Implementing and evaluating a high-resolution diode array for patient-specific quality assurance of robotic brain stereotactic radiosurgery/radiotherapy.

The purpose of the study was to introduce and evaluate a high-resolution diode array for patient-specific quality assurance (PSQA) of CyberKnife brain stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT). Thirty-three intracranial plans were retrospectively delivered on the SRS MapCHECK using fixed cone, Iris, and multileaf collimator (MLC). The plans were selected to cover a range of sites from large tumor bed, single/multiple small brain metastases (METs) to trigeminal neuralgia. Fiducial tracking using the four fiducials embedded around the detector plane was used as image guidance. Results were analyzed before and after registration based on absolute dose gamma criterion of 1 mm distance-to-agreement and 0.5%-3% dose-difference. Overall, the gamma passing rates (1 mm and 3% criterion) before registration for all the patients were above 90% for all three treatment modalities (96.8 ± 3.5%, the lowest passing rate of 90.4%), and were improved after registration (99.3 ± 1.5%). When tighter criteria (1 mm and 2%) were applied, the gamma passing rates after registration for all the cases dropped to 97.3 ± 3.2%. For trigeminal neuralgia cases, we applied 1 mm and 0.5% criterion and the passing rates dropped from 100 ± 0.0% to 98.5 ± 2.0%. The mean delivery time was 33.4 ± 11.7 min, 24.0 ± 4.9 min, and 17.1 ± 2.6 min for the fixed cone, Iris, and MLC, respectively. With superior gamma passing rates and reasonable quality assurance (QA) time, we believe the SRS MapCHECK could be a good option for routine PSQA for CyberKnife SRS/SRT.

Multi-institution validation of a new high spatial resolution diode array for SRS and SBRT plan pretreatment quality assurance.

PURPOSE: The SRS MapCHECK® , a recently developed patient-specific quality assurance (PSQA) tool for end-to-end testing of stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT), was evaluated in a multi-institution study and compared with radiochromic film. METHODS: The SRS MapCHECK was used to collect data on 84 SBRT or SRS PSQA plans/fields at nine institutions on treatment delivery devices (TDD) manufactured by Varian and Elekta. PSQA plans from five different treatment planning software (TPS) were selected and executed on TDDs operating at beam energies of 6 and 10 MV with and without a flattening filter. The patient plans were all VMAT except for ten conformal arc therapy fields. The plans were selected to encompass a range of size and tumor sites including brain, lung, spine, abdomen, ear, pancreas, and liver. Corresponding radiochromic film data was acquired in 50 plans/fields. Results were evaluated using gamma analysis with absolute dose criterion of 3% global dose-difference (DD) and 1 mm distance-to-agreement (DTA). RESULTS: The mean 3% DD/1 mm DTA Gamma pass rate of SRS MapCHECK in comparison to film was 95.9%, whereas comparison of SRS MapCHECK to the treatment planning software was 94.7%. 80% of SRS MapCHECK comparisons against film exceed 95% pass rate, and about 30% of SRS MapCHECK comparisons against film exceed 99% pass rate. To maintain good agreement between SRS MapCHECK and film or TPS, authors recommend avoiding plans with a modified modulation complexity score (MMCS) <0.1 arbitrary units (a.u.). In the examples presented, this coincides with avoiding plans with a mu/dose limit of >3 µ/cGy. CONCLUSIONS: Stereotactic radiosurgery MapCHECK has been validated for PSQA for a variety of clinical SRS/SBRT plans in a wide range of treatment delivery conditions. The SRS MapCHECK comparison with film demonstrates near-equivalence for analysis of patient-specific QA deliveries comprised of small field measurements.

American Association of Physicists in Medicine Task Group 263: Standardizing Nomenclatures in Radiation Oncology.

A substantial barrier to the single- and multi-institutional aggregation of data to supporting clinical trials, practice quality improvement efforts, and development of big data analytics resource systems is the lack of standardized nomenclatures for expressing dosimetric data. To address this issue, the American Association of Physicists in Medicine (AAPM) Task Group 263 was charged with providing nomenclature guidelines and values in radiation oncology for use in clinical trials, data-pooling initiatives, population-based studies, and routine clinical care by standardizing: (1) structure names across image processing and treatment planning system platforms; (2) nomenclature for dosimetric data (eg, dose-volume histogram [DVH]-based metrics); (3) templates for clinical trial groups and users of an initial subset of software platforms to facilitate adoption of the standards; (4) formalism for nomenclature schema, which can accommodate the addition of other structures defined in the future. A multisociety, multidisciplinary, multinational group of 57 members representing stake holders ranging from large academic centers to community clinics and vendors was assembled, including physicists, physicians, dosimetrists, and vendors. The stakeholder groups represented in the membership included the AAPM, American Society for Radiation Oncology (ASTRO), NRG Oncology, European Society for Radiation Oncology (ESTRO), Radiation Therapy Oncology Group (RTOG), Children's Oncology Group (COG), Integrating Healthcare Enterprise in Radiation Oncology (IHE-RO), and Digital Imaging and Communications in Medicine working group (DICOM WG); A nomenclature system for target and organ at risk volumes and DVH nomenclature was developed and piloted to demonstrate viability across a range of clinics and within the framework of clinical trials. The final report was approved by AAPM in October 2017. The approval process included review by 8 AAPM committees, with additional review by ASTRO, European Society for Radiation Oncology (ESTRO), and American Association of Medical Dosimetrists (AAMD). This Executive Summary of the report highlights the key recommendations for clinical practice, research, and trials.

The fungal pathogen Cochliobolus heterostrophus responds to maize phenolics: novel small molecule signals in a plant-fungal interaction.

The transcription factor ChAP1 of the fungal pathogen of maize, Cochliobolus heterostrophus, responds to oxidative stress by migration to the nucleus and activation of antioxidant genes. Phenolic and related compounds found naturally in the host also trigger nuclear localization of ChAP1, but only slight upregulation of some antioxidant genes. ChAP1 thus senses phenolic compounds without triggering a strong antioxidant response. We therefore searched for genes whose expression is regulated by phenolic compounds and/or ChAP1. The C. heterostrophus genome contains a cluster of genes for metabolism of phenolics. One such gene, catechol dioxygenase CCHD1, was induced at least 10-fold by caffeic and coumaric acids. At high phenolic concentrations (≥ 1.6 mM), ChAP1 is needed for maximum CCHD1 expression. At micromolar levels of phenolics CCHD1 is as strongly induced in chap1 mutants as in the wild type. The pathogen thus detects phenolics by at least two signalling pathways: one causing nuclear retention of ChAP1, and another triggering induction of CCHD1 expression. The low concentrations required for induction of CCHD1 indicate fungal receptors for plant phenolics. Symbiotic and pathogenic bacteria are known to detect phenolics, and our findings generalize this to a eukaryotic pathogen. Phenolics and related compounds thus provide a ubiquitous plant-derived signal.

Signaling by the pathogenicity-related MAP kinase of Cochliobolus heterostrophus correlates with its local accumulation rather than phosphorylation.

Phosphorylated mitogen-activated protein kinases (MAPK) transmit signals by activation of their targets. The extent of signal transduction could depend on MAPK phosphorylation level, concentration, and subcellular localization. The pathogenicity MAPK Chk1 of the fungal corn pathogen Cochliobolus heterostrophus is required for central developmental functions, including appressoria formation, conidiation, melanization, virulence, and female fertility. We followed CHK1 transcript level, protein localization, quantity, phosphorylation, and expression of downstream genes during conidial germination on a surface inductive for appressoria formation and in suspension. The Chk1-GFP protein representing a translational fusion of Chk1 and GFP (green fluorescent protein) was very abundant in ungerminated conidia, accumulated in maturating appressoria and appressorial nuclei, but was uniformly distributed in suspension-grown hyphae. Expression of Chk1-dependent genes was upregulated in appressoria-forming hyphae but not in suspension. Despite Chk1 activation, there was no change in its phosphorylation and total protein quantity. Of all conditions tested, a temperature shift caused a decrease whereas hyperosmotic stress caused an increase in Chk1 phosphorylation. Activation of Chk1 during appressoria formation is apparently manifested by its local accumulation but not by significant changes in phosphorylation.

Distinct and combined roles of the MAP kinases of Cochliobolus heterostrophus in virulence and stress responses.

Pathogenicity mitogen-activated protein kinases (MAPKs), related to yeast FUS3/KSS1, are essential for virulence in fungi, including Cochliobolus heterostrophus, a necrotrophic pathogen causing Southern corn leaf blight. We compared the phenotypes of mutants in three MAPK genes: HOG1, MPS1, and CHK1. The chk1 and mps1 mutants show autolytic appearance, light pigmentation, and dramatic reduction in virulence and conidiation. Similarity of mps1 and chk1 mutants is reflected by coregulation by these two MAPKs of several genes. Unlike chk1, mps1 mutants are female-fertile and form normal-looking appressoria. HOG1 mediates resistance to hyperosmotic and, to a lesser extent, oxidative stress, and is required for stress upregulation of glycerol-3-phosphate phosphatase, transaldolase, and a monosaccharide transporter. Hog1, but not Mps1 or Chk1, was rapidly phosphorylated in response to increased osmolarity. The hog1 mutants have smaller appressoria and cause decreased disease symptoms on maize leaves. Surprisingly, loss of MPS1 in a wild-type or hog1 background improved resistance to some stresses. All three MAPKs contribute to the regulation of central developmental functions under normal and stress conditions, and full virulence cannot be achieved without appropriate input from all three pathways.

Melanin biosynthesis in the maize pathogen Cochliobolus heterostrophus depends on two mitogen-activated protein kinases, Chk1 and Mps1, and the transcription factor Cmr1.

The maize pathogen Cochliobolus heterostrophus requires two mitogen-activated protein kinases (MAPKs), Chk1 and Mps1, to produce normal pigmentation. Young colonies of mps1 and chk1 deletion mutants have a white and autolytic appearance, which was partially rescued by a hyperosmotic environment. We isolated the transcription factor Cmr1, an ortholog of Colletotrichum lagenarium Cmr1 and Magnaporthe grisea Pig1, which regulates melanin biosynthesis in C. heterostrophus. Deletion of CMR1 in C. heterostrophus resulted in mutants that lacked dark pigmentation and acquired an orange-pink color. In cmr1 deletion strains the expression of putative scytalone dehydratase (SCD1) and hydroxynaphthalene reductase (BRN1 and BRN2) genes involved in melanin biosynthesis was undetectable, whereas expression of PKS18, encoding a polyketide synthase, was only moderately reduced. In chk1 and mps1 mutants expression of PKS18, SCD1, BRN1, BRN2, and the transcription factor CMR1 itself was very low in young colonies, slightly up-regulated in aging colonies, and significantly induced in hyperosmotic conditions, compared to invariably high expression in the wild type. These findings indicate that two MAPKs, Chk1 and Mps1, affect Cmr1 at the transcriptional level and this influence is partially overridden in stress conditions including aging culture and hyperosmotic environment. Surprisingly, we found that the CMR1 gene was transcribed in both sense and antisense directions, apparently producing mRNA as well as a long noncoding RNA transcript. Expression of the antisense CMR1 was also Chk1 and Mps1 dependent. Analysis of chromosomal location of the melanin biosynthesis genes in C. heterostrophus resulted in identification of a small gene cluster comprising BRN1, CMR1, and PKS18. Since expression of all three genes depends on Chk1 and Mps1 MAPKs, we suggest their possible epigenetic regulation.

Expression of the cercosporin transporter, CFP, in tobacco reduces frog-eye lesion size.

The cercosporin Major Facilitator Superfamily (MFS) transporter, CFP, under the control of the CaMV 35S promoter, was introduced into the Xanthi cultivar of tobacco by Agrobacterium-mediated transformation. CFP(+) transgenic plants were physically indistinguishable from non-transgenic Xanthi and progressed normally through growth to seed set. Accumulation of CFP in the leaf membrane fraction of CFP(+ )transgenic plants was associated with decreased cercosporin phytotoxicity. Frog-eye leaf lesions on CFP(+ )transgenic plants infected with Cercospora nicotianae conidia were smaller but were similar in number to those on non-transgenic plants. We conclude that transgenic expression of CFP may have relevance for a disease control strategy in Cercospora-plant pathosystems where cercosporin is implicated in pathogen virulence.

A decarboxylase encoded at the Cochliobolus heterostrophus translocation-associated Tox1B locus is required for polyketide (T-toxin) biosynthesis and high virulence on T-cytoplasm maize.

Genes at two unlinked loci (Tox1A and Tox1B) are required for production of the polyketide T-toxin by Cochliobolus heterostrophus race T, a pathogenic fungus that requires T-toxin for high virulence to maize with T-cytoplasm. Previous work indicated that Tox1A encodes a polyketide synthase (PKS1) required for T-toxin biosynthesis and for high virulence. To identify genes at Tox1B, a wild-type race T cDNA library was screened for genes missing in the genome of a Tox1B deletion mutant. The library was probed, first with a 415-kb NotI restriction fragment from the genome of the Tox1B mutant, then with the corresponding 560-kb fragment from the genome of wild type. Two genes, DEC1 (similar to acetoacetate decarboxylase-encoding genes) and RED1 (similar to genes encoding members of the medium-chain dehydrogenase/reductase superfamily), were recovered. Targeted disruption of DEC1 drastically reduced both T-toxin production and virulence of race T to T-cytoplasm maize, whereas specific inactivation of RED1 had no apparent effect on T-toxin production (as determined by bioassay) or on virulence. DEC1 and RED1 map within 1.5 kb of each other on Tox1B chromosome 6;12 and are unique to the genome of race T, an observation consistent with the hypothesis that these genes were acquired by C. heterostrophus via a horizontal transfer event.

Transgenic assessment of CFP-mediated cercosporin export and resistance in a cercosporin-sensitive fungus.

Cercosporin is a toxic polyketide produced by many phytopathogenic members of the fungal genus Cercospora. Cercospora species, themselves, exhibit the highest level of self-resistance to this almost universally toxic photosensitizer. Although the mechanism of cercosporin self-resistance is multi-faceted, partial resistance does appear to be provided by the encoded product of CFP ( cercosporin facilitator protein), a gene recently isolated from the pathogen of soybean, C. kikuchii. CFP has significant similarity to the major facilitator superfamily of integral membrane transport proteins. We expressed CFP in the cercosporin non-producing, cercosporin-sensitive fungus, Cochliobolus heterostrophus, in order to assess the transport activity of CFP and the contribution of CFP to cercosporin resistance in a fungal species free of endogenous toxin production. Expression of the CFP transgene in this fungus results in increased resistance to cercosporin due, apparently, to its export out of the fungus.