Virtual unenhanced dual-energy computed tomography for photon radiotherapy: The effect on dose distribution and cone-beam computed tomography based position verification.

Background and Purpose: Virtual Unenhanced images (VUE) from contrast-enhanced dual-energy computed tomography (DECT) eliminate manual suppression of contrast-enhanced structures (CES) or pre-contrast scans. CT intensity decreases in high-density structures outside the CES following VUE algorithm application. This study assesses VUE's impact on the radiotherapy workflow of gynecological tumors, comparing dose distribution and cone-beam CT-based (CBCT) position verification to contrast-enhanced CT (CECT) images. Materials and Methods: A total of 14 gynecological patients with contrast-enhanced CT simulation were included. Two CT images were reconstructed: CECT and VUE. Volumetric Modulated Arc Therapy (VMAT) plans generated on CECT were recalculated on VUE using both the CECT lookup table (LUT) and a dedicated VUE LUT. Gamma analysis assessed 3D dose distributions. CECT and VUE images were retrospectively registered to daily CBCT using Chamfer matching algorithm.. Results: Planning target volume (PTV) dose agreement with CECT was within 0.35% for D2%, Dmean, and D98%. Organs at risk (OARs) D2% agreed within 0.36%. A dedicated VUE LUT lead to smaller dose differences, achieving a 100% gamma pass rate for all subjects. VUE imaging showed similar translations and rotations to CECT, with significant but minor translation differences (<0.02 cm). VUE-based registration outperformed CECT. In 24% of CBCT-CECT registrations, inadequate registration was observed due to contrast-related issues, while corresponding VUE images achieved clinically acceptable registrations. Conclusions: VUE imaging in the radiotherapy workflow is feasible, showing comparable dose distributions and improved CBCT registration results compared to CECT. VUE enables automated bone registration, limiting inter-observer variation in the Image-Guided Radiation Therapy (IGRT) process.

Online adaptive radiotherapy for bladder cancer using a simultaneous integrated boost and fiducial markers.

PURPOSE: The aim was to assess the feasibility of online adaptive radiotherapy (oART) for bladder cancer using a focal boost by focusing on the quality of the online treatment plan and automatic target delineation, duration of the workflow and performance in the presence of fiducial markers for tumor bed localization. METHODS: Fifteen patients with muscle invasive bladder cancer received daily oART with Cone Beam CT (CBCT), artificial intelligence (AI)-assisted automatic delineation of the daily anatomy and online plan reoptimization. The bladder and pelvic lymph nodes received a total dose of 40 Gy in 20 fractions, the tumor received an additional simultaneously integrated boost (SIB) of 15 Gy. The dose distribution of the reference plan was calculated for the daily anatomy, i.e. the scheduled plan. Simultaneously, a reoptimization of the plan was performed i.e. the adaptive plan. The target coverage and V95% outside the target were evaluated for both plans. The need for manual adjustments of the GTV delineation, the duration of the workflow and the influence of fiducial markers were assessed. RESULTS: All 300 adaptive plans met the requirement of the CTV-coverage V95%≥98% for both the boost (55 Gy) and elective volume (40 Gy). For the scheduled plans the CTV-coverage was 53.5% and 98.5%, respectively. Significantly less tissue outside the targets received 55 Gy in case of the adaptive plans as compared to the scheduled plans. Manual corrections of the GTV were performed in 67% of the sessions. In 96% of these corrections the GTV was enlarged and resulted in a median improvement of 1% for the target coverage. The median on-couch time was 22 min. A third of the session time consisted of reoptimization of the treatment plan. Fiducial markers were visible on the CBCTs and aided the tumor localization. CONCLUSIONS: AI-driven CBCT-guided oART aided by fiducial markers is feasible for bladder cancer radiotherapy treatment including a SIB. The quality of the adaptive plans met the clinical requirements and fiducial markers were visible enabling consistent daily tumor localization. Improved automatic delineation to lower the need for manual corrections and faster reoptimization would result in shorter session time.

Comparison of Library of Plans with two daily adaptive strategies for whole bladder radiotherapy.

BACKGROUND AND PURPOSE: Whole bladder radiotherapy is challenging due to inter- and intrafraction size and shape changes. To account for these changes, currently a Library of Plans (LoP) technique is often applied, but daily adaptive radiotherapy is also increasingly becoming available. The aim of this study was to compare LoP with two magnetic resonance imaging guided radiotherapy (MRgRT) strategies by comparing target coverage and volume of healthy tissue inside the planning target volume (PTV) for whole bladder treatments. METHODS AND MATERIALS: Data from 25 MRgRT lymph node oligometastases treatments (125 fractions) were used, with three MRI scans acquired at each fraction at 0, 15 and 30 min. Bladders were delineated and used to evaluate three strategies: 1) LoP with two plans for a 15 min fraction, 2) MRgRT15min for a 15 min fraction and 3) MRgRT30min for a 30 min fraction. The volumes of healthy tissue inside and bladder outside the PTV were analyzed on the simulated post-treatment images. RESULTS: MRgRT30min had 120% and 121% more healthy tissue inside the PTV than LoP and MRgRT15min. For LoP slightly more target outside the PTV was found than for MRgRT30min and MRgRT15min, with median 0% (range 0-23%) compared to 0% (0-20%) and 0% (0-10%), respectively. CONCLUSIONS: Taking into account both target coverage and volume of healthy tissue inside the PTV, MRgRT15min performed better than LoP and MRgRT30min for whole bladder treatments. A 15 min daily adaptive radiotherapy workflow is needed to potentially benefit from replanning compared to LoP.

Evaluating differences in respiratory motion estimates during radiotherapy: a single planning 4DMRI versus daily 4DMRI.

BACKGROUND: In radiotherapy, respiratory-induced tumor motion is typically measured using a single four-dimensional computed tomography acquisition (4DCT). Irregular breathing leads to inaccurate motion estimates, potentially resulting in undertreatment of the tumor and unnecessary dose to healthy tissue. The aim of the research was to determine if a daily pre-treatment 4DMRI-strategy led to a significantly improved motion estimate compared to single planning 4DMRI (with or without outlier rejection). METHODS: 4DMRI data sets from 10 healthy volunteers were acquired. The first acquisition simulated a planning MRI, the respiratory motion estimate (constructed from the respiratory signal, i.e. the 1D navigator) was compared to the respiratory signal in the subsequent scans (simulating 5-29 treatment fractions). The same procedure was performed using the first acquisition of each day as an estimate for the subsequent acquisitions that day (2 per day, 4-20 per volunteer), simulating a daily MRI strategy. This was done for three outlier strategies: no outlier rejection (NoOR); excluding 5% of the respiratory signal whilst minimizing the range (Min95) and excluding the datapoints outside the mean end-inhalation and end-exhalation positions (MeanIE). RESULTS: The planning MRI median motion estimates were 27 mm for NoOR, 18 mm for Min95, and 13 mm for MeanIE. The daily MRI median motion estimates were 29 mm for NoOR, 19 mm for Min95 and 15 mm for MeanIE. The percentage of time outside the motion estimate were for the planning MRI: 2%, 10% and 32% for NoOR, Min95 and MeanIE respectively. These values were reduced with the daily MRI strategy: 0%, 6% and 17%. Applying Min95 accounted for a 30% decrease in motion estimate compared to NoOR. CONCLUSION: A daily MRI improved the estimation of respiratory motion as compared to a single 4D (planning) MRI significantly. Combining the Min95 technique with a daily 4DMRI resulted in a decrease of inclusion time of 6% with a 30% decrease of motion. Outlier rejection alone on a planning MRI often led to underestimation of the movement and could potentially lead to an underdosage. TRIAL REGISTRATION: protocol W15_373#16.007.

Tip-induced chemical manipulation of metal porphyrins at a liquid/solid interface.

Changing abruptly the potential between a scanning tunneling microscope tip and a graphite substrate induces "high-conductance" spots at the molecular level in a monolayer formed by a manganese chloride-porphyrin molecule. These events are attributed to the pulse-induced formation of µ-oxo-porphyrin dimers. The pulse voltage must pass a certain threshold for dimer formation, and pulse polarity determines the yield.

Templating fullerenes by domain boundaries of a nanoporous network.

We present a new templating approach that combines the templating properties of nanoporous networks with the dynamic properties and the lattice mismatch of domain boundaries. This templating approach allows for the inclusion of guests with different sizes without the need for a strict molecular design to tailor the nanoporous network. With this approach, nonperiodic patterns of functional molecules can be formed and studied. We show that domain boundaries in a trimesic acid network are preferred over pores within the network as adsorption sites for fullerenes by a factor of 100-200. Pristine fullerenes of different sizes and functionalized fullerenes were templated in this way.

Detection of different oxidation states of individual manganese porphyrins during their reaction with oxygen at a solid/liquid interface.

Manganese porphyrins have been extensively investigated as model systems for the natural enzyme cytochrome P450 and as synthetic oxidation catalysts. Here, we report single-molecule studies of the multistep reaction of manganese porphyrins with molecular oxygen at a solid/liquid interface, using a scanning tunnelling microscope (STM) under environmental control. The high lateral resolution of the STM, in combination with its sensitivity to subtle differences in the electronic properties of molecules, allowed the detection of at least four distinct reaction species. Real-space and real-time imaging of reaction dynamics enabled the observation of active sites, immobile on the experimental timescale. Conversions between the different species could be tuned by the composition of the atmosphere (argon, air or oxygen) and the surface bias voltage. By means of extensive comparison of the results to those obtained by analogous solution-based chemistry, we assigned the observed species to the starting compound, reaction intermediates and products.

Polymorphism in porphyrin monolayers: the relation between adsorption configuration and molecular conformation.

Self-assembled monolayers of meso-5,10,15,20-tetrakis(undecyl)porphyrin copper(II) on a graphite/1-octanoic acid interface have been studied by Scanning Tunnelling Microscopy. Four distinct polymorphs were observed, varying in their unit cell size. Arrays of unit cells of the various polymorphs seamlessly connect to each other via shared unit cell vectors. The monolayers are not commensurate, but coincident with the underlying graphite substrate. The seamless transition between the polymorphs is proposed to be the result of an adaptation of the molecular conformations in the polymorphs and at the boundaries, which is enabled by the conformational freedom of the alkyl tails of these molecules.

Little exchange at the liquid/solid interface: defect-mediated equilibration of physisorbed porphyrin monolayers.

The transition from low to high density 2D surface structures of copper porphyrins at a liquid/solid interface requires specific defects at which nearly all exchange of physisorbed molecules with those dissolved in the supernatant occurs.

Controlled templating of porphyrins by a molecular command layer.

The copper porphyrin (5,10,15,20-tetraundecylporphyrinato)copper(II) can be templated in a well-defined arrangement using p-(hexadecyloxycarbonyl)phenylacetylene as a command layer on graphite. The bicomponent system was characterized at the submolecular level at a solid/liquid interface by scanning tunneling microscopy (STM). It is proposed that the layer of copper porphyrins is templated on top of the command layer in a hierarchical fashion, via a combination of intermolecular π-π stacking and van der Waals interactions. A very subtle effect, i.e., a superstructure in the alkyl chain region of the phenylacetylene monolayers, was identified as a decisive factor for the templating process.

Axial ligand control over monolayer and bilayer formation of metal-salophens at the liquid-solid interface.

Nickel salophens exclusively form monolayers at a liquid-solid interface, while in contrast zinc salophens mainly self-assemble into bilayers via axial ligand self-coordination which can be disrupted by the addition of pyridine axial ligands.