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Purpose: To evaluate two commercial CT metal artifact reduction (MAR) algorithms for use in proton treatment planning in the head and neck (H&N) area. Methods: An anthropomorphic head phantom with removable metallic implants (dental fillings or neck implant) was CT-scanned to evaluate the O-MAR (Philips) and the iMAR (Siemens) algorithms. Reference images were acquired without any metallic implants in place. Water equivalent thickness (WET) was calculated for different path directions and compared between image sets. Images were also evaluated for use in proton treatment planning for parotid, tonsil, tongue base, and neck node targets. The beams were arranged so as to not traverse any metal prior to the target, enabling evaluation of the impact on dose calculation accuracy from artifacts surrounding the metal volume. Plans were compared based on analysis (1 mm distance-to-agreement/1% difference in local dose) and dose volume histogram metrics for targets and organs at risk (OARs). Visual grading evaluation of 30 dental implant patient MAR images was performed by three radiation oncologists. Results: In the dental fillings images, WET along a low-density streak was reduced from -17.0 to -4.3 mm with O-MAR and from -16.1 mm to -2.3 mm with iMAR, while for other directions the deviations were increased or approximately unchanged when the MAR algorithms were used. For the neck implant images, WET was generally reduced with MAR but residual deviations remained (of up to -2.3 mm with O-MAR and of up to -1.5 mm with iMAR). The analysis comparing proton dose distributions for uncorrected/MAR plans and corresponding reference plans showed passing rates >98% of the voxels for all phantom plans. However, substantial dose differences were seen in areas of most severe artifacts ( passing rates of down to 89% for some cases). MAR reduced the deviations in some cases, but not for all plans. For a single patient case dosimetrically evaluated, minor dose differences were seen between the uncorrected and MAR plans ( passing rate approximately 97%). The visual grading of patient images showed that MAR significantly improved image quality (P < 0.001). Conclusions: O-MAR and iMAR significantly improved image quality in terms of anatomical visualization for target and OAR delineation in dental implant patient images. WET calculations along several directions, all outside the metallic regions, showed that both uncorrected and MAR images contained metal artifacts which could potentially lead to unacceptable errors in proton treatment planning. WET was reduced by MAR in some areas, while increased or unchanged deviations were seen for other path directions. The proton treatment plans created for the phantom images showed overall acceptable dose distributions differences when compared to the reference cases, both for the uncorrected and MAR images. However, substantial dose distribution differences in the areas of most severe artifacts were seen for some plans, which were reduced by MAR in some cases but not all. In conclusion, MAR could be beneficial to use for proton treatment planning; however, case-by-case evaluations of the metal artifact-degraded images are always recommended.

Purpose: To evaluate for proton therapy treatment planning the feasibility of two commercial metal artifact reduction (MAR) algorithms in CT-imaging.Materials and Methods: A head phantom with remov ...

Highlights • A combination of proton therapy and deep inspiration breath-hold can reduce normal tissue dose. • The first patients treated showed clinically acceptable inter breath-hold variations. • The treatment strategy is robust and works well at a proton center., Background Most patients with Hodgkin’s lymphoma are young and have a favourable prognosis, therefore it is of high importance to decrease the radiation doses to normal tissues received during radiotherapy. A combination of proton therapy and deep inspiration breath-hold technique (DIBH) can improve the sparing effect and thereby reduce the risk of late effects. Case presentation The two first patient cases treated with proton therapy in DIBH at the Skandion Clinic, Uppsala, Sweden, are presented here. Proton treatment plans were compared to photon plans based on doses to target and organs at risk. Several CT scans were acquired during the treatment course and inter breath-hold variations were evaluated based on anatomical distances and dosimetric comparisons. Conclusions The results from our first patients treated with proton therapy in DIBH imply that the treatment strategy is robust and has the potential to reduce dose to normal tissue.

The overall aim of this article is to develop in-depth knowledge about the connection between outdoor experiences and moral attitudes towards nature. The study focuses on processes in which moral relations are at stake in encounters between students and nature. The purpose is to identify such events, describe their specific circumstances and clarify how moral relations are established in these events. The empirical material consists of video-recordings of activities in three different outdoor education practices. In order to identify and categorise moral situations, an analytical tool called the ethical tendency is used. This tool is based on Wittgenstein’s language game method. The findings show that in the investigated outdoor education practices, moral relations towards nature are established in several different ways. The article concludes with four educational implications: responsibility when dealing with moral reactions; bring- ing ethical questions to the fore; different educational conditions create different encounters with nature; and the consequences of different language games.

Metal objects in the body such as hip prostheses cause artifacts in CT images. When CT images degraded by artifacts are used for treatment planning of radiotherapy, the artifacts can yield inaccurate dose calculations and, for particle beams, erroneous penetration depths. A metal artifact reduction software (O‐MAR) installed on a Philips Brilliance Big Bore CT has been tested for applications in treatment planning of proton radiotherapy. Hip prostheses mounted in a water phantom were used as test objects. Images without metal objects were acquired and used as reference data for the analysis of artifact‐affected regions outside of the metal objects in both the O‐MAR corrected and the uncorrected images. Water equivalent thicknesses (WET) based on proton stopping power data were calculated to quantify differences in the calculated proton beam penetration for the different image sets. The WET to a selected point of interest between the hip prostheses was calculated for several beam directions of clinical relevance. The results show that the calculated differences in WET relative to the reference case were decreased when the O‐MAR algorithm was applied. WET differences up to 2.0 cm were seen in the uncorrected case while, for the O‐MAR corrected case, the maximum difference was decreased to 0.4 cm. The O‐MAR algorithm can significantly improve the accuracy in proton range calculations. However, there are some residual effects, and the use of proton beam directions along artifact streaks should only be used with caution and appropriate margins. PACS numbers: 87.55.D‐, 87.57.cp

CD8

Tooling manufacturers are looking at simulations to cut the time and cost in producing near-net-shape parts through injection moulding…

We have previously reported the molecular signature of murine pathogenic TH17 cells that induce experimental autoimmune encephalomyelitis (EAE) in animals. Here we show that human peripheral blood IFN-γ+IL-17+ (TH1/17) and IFN-γ−IL-17+ (TH17) CD4+ T cells display distinct transcriptional profiles in high-throughput transcription analyses. Compared to TH17 cells, TH1/17 cells have gene signatures with marked similarity to mouse pathogenic TH17 cells. Assessing 15 representative signature genes in patients with multiple sclerosis, we find that TH1/17 cells have elevated expression of CXCR3 and reduced expression of IFNG, CCL3, CLL4, GZMB, and IL10 compared to healthy controls. Moreover, higher expression of IL10 in TH17 cells is found in clinically stable vs. active patients. Our results define the molecular signature of human pro-inflammatory TH17 cells, which can be used to both identify pathogenic TH17 cells and to measure the effect of treatment on TH17 cells in human autoimmune diseases., CD4+ T cells secreting interleukin-17 (TH17) have diverse functions in modulating autoimmune diseases. Here the authors show via transcriptome analyses that a subset of human TH 17 co-expressing interferon-γ (TH1/17) has a molecular signature similar to “pathogenic” mouse TH 17 but distinct from “non-pathogenic” mouse TH 17.

Objectives: To evaluate metal artefact reduction (MAR) techniques from four computed tomography (CT) vendors in hip prosthesis imaging. Methods: Bilateral hip prosthesis phantom images, obtained by using MAR algorithms for single energy CT data or dual energy CT (DECT) data and by monoenergetic reconstructions of DECT data, were visually graded by five radiologists using ten image quality criteria. Comparisons between the MAR images and a reference image were performed for each scanner separately. Ordinal probit regression analysis was used. Results: The MAR algorithms in general improved the image quality based on the majority of the criteria (up to between 8/10 and 10/10) with a statistically improvement in overall image quality (P

The aim of this study was to evaluate commercial metal artefact reduction (MAR) techniques in X-ray CT imaging of hip prostheses.Monoenergetic reconstructions of dual-energy CT (DECT) data and several different MAR algorithms, combined with single-energy CT or DECT, were evaluated by imaging a bilateral hip prosthesis phantom. The MAR images were compared with uncorrected images based on CT number accuracy and noise in different regions of interest.The three MAR algorithms studied implied a general noise reduction (up to 67%, 74% and 77%) and an improvement in CT number accuracy, both in regions close to the prostheses and between the two prostheses. The application of monoenergetic reconstruction, without any MAR algorithm, did not decrease the noise in the regions close to the prostheses to the same extent as did the MAR algorithms and even increased the noise in the region between the prostheses.The MAR algorithms evaluated generally improved CT number accuracy and substantially reduced the noise in the hip prostheses phantom images, both close to the prostheses and between the two prostheses. The study showed that the monoenergetic reconstructions evaluated did not sufficiently reduce the severe metal artefact caused by large orthopaedic implants.This study evaluates several commercially available MAR techniques in CT imaging of large orthopaedic implants.