to the E-V plans, in which the CI ranges from 1.00 to 1.15 with a mean of 1.07. Accounting for all nine patients in three groups, 45% of the critical structures received a lower mean dose for the C-M plans as compared with the E-V plans, and similarly, 48% received a lower maximum dose. Furthermore, the average difference of the mean critical structure dose between the C-M and E-V plans over all critical structures for all patients showed only +2.10% relative to the prescription dose and the similar comparison finds the average difference of the maximum critical structure dose of only +1.24%. The estimated delivery times for the C-M plans on the CK-M6 range from 18 to 24 minutes while they are from 7 to 13.7 min for the E-V plans on the Varian Linac. CONCLUSIONS: For treating hepatic lesions, for the C-M plans that are comparable to E-V plans in quality, the times needed to deliver these C-M plans on the CK-M6 are longer than the delivery time for the E-V plans on the Varian Linac, but may be clinically acceptable.

Intrafractional prostate motion during external beam radiotherapy monitored by a real-time target localization system.

This paper investigates the clinical significance of real-time monitoring of intrafractional prostate motion during external beam radiotherapy using a commercial 4D localization system. Intrafractional prostate motion was tracked during 8,660 treatment fractions for 236 patients. The following statistics were analyzed: 1) the percentage of fractions in which the prostate shifted 2-7 mm for a certain duration; 2) the proportion of the entire tracking time during which the prostate shifted 2-7mm; and 3) the proportion of each minute in which the shift exceeded 2-7 mm. The ten patients exhibiting maximum intrafractional-motion patterns were analyzed separately. Our results showed that the percentage of fractions in which the prostate shifted by > 2, 3, 5, and 7 mm off the baseline in any direction for > 30 s was 56.8%, 27.2%, 4.6%, and 0.7% for intact prostate and 68.7%, 35.6%, 10.1%, and 1.8% for postprostatectomy patients, respectively. For the ten patients, these percentages were 91.3%, 72.4%, 36.3%, and 6%, respectively. The percentage of tracking time during which the prostate shifted > 2, 3, 5, and 7 mm was 27.8%, 10.7%, 1.6%, and 0.3%, respectively, and it was 56.2%, 33.7%, 11.2%, and 2.1%, respectively, for the ten patients. The percentage of tracking time for a > 3 mm posterior motion was four to five times higher than that in other directions. For treatments completed in 5 min (VMAT) and 10 min (IMRT), the proportion for the prostate to shift by > 3mm was 4% and 12%, respectively. Although intrafractional prostate motion was generally small, caution should be taken for patients who exhibit frequent large intrafractional motion. For those patients, adjustment of patient positioning may be necessary or a larger treatment margin may be used. After the initial alignment, the likelihood of prostate motion increases with time. Therefore, it is favorable to use advanced techniques (e.g., VMAT) that require less delivery time in order to reduce the treatment uncertainty resulting from intrafractional prostate motion.

Intensity-modulated radiation therapy for pancreatic and prostate cancer using pulsed low-dose rate delivery techniques.

Reirradiation of patients who were previously treated with radiotherapy is vastly challenging. Pulsed low-dose rate (PLDR) external beam radiotherapy has the potential to reduce normal tissue toxicities while providing significant tumor control for recurrent cancers. This work investigates treatment planning techniques for intensity-modulated radiation therapy (IMRT)-based PLDR treatment of various sites, including cases with pancreatic and prostate cancer. A total of 20 patients with clinical recurrence were selected for this study, including 10 cases with pancreatic cancer and 10 with prostate cancer. Large variations in the target volume were included to test the ability of IMRT using the existing treatment planning system and optimization algorithm to deliver uniform doses in individual gantry angles/fields for PLDR treatments. Treatment plans were generated with 10 gantry angles using the step-and-shoot IMRT delivery technique, which can be delivered in 3-minute intervals to achieve an effective low dose rate of 6.7cGy/min. Instead of dose constraints on critical structures, ring structures were mainly used in PLDR-IMRT optimization. In this study, the PLDR-IMRT plans were compared with the PLDR-3-dimensional conformal radiation therapy (3DCRT) plans and the PLDR-RapidArc plans. For the 10 cases with pancreatic cancer that were investigated, the mean planning target volume (PTV) dose for each gantry angle in the PLDR-IMRT plans ranged from 17.6 to 22.4cGy. The maximum doses ranged between 22.9 and 34.8cGy. The minimum doses ranged from 8.2 to 17.5cGy. For the 10 cases with prostate cancer that were investigated, the mean PTV doses for individual gantry angles ranged from 18.8 to 22.6cGy. The maximum doses per gantry angle were between 24.0 and 34.7cGy. The minimum doses per gantry angle ranged from 4.4 to 17.4cGy. A significant reduction in the organ at risk (OAR) dose was observed with the PLDR-IMRT plan when compared with that using the PLDR-3DCRT plan. The volume receiving an 18-Gy (V18) dose for the left and right kidneys was reduced by 10.6% and 12.5%, respectively, for the pancreatic plans. The volume receiving a 45-Gy (V45) dose for the small bowel decreased from 65.3% to 45.5%. For the cases with prostate cancer, the volume receiving a 40-Gy (V40) dose for the bladder and the rectum was reduced significantly by 25.1% and 51.2%, respectively. When compared with the RapidArc technique, the volume receiving a 30-Gy (V30) dose for the left and the right kidneys was lower in the IMRT plans. For most OARs, no significant differences were observed between the PLDR-IMRT and the PLDR-RapidArc plans. These results clearly demonstrated that the PLDR-IMRT plan was suitable for PLDR pancreatic and prostate cancer treatments in terms of the overall plan quality. A significant reduction in the OAR dose was achieved with the PLDR-IMRT plan when compared with that using the PLDR-3DCRT plan. For most OARs, no significant differences were observed between the PLDR-IMRT and the PLDR-RapidArc plans. When compared with the PLDR-3DCRT plan, the PLDR-IMRT plan could provide superior target coverage and normal tissue sparing for PLDR reirradiation of recurrent pancreatic and prostate cancers. The PLDR-IMRT plan is an effective treatment choice for recurrent cancers in most cancer centers.

Planning target volume-to-skin proximity for head-and-neck intensity modulated radiation therapy treatment planning.

PURPOSE: The goal of this work is to evaluate planning target volume (PTV)-to-skin proximity versus plan quality as well as the effects of calculation voxel size on dose uncertainty in the surface region. METHODS AND MATERIALS: A right-sided clinical target volume with the lateral border 5 mm from the surface was delineated on the computed tomographic data of a head-and-neck phantom. A 5-mm PTV expansion was generated except laterally where distances of 0-5 mm were used. A 7-field intensity modulated radiation therapy plan was generated using the Eclipse treatment planning system. Optimization was performed where 95% of the PTV receives the prescription dose using a voxel size of 2 mm(3). Dose calculations were repeated for voxel sizes of 1, 3, and 5 mm(3). For each plan, 9 point dose values were obtained just inside the phantom surface, corresponding to a 2 cm × 2 cm grid near the central target region. Nine ultrathin thermoluminescent dosimeters were placed on the phantom surface corresponding to the grid. Measured and calculated dose values were compared. Conformality, homogeneity, and target coverage were compared as well. This process was repeated for volumetric modulated arc therapy (VMAT) calculated with a 2-mm(3) voxel size. RESULTS: Surface dose is overestimated by the treatment planning system (TPS) by approximately 21% and 9.5% for 5- and 3-mm(3) voxels, respectively, and is accurately predicted for 2-mm(3) voxels. A voxel size of 1 mm(3) results in underestimation by 11%. Conformality improves with increasing PTV-to-skin distance and a conformality index of unity is obtained for grid sizes between 1 and 3 mm(3) and PTV-to-skin distances of 4-4.5 mm. Hot spot also improves and falls below 110% at 4-mm PTV-to-skin distance. Underdosage worsens as the PTV approaches the skin. All of the above appear to hold for volumetric modulated arc therapy. CONCLUSIONS: For decreasing PTV-to-skin distance with this TPS, isodose conformality decreases, "hot spot" increases, and target coverage degrades. Surface dose is overestimated when voxel sizes greater than 2 mm(3) are chosen, and underestimated for smaller voxels.

Dosimetric evaluation of integrated IMRT treatment of the chest wall and supraclavicular region for breast cancer after modified radical mastectomy.

To investigate the dosimetric characteristics of irradiation of the chest wall and supraclavicular region as an integrated volume with intensity-modulated radiation therapy (IMRT) after modified radical mastectomy. This study included 246 patients who received modified radical mastectomy. The patients were scanned with computed tomography, and the chest wall (with or without the internal mammary lymph nodes) and supraclavicular region were delineated. For 143 patients, the chest wall and supraclavicular region were combined as an integrated planning volume and treated with IMRT. For 103 patients, conventional treatments were employed with 2 tangential fields for the chest wall, abutting a mixed field of 6-MV x-rays (16Gy) and 9-MeV electrons (34Gy) for the upper supraclavicular region. The common prescription dose was 50Gy/25Fx/5W to 90% of the target volume. The dosimetric characteristics of the chest wall, the supraclavicular region, and normal organs were compared. For the chest wall target, compared with conventional treatments, the integrated IMRT plans lowered the maximum dose, increased the minimum dose, and resulted in better conformity and uniformity of the target volume. There was an increase in minimum, average, and 95% prescription dose for the integrated IMRT plans in the supraclavicular region, and conformity and uniformity were improved. The V30 of the ipsilateral lung and V10, V30, and mean dose of the heart on the integrated IMRT plans were lower than those of the conventional plans. The V5 and V10 of the ipsilateral lung and V5 of the heart were higher on the integrated IMRT plans (p < 0.05) than on conventional plans. Without an increase in the radiation dose to organs at risk, the integrated IMRT treatment plans improved the dose distribution of the supraclavicular region and showed better dose conformity and uniformity of the integrated target volume of the chest wall and supraclavicular region.

Reduction of prostate intrafractional motion from shortening the treatment time.

This study aims to quantify the reduction of the intrafractional motion when the prostate intensity modulated radiation therapy (IMRT) treatment time is shortened. Prostate intrafractional motion data recorded by the Calypso system for 105 patients was analyzed. Statistical distributions of the prostate displacements for the regular IMRT treatment and the first 1, 2, 3 and 5 min of the treatment were calculated and used for treatment margin estimation for all the selected patients. The treatment margins estimated for the first 1, 2, 3 and 5 min were compared with those for the regular IMRT treatment to quantify the reduction of the motion. If the treatment can be completed within 5 (3) min, the standard deviation of the prostate displacement could be reduced by up to 45% and the required treatment margins could be reduced to 1.2 (1.1), 0.9 (0.8), 2.2 (1.9), 1.9 (1.5), 1.9 (1.7) and 2.8 (2.4) mm from 1.5, 1.1, 2.8, 3.0, 2.4 and 3.9 mm in the left, right, superior, inferior, anterior and posterior directions, respectively. The same work was also performed for 19 of the 105 patients who exhibited the largest motion with 30% of their treatment time having 3D motion more than 3 mm. For this group of patients, the required margins change to 1.4 (1.2), 0.8 (0.8), 1.8 (1.6), 2.3 (1.8), 1.7 (1.5) and 3.4 (2.8) mm from 1.9, 1.2, 1.7, 3.7, 1.6 and 4.9 mm in the six directions when the treatment time is reduced to 5 (3) min. The intrafractional motion effects on prostate treatment are significantly smaller and the required margins can be therefore reduced when the treatment is shortened.

[Skin needle roller importing triamcinolone acetonide into scar to treat hypertrophic scars].

OBJECTIVE: To evaluate the effect of importing triamcinolone acetonide into hypertrophic scars with skin roller needles. METHODS: Thirty-two cases with burn hypertrophic scar were treated. The skin roller needles were moved back and forth on the hypertrophic scars with triamcinolone acetonide dropping on the scar surface at the same time. So the triamcinolone acetonide could be imported into the scar through needles and needle holes. The effect was evaluated as cured, effective, and no effect. The Vancouver scaring criteria and visual analogue scale was used to assess the scar color, thickness, texture and feeling before and after treatment, as well as at the untreated scar area (control). RESULTS: Thirty-two cases were treated 1-3 times, including 28 cases with cured result and 4 cases with effective result. The total effective rate was 100%. The scar color, thickness, texture and feeling was significantly different between the scar before and after treatment, or between the treated and untreated scar (P < 0.05). CONCLUSIONS: Importing triamcinolone acetonide into hypertrophic scars with skin roller needles is effective. It is a new method for the treatment of large hypertrophic scar with medicine.

Five-year local control in a phase II study of hypofractionated intensity modulated radiation therapy with an incorporated boost for early stage breast cancer.

PURPOSE: Conventional radiation fractionation of 1.8-2 Gy per day for early stage breast cancer requires daily treatment for 6-7 weeks. We report the 5-year results of a phase II study of intensity modulated radiation therapy (IMRT), hypofractionation, and incorporated boost that shortened treatment time to 4 weeks. METHODS AND MATERIALS: The study design was phase II with a planned accrual of 75 patients. Eligibility included patients aged≥18 years, Tis-T2, stage 0-II, and breast conservation. Photon IMRT and an incorporated boost was used, and the whole breast received 2.25 Gy per fraction for a total of 45 Gy, and the tumor bed received 2.8 Gy per fraction for a total of 56 Gy in 20 treatments over 4 weeks. Patients were followed every 6 months for 5 years. RESULTS: Seventy-five patients were treated from December 2003 to November 2005. The median follow-up was 69 months. Median age was 52 years (range, 31-81). Median tumor size was 1.4 cm (range, 0.1-3.5). Eighty percent of tumors were node negative; 93% of patients had negative margins, and 7% of patients had close (>0 and <2 mm) margins; 76% of cancers were invasive ductal type: 15% were ductal carcinoma in situ, 5% were lobular, and 4% were other histology types. Twenty-nine percent of patients 29% had grade 3 carcinoma, and 20% of patients had extensive in situ carcinoma; 11% of patients received chemotherapy, 36% received endocrine therapy, 33% received both, and 20% received neither. There were 3 instances of local recurrence for a 5-year actuarial rate of 2.7%. CONCLUSIONS: This 4-week course of hypofractionated radiation with incorporated boost was associated with excellent local control, comparable to historical results of 6-7 weeks of conventional whole-breast fractionation with sequential boost.

Effect of gold marker seeds on magnetic resonance spectroscopy of the prostate.

PURPOSE: Magnetic resonance stereoscopic imaging (MRSI) of the prostate is an emerging technique that may enhance targeting and assessment in radiotherapy. Current practices in radiotherapy invariably involve image guidance. Gold seed fiducial markers are often used to perform daily prostate localization. If MRSI is to be used in targeting prostate cancer and therapy assessment, the impact of gold seeds on MRSI must be investigated. The purpose of this study was to quantify the effects of gold seeds on the quality of MRSI data acquired in phantom experiments. METHODS AND MATERIALS: A cylindrical plastic phantom with a spherical cavity 10 centimeters in diameter wss filled with water solution containing choline, creatine, and citrate. A gold seed fiducial marker was put near the center of the phantom mounted on a plastic stem. Spectra were acquired at 1.5 Tesla by use of a clinical MRSI sequence. The ratios of choline + creatine to citrate (CC/Ci) were compared in the presence and absence of gold seeds. Spectra in the vicinity of the gold seed were analyzed. RESULTS: The maximum coefficient of variation of CC/Ci induced by the gold seed was found to be 10% in phantom experiments at 1.5 T. CONCLUSION: MRSI can be used in prostate radiotherapy in the presence of gold seed markers. Gold seeds cause small effects (in the order of the standard deviation) on the ratio of the metabolite's CC/Ci in the phantom study done on a 1.5-T scanner. It is expected that gold seed markers will have similar negligible effect on spectra from prostate patients. The maximum of 10% of variation in CC/Ci found in the phantom study also sets a limit on the threshold accuracy of CC/Ci values for deciding whether the tissue characterized by a local spectrum is considered malignant and whether it is a candidate for local boost in radiotherapy dose.

Uncertainties in IMRT dosimetry.

PURPOSE: The purpose of this study is to investigate some characteristics of the beam delivery system and their effects on the dose distribution of intensity-modulated radiation therapy (IMRT) and the results of patient-specific IMRT quality assurance (QA). These characteristics include the accelerator source distribution and multileaf collimator (MLC) geometry. METHODS: Monte Carlo dose calculations based on intensity maps that were built from the actual deliverable IMRT leaf sequences with and without considering the characteristics of the beam delivery system were performed in this study using in-house Monte Carlo software. The effect of the resolution of the intensity maps on the dose distribution was investigated first. The mean dose of the treatment target and the voxel doses in the high dose region of seven IMRT plans generated by different treatment planning systems for Varian 21EX and Siemens Primus linear accelerators were used for comparison and evaluation. RESULTS: The results show that a 0.2 x 0.2 mm2 or smaller pixel size is needed for the intensity maps for accurate IMRT dose calculation. The extrafocal source, MLC leaf thickness, leakage, tongue-and-groove structure, and the effective leaf offset can affect the mean dose by up to 1.5%, 4.5%, 5.6%, 5.3%, and 7.8%, respectively, when these factors are considered separately. They also cause significant uncertainties to the voxel dose with standard deviations up to 2.5%, 0.7%, 2.1%, 1.3%, and 5%, respectively. The overall effect on the mean dose is up to 8% and the standard deviation of the voxel dose uncertainty is up to 6.4% when all the effects are included. The maximum standard deviation is reduced to 4.6% if the voxel size of the dose calculation matrix is increased from 0.04 to 0.3 cm3 to make it comparable with the sensitive volume of the ionization chamber used for IMRT QA measurements. CONCLUSIONS: It can be concluded that the characteristics of the beam delivery system are the major contributors to the uncertainty of measurement-based IMRT QA because most of them are not fully considered in the currently available treatment planning systems.