Search

Coherent perfect absorption (CPA) describes the absence of all outgoing modes from a lossy resonator, driven by lossless incoming modes. Here, we show that for nanoresonators that also exhibit radiative losses, e.g., plasmonic nanoantennas, a generalized version of CPA (gCPA) can be applied. In gCPA outgoing modes are suppressed only for a subset of (guided plasmonic) modes while other (radiative) modes are treated as additional loss channels - a situation typically referred to as perfect impedance matching. Here we make use of gCPA to show how to achieve perfect impedance matching between a single nanowire plasmonic waveguide and a plasmonic nanoantenna. Antennas with both radiant and subradiant characteristics are considered. We further demonstrate potential applications in background-free sensing.

Motivation: Online adaptive radiotherapy with Ethos is based on the anatomy determined from daily cone beam computed tomography (CBCT) images. Dose optimization and computation are performed on the density map of a synthetic CT (sCT), a deformable registration of the initial planning CT (pCT) onto the current CBCT. Large density changes as present in the lung region are challenging the system. Methods: Treatment plans for Ethos were created and delivered for 1, 2, and 3 cm diameter lung lesions in an anthropomorphic phantom, combining different insets in the pCT and during adaptive and non‐adaptive treatment sessions. Primary and secondary dose calculations as well as back‐projected dose from portal images were evaluated. Results: Density changes due to changed insets were not considered in the sCTs. This resulted in errors in the dose; for example, ‐15.9% of the mean dose for a plan when changing from a 3 cm inset in the pCT to 1 cm at the time of treatment. Secondary dose calculation is based on the sCT and could therefore not reveal these dose errors. However, dose calculation on the CBCT, either as a recalculation in the treatment planning system or as pre‐treatment quality assurance (QA) before the treatment, indicated the differences. EPID in‐vivo QA also reported discrepancies between calculated and delivered dose distributions. Conclusions: An incorrect density distribution in the sCT has an impact on the dose calculation accuracy in the adaptive treatment workflow with the Ethos system. Additional quality checks of the sCT can detect such errors. [ABSTRACT FROM AUTHOR]

Cranial stereotactic irradiations require accurate reproduction of the planning CT patient position at the time of treatment, including removal of rotational offsets. A device prototype was evaluated for potential clinical use to correct rotational positional offsets in image‐guided radiotherapy workflow. Analysis was carried out with a prototype device "RPS head" by gKteso GmbH, rotatable up to 4° in three dimensions by hand wheels. A software tool accounts for the nonrectangular rotation axes and also indicates translational motions to be performed with the standard couch to correct the initial offset and translational shifts introduced by the rotational motion. The accuracy of angular corrections and positioning of an Alderson RANDO head phantom using the prototype device was evaluated for nine treatment plans for cranial targets. Corrections were obtained from cone beam computed tomography (CBCT) imaging. The phantom position was adjusted and the final position was then verified by another CBCT. The long‐term stability of the prototype device was evaluated. Attenuation by the device along its three main axes was assessed. A planning study was performed to evaluate if regions of high‐density material can be avoided during plan generation. The device enabled the accurate correction of rotational offsets in a clinical setup with a mean residual angular difference of (0.0 ± 0.1)° and a maximum deviation of 0.2°. Translational offsets were less than 1 mm. The device was stable over a period of 20 min, not changing the head support plate position by more than (0.7 ± 0.6) mm. The device contains high‐density material in the adjustment mechanism and slightly higher density in the support structures. These can be avoided during planning generation maintaining comparable plan quality. The head positioning device can be used to correct rotational offsets in a clinical setting. [ABSTRACT FROM AUTHOR]

Purpose: Secondary dose calculation (SDC) with an independent algorithm is one option to perform plan‐specific quality assurance (QA). While measurement‐based QA can potentially detect errors in plan delivery, the dose values are typically only compared to calculations on homogeneous phantom geometries instead of patient CT data. We analyzed the sensitivity and specificity of an SDC software by purposely introducing different errors and determined thresholds for optimal decisions. Methods: Thirty head and neck VMAT plans and 30 modifications of those plans, including errors related to density and beam modelling, were recalculated using RadCalc with a Monte Carlo algorithm. Decision thresholds were obtained by receiver operating characteristics (ROC) analysis. For comparison, measurement‐based QA using the ArcCHECK phantom was carried out and evaluated in the same way. Results: Despite optimized decision thresholds, none of the systems was able to reliably detect all errors. ArcCHECK analysis using a 2%/2 mm criterion with a threshold of 91.1% had an area under the curve (AUC) of 0.80. Evaluating differences in recalculated and planned DVH parameter of the target structures in RadCalc with a 2% threshold an AUC of 0.86 was achieved. Out‐of‐field deviations could be attributed to weaknesses in the beam model. Conclusions: Secondary dose calculation with RadCalc is an alternative to established measurement‐based phantom QA. Different tools catch different errors; therefore, a combination of approaches should be preferred. [ABSTRACT FROM AUTHOR]

Purpose: Developed as a plan‐specific pre‐treatment QA tool, Varian portal dosimetry promises a fast, high‐resolution, and integrated QA solution. In this study, the agreement between predicted fluence and measured cumulative portal dose was determined for the first 140 patient plans at our Halcyon linear accelerator. Furthermore, the capability of portal dosimetry to detect incorrect plan delivery was compared to that of a common QA phantom. Finally, tolerance criteria for verification of VMAT plan delivery with Varian portal dosimetry were derived. Methods: All patient plans and the corresponding verification plans were generated within the Eclipse treatment planning system. Four representative plans of different treatment sites (prostate, prostate with lymphatic drainage, rectum, and head & neck) were intentionally altered to model incorrect plan delivery. Investigated errors included both systematic and random errors. Gamma analysis was conducted on both portal dose (criteria γ2%/2 mm, γ2%/1 mm, and γ1%/1 mm) and ArcCHECK measurements (criteria γ3%/3 mm, γ3%/2 mm, and γ2%/2 mm) with a 10% low‐dose threshold. Performance assessment of various acceptance criteria for plan‐specific treatment QA utilized receiver operating characteristic (ROC) analysis. Results: Predicted and acquired portal dosimetry fluences demonstrated a high agreement evident by average gamma passing rates for the clinical patient plans of 99.90%, 96.64%, and 91.87% for γ2%/2 mm, γ2%/1 mm, and γ1%/1 mm, respectively. The ROC analysis demonstrated a very high capability of detecting erroneous plan delivery for portal dosimetry (area under curve (AUC) > 0.98) and in this regard outperforms QA with the ArcCHECK phantom (AUC ≈ 0.82). With the suggested optimum decision thresholds excellent sensitivity and specificity is simultaneously possible. Conclusions: Owing to the high achievable spatial resolution, portal dosimetry at the Halcyon can reliably be deployed as plan‐specific pre‐treatment QA tool to screen for errors. It is recommended to support the fluence integrated portal dosimetry QA by independent phantom‐based measurements of a random sample survey of treatment plans. [ABSTRACT FROM AUTHOR]

Objectives: Dual-source dual-energy CT (DECT) facilitates reconstruction of virtual non-contrast images from contrast-enhanced scans within a limited field of view. This study evaluates the replacement of true non-contrast acquisition with virtual non-contrast reconstructions and investigates the limitations of dual-source DECT in obese patients. Materials and Methods: A total of 253 oncologic patients (153 women; age 64.5 ± 16.2 years; BMI 26.6 ± 5.1 kg/m2) received both multi-phase single-energy CT (SECT) and DECT in sequential staging examinations with a third-generation dual-source scanner. Patients were allocated to one of three BMI clusters: non-obese: <25 kg/m2 (n = 110), pre-obese: 25–29.9 kg/m2 (n = 73), and obese: >30 kg/m2 (n = 70). Radiation dose and image quality were compared for each scan. DECT examinations were evaluated regarding liver coverage within the dual-energy field of view. Results: While arterial contrast phases in DECT were associated with a higher CTDIvol than in SECT (11.1 vs. 8.1 mGy; p < 0.001), replacement of true with virtual non-contrast imaging resulted in a considerably lower overall dose-length product (312.6 vs. 475.3 mGy·cm; p < 0.001). The proportion of DLP variance predictable from patient BMI was substantial in DECT (R2 = 0.738) and SECT (R2 = 0.620); however, DLP of SECT showed a stronger increase in obese patients (p < 0.001). Incomplete coverage of the liver within the dual-energy field of view was most common in the obese subgroup (17.1%) compared with non-obese (0%) and pre-obese patients (4.1%). Conclusion: DECT facilitates a 30.8% dose reduction over SECT in abdominal oncologic staging examinations. Employing dual-source scanner architecture, the risk for incomplete liver coverage increases in obese patients. [ABSTRACT FROM AUTHOR]

Simple Summary: Patients, who suffer from oligorecurrent prostate cancer with limited nodal involvement, may be offered positron emission tomography (PET)-directed salvage nodal radiotherapy to delay disease progression. This current analysis aimed to access salvage radiotherapy for nodal oligorecurrent prostate cancer with simultaneous integrated boost to PET-involved lymph nodes as metastasis-directed therapy. A long-term oncological outcome was favorable after salvage nodal radiotherapy and severe toxicity rates were low. Androgen deprivation therapy plays a major role in recurrent prostate cancer management and demonstrates a positive influence on the rate of biochemical progression in patients receiving salvage nodal radiotherapy. The present long-term analysis may help clinicians identify patients who would benefit from salvage nodal radiotherapy and androgen deprivation therapy, as a multimodal treatment strategy for oligorecurrent prostate cancer. Background: The study aimed to access the long-term outcome of salvage nodal radiotherapy (SNRT) in oligorecurrent prostate cancer. Methods: A total of 95 consecutive patients received SNRT for pelvic and/or extrapelvic nodal recurrence after prostate-specific membrane antigen (PSMA) or choline PET from 2010 to 2021. SNRT was applied as external beam radiotherapy with simultaneous integrated boost up to a median total dose of 62.9 Gy (EQD21.5Gy) to the recurrent lymph node metastases. The outcome was analyzed by cumulative incidence functions with death as the competing risk. Fine–Gray regression analyses were performed to estimate the relative hazards of the outcome parameters. Genitourinary (GU)/gastrointestinal (GI) toxicity evaluation utilized Common Toxicity Criteria for Adverse Events (v5.0). The results are as follows: the median follow-up was 47.1 months. The five-year biochemical progression rate (95% CI) was 50.1% (35.7–62.9%). Concomitant androgen deprivation therapy (ADT) was adminstered in 60.0% of the patients. The five-year biochemical progression rate was 75.0% (42.0–90.9%) without ADT versus 35.3% (19.6–51.4%) with ADT (p = 0.003). The cumulative five-year late grade 3 GU toxicity rate was 2.1%. No late grade 3 GI toxicity occured. Conclusions: Metastasis-directed therapy through SNRT for PET-staged oligorecurrent prostate cancer demonstrated a favorable long-term oncologic outcome. Omittance of ADT led to an increased biochemical progression. [ABSTRACT FROM AUTHOR]

Purpose: To compare radiotherapy plans between an O‐ring and a conventional C‐arm linac for hypofractionated high‐dose prostate radiotherapy in terms of plan quality, dose distribution, and quality assurance in a multi‐vendor environment. Methods: Twenty prostate cancer treatment plans were irradiated on the O‐ring Varian Halcyon linac and were re‐optimized for the C‐arm Elekta Synergy Agility linac. Dose‐volume histogram metrics for target coverage and organ at risk dose, quality assurance, and monitor units were retrospectively compared. Patient‐specific quality assurance with ion chamber measurements, gamma index analysis, and portal dosimetry was performed using the Varian Portal Dosimetry system and the ArcCHECK® phantom (Sun Nuclear Corporation). Prostate‐only radiotherapy was delivered with simultaneous integrated boost (SIB) volumetric modulated arc therapy (VMAT) in 20 fractions of 2.5/3.0 Gy each. Results: For both linacs, target coverage was excellent and plan quality comparable. Homogeneity in PTVBoost was high for Synergy as well as Halcyon with a mean homogeneity index of 0.07 ± 0.01 and 0.05 ± 0.01, respectively. Mean dose for the organs at risk rectum and bladder differed not significantly between the linacs but were higher for the femoral heads and penile bulb for Halcyon. Quality assurance showed no significant differences in terms of ArcCHECK gamma pass rates. Median pass rate for 3%/2 mm was 99.3% (96.7 to 99.8%) for Synergy and 99.8% (95.6 to 100%) for Halcyon. Agreement between calculated and measured dose was high with a median deviation of −0.6% (−1.7 to 0.8%) for Synergy and 0.2% (−0.6 to 2.3%) for Halcyon. Monitor units were higher for the Halcyon by approximately 20% (p < 0.001). Conclusion: Hypofractionated high‐dose prostate cancer SIB VMAT on the Halcyon system is feasible with comparable plan quality in reference to a standard C‐arm Elekta Synergy linac. [ABSTRACT FROM AUTHOR]

Purpose: The integral quality monitor (IQM) transmission detector is a wedge‐shaped large area ionization chamber that reports a position‐weighted dose area product for each control point of an IMRT or VMAT plan. In this study, the accuracy of the signal prediction is verified for the Synergy Agility MLC. Tolerance criteria for VMAT plan verification with the IQM were obtained from the observed sensitivity for the detection of incorrectly delivered plans. Methods: The predicted IQM signal was compared to the measured signal recorded for a set of 30 VMAT plans for each beam quality of 6 and 10 MV. The system's capability to detect incorrectly delivered plans was tested by measuring altered plans containing small, random deviations. In addition, the observed deviations were related to measurements performed with a second QA phantom. Results: The cumulative IQM signal per arc deviated from the respective calculation on average by −0.48% (6 MV) and +0.21% (10 MV) with a standard deviation of 1.08% in both cases, suggesting a 2% warning and 3% action threshold as plan acceptance criteria. This choice was confirmed by the optimum threshold of 2.5% obtained via receiver operating characteristic (ROC) analysis. Reproducibility of individual control points in multiply measured plans was low (on average 7% for 1SD) and thus, segment‐by‐segment comparison was impractical. A suitable criterion to resolve the angular distribution of the plan was identified by binning three to five control points as a running average. While the correlation between IQM signal deviations and gamma passing rates obtained with the ArcCHECK phantom was low for clinical plans, it was apparent for erroneous plans. Binning led to even higher sensitivity to errors. Conclusions: The IQM was able to detect induced errors at least as reliable as the standard phantom and showed the potential to be used in pretreatment plan verification to ensure the correct plan transfer and delivery. However, there is no direct correlation between the IQM signal deviation and DVH metrics, so the IQM should be primarily used to screen for errors. Finer diagnostics should then be carried out using a different phantom. [ABSTRACT FROM AUTHOR]

• Varying bolus thicknesses were reproduced within 2 mm accuracy in synthetic CTs on Ethos. • Different air gaps between planning CT and treatment resulted in deformations in the synthetic CT. • Tight-fitting air gap-free bolus should be preferred. Ethos allows online adaption of radiotherapy treatment plans. Dose is calculated on synthetic computed tomographies (sCT), CT-like images generated by deforming planning CTs (pCT) onto daily cone beam CTs (CBCT) acquired during treatment sessions. Errors in sCT density distribution may lead to dose calculation errors. sCT correctness was investigated for bolus-covered surfaces. pCTs were recorded of a slab phantom covered with bolus of different thicknesses and with air gaps introduced by spacer rings of variable diameters and heights. Treatment plans were irradiated following the adaptive workflow with different bolus configurations present in the pCT and CBCT. sCT densities were compared to those of the pCT for the same air gap size. Additionally, the neck region of an anthropomorphic phantom was imaged using a plane standard bolus versus an individual bolus adapted to the phantom's outer contour. Varying bolus thickness by 5 mm between pCT and CBCT was reproduced in the sCT within 2 mm accuracy. Different air gaps in pCT and CBCT resulted in highly variable bolus thickness in the sCT with a typical error of 5 mm or more. In extreme cases, air gaps were filled with bolus material density in the sCT or the phantom was unrealistically deformed near changed bolus geometries. Changes in bolus thickness and deformation also occurred in the anthropomorphic phantom. sCTs must be critically examined and included in plan-specific quality assurance. The use of tight-fitting air gap-free bolus should be preferred to increase the similarity between sCT and CBCT. [ABSTRACT FROM AUTHOR]

The design of noble-metal plasmonic devices and nanocircuitry requires a fundamental understanding and control of the interference of plasmonic modes. Here we report the first visualization of the propagation and interference of guided modes in a showcase plasmonic nanocircuit using normal-incidence nonlinear two-photon photoemission electron microscopy (PEEM). We demonstrate that in contrast to the commonly used grazing-incidence illumination scheme, normal-incidence PEEM provides a direct image of the structure's near-field intensity distribution due to the absence of beating patterns and despite the transverse character of the plasmonic modes. Based on a simple heuristic numerical model for the photoemission yield, we are able to model all experimental findings if global plane wave illumination and coupling to multiple input/output ports, and the resulting interference effects are accounted for. [ABSTRACT FROM AUTHOR]

The article offers information on a study conducted by the authors on transfer of angular momentum in optical near-fields of optical antennas. Topics discussed include deviation of geometrical antenna from photoemission yield, confinement of near-field to antenna arms with reduced polarization, increased circular polarization in the center of antenna, and momentum transfer by transfer of spin polarized electrons.

We experimentally demonstrate synthesis and in situ analysis of multimode plasmonic excitations in two-wire transmission lines supporting a symmetric and an antisymmetric eigenmode. To this end we irradiate an incoupling antenna with a diffraction-limited excitation spot exploiting a polarization- and position-dependent excitation efficiency. Modal analysis is performed by recording the far-field emission of two mode-specific spatially separated emission spots at the far end of the transmission line. To illustrate the power of the approach we selectively determine the group velocities of symmetric and antisymmetric contributions of a multimode ultrafast plasmon pulse. [ABSTRACT FROM AUTHOR]

The results of 10 years of patch testing in children aged 3-16 years are reported. The commonest allergens found were nickel, cobalt, para-dyes and chromate. 26 cases are recorded in detail. [ABSTRACT FROM AUTHOR]