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The widespread use of deformable dose accumulation (DDA) in adaptive radiotherapy (ART) has been limited due to the lack of clinically compatible methods to consider its related uncertainties.We estimate dose reconstruction uncertainties in daily DDA during CT-guided radiotherapy of head-and-neck cancer (HNC). We project confidence intervals of cumulative dose-volume parameters to the parotids and determine threshold values to guide clinical decision-making in ART.Doses from daily images (megavoltage CTs [MVCTs]) of 20 HNC patients treated with tomotherapy were reconstructed and accumulated in the planning CT (PCT) utilizing a commercial DDA algorithm (PreciseART, Accuray, Inc.). For each mapped fraction, we warped the planning contours to the MVCT. Dose-volume histograms (DVHs) calculated in the MVCT (with warped contour and native dose) and the PCT (with native contour and mapped dose) were compared; the observed inconsistencies were associated with dose reconstruction errors. We derived uncertainty bounds for the transferred dose to voxels within the structure of interest in the PCT. The confidence intervals of cumulative dose-volume parameters were mid-treatment projected and evaluated as predictors of the end of treatment cumulative metrics. The need for plan adaptation was tested by comparing the projected uncertainty bounds with the treatment constraint points.Among all cases, the uncertainty in mean values of daily dose distributions mapped to the reference parotid's contours averaged between 2.8% and 3.8% of typical single fraction planning values and less than 1% for the planning target volume (PTV) D95%. These daily inconsistencies were higher in the ipsilateral compared to the contralateral parotid and increased toward the end of treatment. The magnitude of the uncertainty bounds for the cumulative treatment mean dose, D50%, and V20 Gy to the parotids, and PTV D95% were on average 3.5%, 6.6%, 4.6%, and 0.4% of the planned or prescribed values, with confidence intervals of 97.1%-107.0%, 98.2%-110.4%, 95.6%-111.1%, and 98.2%-100.2% respectively. The uncertainty intervals projected at mid-treatment intersected with the end of treatment bounds in 82% of the parotid's metrics; half of them presented an overlapping percentage greater than 60%. In five patients, the cumulative mean doses were projected at mid-treatment to exceed the total treatment constraint point by at least 3%; this threshold was exceeded at the end of treatment in the five cases. Underdosing was projected in only one case; the cumulative PTV D95% at the end of treatment was below the clinical threshold.Uncertainty bounds were incorporated into the results of a commercial DDA tool. The cohort's statistics showed that the parotids' cumulative DVH metrics frequently exceeded the planning values if confidence intervals were included. Most of the uncertainty bounds of the PTV metrics were kept within the clinical thresholds. We verified that mid-treatment violation projections led to exceeding the constraint point at the end of the treatment. Based on a 3% threshold, approximately one fourth of the patients are expected to be replanned at mid-treatment for parotids sparing during HNC radiotherapy.

The abstract is available here: https://uscholar.univie.ac.at/o:1649467

PURPOSE We present a DVH overlay technique as a quality assurance (QA) metric for deformable image registration-based dose accumulation (DIR-DA). We use the technique to estimate the uncertainty in a DIR-DA for a revised treatment plan, and to compare two different DIR algorithms. MATERIALS AND METHODS The required inputs to the DVH overlay workflow are deformably registered primary and secondary images, primary regions-of-interest (ROIs), and secondary dose distribution. The primary ROIs were forward warped to the secondary image, the secondary dose was inversely warped to the primary image, and the DVHs for each image were compiled. Congruent DVHs imply minimal inverse consistency error (ICE) within an ROI. For a pancreas case re-planned after 21 fractions of a 29-fraction course, the workflow was used to quantify dose accumulation error attributable to ICE, based on a hybrid contour-and-intensity-based DIR. The usefulness of the workflow was further demonstrated by assessing the performance of two DIR algorithms (one free-form intensity-based, FFIB, the other using normalized correlation coefficients, NCC, over small neighborhood patches) as applied toward kVCT-to-MVCT registration and five-fraction dose accumulation of ten male pelvis cases. RESULTS For the re-planned pancreas case, when applying the DVH-overlay-based uncertainties the resulting accumulated dose remained compliant with all but two of the original plan objectives. Among the male pelvis cases, FFIB and NCC DIR showed good invertibility within the PTV, according to the DVH overlay QA results. NCC DIR exhibited better invertibility for the bladder and rectum compared with FFIB. However, compared with FFIB, NCC DIR exhibited less regional deformation for the bladder and a tendency for increased local contraction of the rectum ROI. For the five-fraction summations, ICE for the PTV V100%Rx is comparable for both algorithms (FFIB 0.8±0.7%, NCC 0.7±0.3%). For the bladder and rectum V70%Rx , ICE is greater for FFIB (1.8±0.7% for bladder, 1.7±0.6% for rectum) than for NCC (1.0±0.3% for bladder, 1.0±0.4% for rectum). CONCLUSIONS The DVH overlay technique identified instances in which a DIR exhibits favorable invertibility, implying low inverse consistency error in a DIR-based dose accumulation. Differences in the overlaid DVHs can also estimate dose accumulation errors attributable to ICE for given ROIs. This article is protected by copyright. All rights reserved.

Purpose The paper presents a novel method to reduce the RF-induced heating of active implantable medical devices during MRI. Methods With the addition of an energy decoying and dissipating structure, RF energy can be redirected toward the dissipating rings through the decoying conductor. Three lead groups (45 cm-50 cm) and 4 (50 cm-100 cm) were studied in 1.5 Tesla MR systems by simulation and measurement, respectively. In vivo modeling was performed using human models to estimate the RF-induced heating of an active implantable medical device for spinal cord treatment. Result In the simulation study, it was shown that the peak 1g-averaged specific absorption rate near the lead-tips can be reduced by 70% to 80% compared to those from the control leads. In the experimental measurements during a 2-min exposure test in a 1.5 Telsa MR system, the temperature rises dropped from the original 18.3℃, 25.8℃, 8.1℃, and 16.1℃ (control leads 1-4) to 5.4℃, 6.9℃, 1.6℃, and 3.3℃ (leads 1-4 with the energy decoying and dissipation structure). The in vivo calculation results show that the maximum induced temperature rise among all cases can be substantially reduced (up to 80%) when the energy decoying and dissipating structures were used. Conclusion Our studies confirm the effectiveness of the novel technique for a variety of scanning scenarios. The results also indicate that the decoying conductor length, number of rings, and ring area must be carefully chosen and validated.

Consumers feeding at the aquatic–terrestrial ecosystem interface may obtain a mixture of aquatic and terrestrial diet resources that vary in nutritional composition. However, in lake riparian spiders, the relative significance of aquatic versus terrestrial diet sources remains to be explored. We investigated the trophic transfer of lipids and polyunsaturated fatty acids (PUFA) from emergent aquatic and terrestrial insects to spiders at varying distances from the shoreline of a subalpine lake in Austria, using differences in fatty acid profiles and compound-specific stable carbon (δ13C) and hydrogen (δ2H) isotopes. The omega-3 PUFA content of emergent aquatic insects was higher than that of terrestrial insects. Emergent aquatic insects contained on average 6.6 times more eicosapentaenoic acid (EPA) and 1.2 times more α-linolenic acid (ALA) than terrestrial insects, whereas terrestrial insects contained on average 2.6 times more linoleic acid (LIN) than emergent aquatic insects. Spiders sampled directly on the lake and in upland habitats had similar EPA contents, but this EPA was derived from different diet sources, depending on the habitat. The δ13CEPA and δ2HEPA values of ‘lake spiders' revealed an aquatic diet pathway (i.e. EPA of aquatic origin). In contrast, EPA of spiders collected in terrestrial habitats was depleted in both 13C and 2H compared to any potential food sources, and their ALA isotopic values, suggesting that EPA was partly bioconverted from its dietary precursor ALA (i.e. internal pathway). The δ2H values of fatty acids clearly indicated that diet sources differed depending on the spider's habitat, which was less evident from the δ13C values of the fatty acids. Our data highlight that spiders can use two distinct pathways (trophic versus metabolic) to satisfy their physiological EPA demand, depending on habitat use and dietary availability. published

1. Omega-3 long-chain polyunsaturated fatty acids (n-3 LC-PUFA) are essential micronutrients for optimal functioning of cellular metabolism and for somatic growth of all vertebrates including fishes. In addition, n-3 LC-PUFA could also play a key role in response of fishes and other ectothermic vertebrates to changing temperatures. 2. An important, but largely overlooked, consequence of climate change is the reduced availability of dietary n-3 LC-PUFA in aquatic food webs. Changes in availability of dietary n-3 LC-PUFA have recently been proposed as a major driver of novel adaptations and diversification of consumers. Yet, there is only limited knowledge about how n-3 LC-PUFA depletion in aquatic food-webs will affect the performance of wild fishes. 3. Here we combine biochemistry and physiology at the cellular level with physiological and cognitive processes at the whole-animal level to test how ecologically relevant deprivation of n-3 LC-PUFA affects performance of wild juvenile Atlantic salmon (Salmo salar). 4. We found that juvenile salmon had a limited capacity to maintain the fatty acid profile of both muscle and brain under a n-3 LC-PUFA-deficient diet. Despite these findings, brain tissues showed remarkable functional stability in mitochondrial metabolism, and we found no effect of diet on learning ability. However, we found that mitochondrial efficiency in muscles and the somatic growth were reduced under a n-3 LC-PUFA-deficient diet. Importantly, we discovered that the somatic growth of juvenile salmon within both treatments decreased with increasing rate of DHA synthesis and retention. 5. Since DHA is essential for functioning of cellular metabolism, which together with body size are traits closely related to fitness of wild fishes, we suggest that the trade-off between growth rate and accumulation of DHA could play a critical role in resilience of juvenile salmon to the ongoing rapid environmental change.

1. Organisms at the base of aquatic food webs synthesize essential nutrients, such as omega-3 polyunsaturated fatty acids (n-3 PUFA), which are transferred to consumers at higher trophic levels. Many consumers, requiring n-3 long-chain (LC) PUFA, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have limited ability to biosynthesize them from the essential dietary precursor alpha-linolenic acid (ALA) and thus rely on dietary provision of LC-PUFA. 2. We investigated LC-PUFA metabolism in freshwater zooplankton using stable hydrogen isotopes (delta H-2) of fatty acids as tracers. We conducted feeding experiments with the freshwater keystone grazer Daphnia to quantify changes in the delta H-2 value of body FA in response to the FA composition of their food and the delta H-2 value of the ambient water. 3. The isotopic composition of LC-PUFA changed in Daphnia, depending on the integration of H-2 from ambient water during de novo synthesis or bioconversion from dietary precursors, allowing us to distinguish dietary from bioconverted EPA in body tissue. We tested the applicability of these laboratory findings in a field setting by analysing delta H-2 values of PUFA in primary producers and consumers in eutrophic ponds to track EPA sources of zooplankton. 4. Multilinear regression models that included conversion of ALA to EPA correlated better with zooplankton delta H-2 EpA than seston delta H-2(EPA) at low dietary EPA supply. 5. This study provides evidence that zooplankton can compensate for low dietary EPA supply by activating LC-PUFA biosynthesis and shows that herbivorous zooplankton play a crucial role in upgrading FA for higher trophic levels during low dietary EPA supply.

Purpose This paper studies the RF-induced heating for modular external fixation devices applied on the leg regions of the human bodies. Through numerical investigations of RF-induced heating related to different patient orientations, landmark positions, and device positions under 1.5T and 3T MRI systems, simple and practical methods to reduce RF-induced heating are recommended. Methods Numerical simulations using a full-wave electromagnetic solver based on the finite-difference time-domain method were performed to characterize the effects of patient orientations (head-first/feet-first), landmark positions (the scanning area of the patient), and device positions (device on left or right leg) on the RF-induced heating of the external fixation devices. The G32 coil design and three anatomical human models (Duke model, Ella model, and Fats model) were adopted to model the MRI RF coil and the patients. Results The relative positions of the patient, device, and coil can significantly affect the RF-induced heating. With other conditions remaining the same, changing the device position or patient orientation can lead to a peak 1-g averaged spatial absorption ratio variation of a factor around four. By changing the landmark position and the patient orientation, the RF-induced heating can be reduced from 1323.6 W/kg to 217.5 W/kg for the specific scanning situations studied. Conclusion Patient orientations, landmark positions, and device positions influence the RF-induced heating of modular external fixation devices at 1.5 T and 3 T. These features can be used to reduce the RF-induced heating during MRI simply and practically.

X‐ray regulations and room design methodology vary widely across Canada. The Canadian Organization of Medical Physicists (COMP) conducted a survey in 2016/2017 to provide a useful snapshot of existing variations in rules and methodologies for human patient medical imaging facilities. Some jurisdictions no longer have radiation safety regulatory requirements and COMP is concerned that lack of regulatory oversight might erode safe practices. Harmonized standards will facilitate oversight that will ensure continued attention is given to public safety and to control workplace exposure. COMP encourages all Canadian jurisdictions to adopt the dose limits and constraints outlined in Health Canada Safety Code 35 with the codicil that the design standards be updated to those outlined in NCRP 147 and BIR 2012.

Background: Ultrasound (US) imaging is characterised by high levels of operator subjectivity and variability. Recent advances in artificial intelligence (AI) have demonstrated the potential to reduce both factors. This study pilots the end-to-end automation of multiple elements of the mid-trimester obstetric screening US scan using AI-enabled tools. Methods: A single centre, prospective method comparison study was conducted. Participants had both standard manual and AI-assisted US scans performed independently by different blinded sonographers. The AI-tools automated the acquisition of standard plane images, measurement of fetal biometrics and the production of a written clinical report with saved images available for review. A feedback survey captured the sonographers’ perception of scanning with both methods. Findings: Twenty-three subjects were studied. The average time saving per scan was 7.62 min (34.7%) when using the AI-assisted method (p

1. Omega-3 long-chain polyunsaturated fatty acids (n-3 LC-PUFA) are essential micronutrients for optimal functioning of cellular metabolism and for somatic growth of all vertebrates including fishes. In addition, n-3 LC-PUFA could also play a key role in response of fishes and other ectothermic vertebrates to changing temperatures.\ud \ud 2. An important, but largely overlooked, consequence of climate change is the reduced availability of dietary n-3 LC-PUFA in aquatic food webs. Changes in availability of dietary n-3 LC-PUFA have recently been proposed as a major driver of novel adaptations and diversification of consumers. Yet, there is only limited knowledge about how n-3 LC-PUFA depletion in aquatic food-webs will affect the performance of wild fishes.\ud \ud 3. Here we combine biochemistry and physiology at the cellular level with physiological and cognitive processes at the whole-animal level to test how ecologically relevant deprivation of n-3 LC-PUFA affects performance of wild juvenile Atlantic salmon (Salmo salar).\ud \ud 4. We found that juvenile salmon had a limited capacity to maintain the fatty acid profile of both muscle and brain under a n-3 LC-PUFA-deficient diet. Despite these findings, brain tissues showed remarkable functional stability in mitochondrial metabolism, and we found no effect of diet on learning ability. However, we found that mitochondrial efficiency in muscles and the somatic growth were reduced under a n-3 LC-PUFA-deficient diet. Importantly, we discovered that the somatic growth of juvenile salmon within both treatments decreased with increasing rate of DHA synthesis and retention.\ud \ud 5. Since DHA is essential for functioning of cellular metabolism, which together with body size are traits closely related to fitness of wild fishes, we suggest that the trade-off between growth rate and accumulation of DHA could play a critical role in resilience of juvenile salmon to the ongoing rapid environmental change.