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In November 2011, a 61-year-old woman was diagnosed with squamous cell carcinoma (SCC) of the cervix in a uterus didelphys with vaginal septum. The patient was diagnosed with Fédération Internationale de Gynécologie et d’Obstétrique (FIGO) stage IIB because of infiltration to the left parametrium without infiltration to the pelvic wall. The patient was treated with external-beam radiotherapy (EBRT) and brachytherapy (BT), using concomitant chemotherapy with cisplatin. A total of 50 Gy were delivered (2 Gy/fraction/day) to the pelvis, with a central shield after 40 Gy. The patient was treated four times with BT (6 Gy × 4 fractions), with tandem and ovoid applicators inserted once to the left side; tandem to the left side and ovoid bilaterally were inserted twice; and tandem to the right side and ovoid bilaterally were inserted once. Six years and 8 months after the start of treatment, the patient had had no relapse or severe late adverse effects. For accurate diagnosis and optimal treatment of the uterus didelphys, careful interview and pelvic examination at initial diagnosis of a patient are very important.

Purpose The aim of the current study was to evaluate the backscatter dose and energy spectrum from the Lipiodol with flattening filter (FF) and flattening filter‐free (FFF) beams. Moreover, the backscatter range, that was defined as the backscatter distance (BD) are revealed. Methods 6 MVX FF and FFF beams were delivered by TrueBeam. Two dose calculation methods with Monte Carlo calculation were used with a virtual phantom in which the Lipiodol (3 × 3 × 3 cm3) was located at a depth of 5.0 cm in a water‐equivalent phantom (20 × 20 × 20 cm3). The first dose calculation was an analysis of the dose and energy spectrum with the complete scattering of photons and electrons, and the other was a specified dose analysis only with scattering from a specified region. The specified dose analysis was divided into a scattering of primary photons and a scattering of electrons. Results The lower‐energy photons contributed to the backscatter, while the high‐energy photons contributed the difference of the backscatter dose between the FF and FFF beams. Although the difference in the dose from the scattered electrons between the FF and FFF beams was within 1%, the difference of the dose from the scattered photons between the FF and FFF beams was 5.4% at a depth of 4.98 cm. Conclusions The backscatter range from the Lipiodol was within 3 mm and depended on the Compton scatter from the primary photons. The backscatter dose from the Lipiodol can be useful in clinical applications in cases where the backscatter region is located within a tumor.

Aim and background IGRT based on bone matching may produce a large target positioning error in terms of the reproducibility of expiration breath-holding on SBRT for liver cancer. We evaluated the intrafractional and interfractional errors using the diaphragm position at the end of expiration by utilising Abches and analysed the factor of the interfractional error. Materials and methods Intrafractional and interfractional errors were measured using a couple of frontal kV images, planning computed tomography (pCT) and daily cone-beam computed tomography (CBCT). Moreover, max–min diaphragm position within daily CBCT image sets with respect to pCT and the maximum value of diaphragm position difference between CBCT and pCT were calculated. Results The mean ± SD (standard deviation) of the intra-fraction diaphragm position variation in the frontal kV images was 1.0 ± 0.7 mm in the C-C direction. The inter-fractional diaphragm changes were 0.4 ± 4.6 mm in the C-C direction, 1.4 ± 2.2 mm in the A-P direction, and −0.6 ± 1.8 mm in the L-R direction. There were no significant differences between the maximum value of the max–min diaphragm position within daily CBCT image sets with respect to pCT and the maximum value of diaphragm position difference between CBCT and pCT. Conclusions Residual intrafractional variability of diaphragm position is minimal, but large interfractional diaphragm changes were observed. There was a small effect in the patient condition difference between pCT and CBCT. The impact of the difference in daily breath-holds on the interfractional diaphragm position was large or the difference in daily breath-holding heavily influenced the interfractional diaphragm change.

Purpose Lipiodol, which was used in transcatheter arterial chemoembolization before liver stereotactic body radiation therapy (SBRT), remains in SBRT. Previous we reported the dose enhancement in Lipiodol using 10 MV (10×) FFF beam. In this study, we compared the dose enhancement in Lipiodol and evaluated the probability of electron generation (PEG) for the dose enhancement using flattening filter (FF) and flattening filter free (FFF) beams. Methods FF and FFF for 6 MV (6×) and 10× beams were delivered by TrueBeam. The dose enhancement factor (DEF), energy spectrum, and PEG was calculated using Monte Carlo (MC) code BEAMnrc and heavy ion transport code system (PHITS). Results DEFs for FF and FFF 6× beams were 7.0% and 17.0% at the center of Lipiodol (depth, 6.5 cm). DEFs for FF and FFF 10× beams were 8.2% and 10.5% at the center of Lipiodol. Spectral analysis revealed that the FFF beams contained more low‐energy (0–0.3 MeV) electrons than the FF beams, and the FF beams contained more high‐energy (>0.3 MeV) electrons than the FFF beams in Lipiodol. The difference between FFF and FF beam DEFs was larger for 6× than for 10×. This occurred because the 10× beams contained more high‐energy electrons. The PEGs for photoelectric absorption and Compton scattering for the FFF beams were higher than those for the FF beams. The PEG for the photoelectric absorption was higher than that for Compton scattering. Conclusions FFF beam contained more low‐energy photons and it contributed to the dose enhancement. Energy spectra and PEGs are useful for analyzing the mechanisms of dose enhancement.

Purpose Stereotactic body radiation therapy (SBRT) combining trans-arterial chemoembolization (TACE) with Lipiodol is expected to improve local control. This study is aimed to estimate the dose enhancement in Lipiodol's proximity and to evaluate the dose calculation accuracy of the Acuros XB (AXB) algorithm and anisotropic analytical algorithm (AAA) in the Eclipse treatment planning system (TPS) (ver. 11, Varian Medical Systems, Palo Alto, USA), compared with that of the Monte Carlo (MC) calculation (using BEAMnrc/DOSXYZnrc code) for a virtual phantom and a treatment plan for liver SBRT after TACE. Methods The MC calculation accuracy was validated by comparing its results with the percent depth dose (PDD) and the off-axis ratio (OAR) measured using a water-equivalent phantom containing Lipiodol. The dose difference in Lipiodol's proximity and the inhomogeneity correction accuracies of the AAA, AXB algorithm, and MC calculation were evaluated by calculating the PDDs and OARs for the virtual phantom with Lipiodol and the lateral profile for the clinical plan data. Results The measured data and the MC results agreed within 3%. The average dose in the Lipiodol uptake region was higher by 8.1% for the virtual phantom and 6.0% for the clinical case compared to that in regions without Lipiodol uptake. For the virtual phantom, compared with the MC calculation, the AAA and the AXB algorithm underestimated the doses immediately upstream of the Lipiodol region by 5.0% and 4.2%, in the Lipiodol region by 7.4% and 9.8%, and downstream of the Lipiodol region by 5.5% and 3.9% respectively. These discrepancy between the AXB and MC calculations were due to the incorrect assignment of Lipiodol material properties. Namely, the bone material was assigned automatically by the AXB algorithm as the materials for the AXB algorithm do not contain iodine, which is the main constituent of Lipiodol. Conclusions The MC calculation indicated a larger and more accurate dose increase in Lipiodol compared with the TPS algorithms. The observed dose enhancement in the tumor area could be clinically significant.

A new randomized Phase III trial, the Japan Clinical Oncology Group (JCOG) 1408, which compares two dose fractionations (JCOG 0403 and JCOG 0702) for medically inoperable Stage IA NSCLC or small lung lesions clinically diagnosed as primary lung cancer, involves the introduction of a prescribed dose to the D95% of the planning target volume (PTV) using a superposition/convolution algorithm. Therefore, we must determine the prescribed dose in the D95% prescribing method to begin JCOG1408. JCOG 0702 uses density correction and the D95% prescribing method. However, JCOG 0403 uses no density correction and isocenter- prescribing method. The purpose of this study was to evaluate the prescribed dose to the D95% of the PTV equivalent to a dose of 48 Gy to the isocenter (JCOG 0403) using a superposition algorithm. The peripheral isodose line, which has the highest conformity index, and the D95% of the PTV were analyzed by considering the weighting factor, i.e. the inverse of the difference between the doses obtained using the superposition and Clarkson algorithms. The average dose at the isodose line of the highest conformity index and the D95% of the PTV were 41.5 ± 0.3 and 42.0 ± 0.3 Gy, respectively. The D95% of the PTV had a small correlation with the target volume (r2 = 0.0022) and with the distance between the scatterer and tumor volumes (r2 = 0.19). Thus, the prescribed dose of 48 Gy using the Clarkson algorithm (JCOG0403) was found to be equivalent to the prescribed dose of 42 Gy to the D95% of the PTV using the superposition algorithm.

Purpose: Nowadays, patient positioning and target localization can be verified by using kilovolt cone beam computed tomography (kV-CBCT). There have been various studies on the absorbed doses and image qualities of different kV-CBCT systems. However, the Varian TrueBeam CBCT (TB CBCT) system has not been investigated so far. We assess the image quality and absorbed dose of TB CBCT through comparison with those of on-board imager (OBI) CBCT. Methods: The image quality was evaluated using two phantoms. A CATPHAN phantom measured the image quality parameters of the American Association of Physicists in Medicine Task Group 142 (AAPM TG-142) report. These factors are the pixel value stability and accuracy, noise, high-contrast resolution, low-contrast resolution, and image uniformity. A H2SO4 phantom was used to evaluate the image uniformity over a larger region than the CATPHAN phantom. In evaluating the absorbed dose, the radial dose profile and the patient organ doses at the prostate and rectum levels were evaluated. Results: The image quality parameters of AAPM TG-142 using TB CBCT are equal to or greater than those of OBI CBCT. In particular, the contrast-to-noise ratio with TB CBCT is 2.5 times higher than that with OBI CBCT. For the test of a large field uniformity, the maximum difference in the Hounsfield unit (HU) values between the centre and peripheral regions is within 30 HU with TB CBCT and 283 HU with OBI CBCT. The maximum absorbed dose with TB CBCT is decreased by 60%. Conclusions: We find that the image quality improved and the absorbed dose decreased with TB CBCT in comparison to those with OBI CBCT. Its image uniformity is also superior over a larger scanning range.

OBJECTIVES: The aim of the current study is to evaluate the accuracy and the precision of raw-data-based relative electron density (RED(raw)) and the calibration-based RED (RED(cal)) at a range of low-RED to high-RED for tissue-equivalent phantom materials by comparing them with reference RED (RED(ref)) and to present the difference of RED(raw) and RED(cal) for the contrast medium using dual-energy CT (DECT). METHODS: The RED(raw) images were reconstructed by raw-data-based decomposition using DECT. For evaluation of the accuracy of the RED(raw), RED(ref) was calculated for the tissue-equivalent phantom materials based on their specified density and elemental composition. The RED(cal) images were calculated using three models: Lung-Bone model, Lung-Ti model and Lung-Ti (SEMAR) model which used single-energy metal artifact reduction (SEMAR). The difference between RED(raw) and RED(cal) was calculated. RESULTS: In the titanium rod core, the deviations of RED(raw) and RED(cal) (Lung-Bone model, Lung-Ti model and Lung-Ti model with SEMAR) from RED(ref) were 0.45%, 50.8%, 15.4% and 15.0%, respectively. The largest differences between RED(raw) and RED(cal) (Lung-Bone model, Lung-Ti model and Lung-Ti model with SEMAR) in the contrast medium phantom were 8.2%, −23.7%, and 28.7%, respectively. However, the differences between RED(raw) and RED(cal) values were within 10% at 20 mg/ml. The standard deviation of the RED(raw) was significantly smaller than the RED(cal) with three models in the titanium and the materials that had low CT numbers. CONCLUSION: The RED(cal) values could be affected by beam hardening artifacts and the RED(cal) was less accurate than RED(raw) for high-Z materials as titanium. ADVANCES IN KNOWLEDGE: The raw-data-based reconstruction method could reduce the beam hardening artifact compared with image-based reconstruction and increase the accuracy for the RED estimation in high-Z materials, such as titanium and iodinated contrast medium.

Aim In high-precision radiation therapy, kilovoltage cone-beam computed tomography plays an important role in verifying the position of patient and localization of the target. However, the exposure dose is a problem with kilovoltage cone-beam computed tomography. Flux overlap region increases the patient dose around the center when the scan is performed in a full-scan mode. We assessed the influence of flux overlap region in a full-scan mode to understand the relationship between dose and image quality and investigated methods to achieve a dose reduction. Method A Catphan phantom was scanned using various flux overlap region patterns in the pelvis on a full-scan mode. We used an intensity-modulated radiation therapy phantom for measuring the central dose. DoseLab was used to perform image analysis and to evaluate the linearity of the computed tomography values, uniformity, high-contrast resolution, and contrast-to-noise ratio. Results The Hounsfield unit value varied by ±40 Hounsfield unit of the acceptance value for the X 1 field size of 3.5 cm. However, there were no differences in high-contrast resolution and contrast-to-noise ratio among different scan patterns. The absorbed dose decreased by 7% at maximum for the case within the tolerance value. Conclusion Dose reduction is possible by reducing the overlap region after calibration and by performing computed tomography in the appropriate overlap region.

The characteristics of a flattening filter-free (FFF) beam are different from those of a beam with a flattening filter. For small-field dosimetry, the beam data needed by the radiation treatment planning system (RTPS) includes the percent depth dose (PDD), off-center ratio (OCR), and output factor (OPF) for field sizes down to 3 × 3 cm2 to calculate the beam model. The purpose of this study was to evaluate the accuracy of calculations for the FFF beam by the Eclipse™ treatment planning system for field sizes smaller than 3 × 3 cm2 (2 × 2 and 1 × 1 cm2). We used 6X and 10X FFF beams by the Varian TrueBeam™ to produce. The AAA and AXB algorithms of the Eclipse were used to compare the Monte Carlo (MC) calculation and the measurements from three dosimeters, a diode detector, a PinPoint dosimeter, and EBT3 film. The PDD curves and the penumbra width in the OCR calculated by the Eclipse, measured data, and those from the MC calculations were in good agreement to within ±2.8 % and ±0.6 mm, respectively. However, the difference in the OPF values between AAA and AXB for a field size of 1 × 1 cm2 was 5.3 % for the 6X FFF beam and 7.6 % for the 10X FFF beam. Therefore, we have to confirm the small field data that is included for the RTPS commission procedures.

Objective: The aim of the current study is to evaluate the effectiveness of reduction metal artifacts using kV-CT image with the single-energy based metal artefact reduction (SEMAR) technique by single-energy reconstruction, monochromatic CT and rED reconstructed by dual-energy reconstruction. Methods: Seven different metal materials (brass, aluminum, copper, stainless, steel, lead and titanium) were placed inside the water-based PMMA phantom. After DECT-based scan, the artefact index (AI) were evaluated with the kV-CT images with and without SEMAR by single-energy reconstruction, and raw-data based electron density (rED), monochromatic CT images by dual-energy reconstruction. Moreover, the AI with evaluated with rED and the converted ED images from the kV-CT and monochromatic CT images. Results: The minimum average value of the AI with all-metal inserts was approximately 80 keV. The AI without SEMAR was larger than that with SEMAR for the 80 kV and 135 kV CT images. In the comparison of the AI for the rED and ED images that were converted from 80 kV and 135 kV CT images with and without SEMAR, the monochromatic CT images of the PMMA phantom with inserted metal materials at 80 keV revealed that the kV-CT with SEMAR reduced the metal artefact substantially. Conclusion: The converted ED from the kV-CT and monochromatic CT images could be useful for a comparison of the AI using the same contrast scale. The kV-CT image with SEMAR by single-energy reconstruction was found to substantially reduce metal artefact. Advances in knowledge: The effectiveness of reduction of metal artifacts using single-energy based metal artefact reduction (SEMAR) technique and dual-energy CT (DECT) was evaluated the electron density conversion techniques.

Aim Lipiodol was used for stereotactic body radiotherapy combining trans arterial chemoembolization. Lipiodol used for tumour seeking in trans arterial chemoembolization remains in stereotactic body radiation therapy. In our previous study, we reported the dose enhancement effect in Lipiodol with 10× flattening-filter-free (FFF). The objective of our study was to evaluate the dose enhancement and energy spectrum of photons and electrons due to the Lipiodol depth with flattened (FF) and FFF beams. Methods FF and FFF for 6 MV beams from TrueBeam were used in this study. The Lipiodol (3 × 3 × 3 cm3) was located at depths of 1, 3, 5, 10, 20, and 30 cm in water. The dose enhancement factor (DEF) and the energy fluence were obtained by Monte Carlo calculations of the particle and heavy ion transport code system (PHITS). Results The DEFs at the centre of Lipiodol with the FF beam were 6.8, 7.3, 7.6, 7.2, 6.1, and 5.7% and those with the FFF beam were 20.6, 22.0, 21.9, 20.0, 12.3, and 12.1% at depths of 1, 3, 5, 10, 20, and 30 cm, respectively, where Lipiodol was located in water. Moreover, spectrum results showed that more low-energy photons and electrons were present at shallow depth where Lipiodol was located in water. The variation in the low-energy spectrum due to the depth of the Lipiodol position was more explicit with the FFF beam than that with the FF beam. Conclusions The current study revealed variations in the DEF and energy spectrum due to the depth of the Lipiodol position with the FF and FFF beams. Although the FF beam could reduce the effect of energy dependence due to the depth of the Lipiodol position, the dose enhancement was overall small. To cause a large dose enhancement, the FFF beam with the distance of the patient surface to Lipiodol within 10 cm should be used.

Objective:To evaluate the accuracy of raw-data-based effective atomic number (Zeff) values and monochromatic CT numbers for contrast material of varying iodine concentrations, obtained using dual-energy CT.Methods:We used a tissue characterization phantom and varying concentrations of iodinated contrast medium. A comparison between the theoretical values of Zeff and that provided by the manufacturer was performed. The measured and theoretical monochromatic CT numbers at 40–130 keV were compared.Results:The average difference between the Zeff values of lung (inhale) inserts in the tissue characterization phantom was 81.3% and the average Zeff difference was within 8.4%. The average difference between the Zeff values of the varying concentrations of iodinated contrast medium was within 11.2%. For the varying concentrations of iodinated contrast medium, the differences between the measured and theoretical monochromatic CT values increased with decreasing monochromatic energy. The Zeff and monochromatic CT nu...

Objectives We examine the contrast agent Lipiodol effect on the relative biological effectiveness (RBE) values for flattening filter free (FFF) and flattening filter (FF) beams of 6 MV-Xray (6 MVX) and 10 MVX. Methods Lipiodol was placed at 5 cm depth in water. According to the microdosimetric kinetic model, the RBE values for killing the human liver hepatocellular cells were calculated from dose and lineal energy (yd(y)) from Monte Carlo simulations. RBE200kVX and RBECo were defined as the ratios of dose using reference radiation (200 kVX, Co-ɤ) to the dose of test radiation (FFF and FF beams for 6 MV and 10 MV) to produce the same biological effects. The dose enhancement RBE (RBEDE) was defined as the ratios of a dose without Lipiodol to with Lipiodol using to produce the same biological effects. The dose needed to achieve 10% (D10%) and 1% cell survival (D1%) was evaluated by cell surviving fraction (SF) formula. Results The deviation of mean y ‾ D values with and without Lipiodol were 3.9–4.8% for 6 MVX and 3.5–3.6% for 10 MVX. The RBE200kVX and RBECo with Lipiodol were larger than that without Lipiodol. The RBEDE was larger for FFF beam than for FF beam. The deviation of RBEDE for FFF and FF beams of 6 MVX was larger than that of 10 MVX. Conclusion The presence of Lipiodol seemed to locally increase the absorbed dose and to also cause an enhancement of the relative biological effectiveness.

PURPOSE Liver image guided radiation therapy (IGRT) based on bone matching risks generating serious target positioning errors for reasons of lack of reproducibility of expiration breath hold. We therefore investigated the feasibility of 3D image matching between planning CT images and pretreatment cone-beam computed tomography (CBCT) images based on diaphragm surface matching. METHOD 27 liver stereotactic body radiotherapy (SBRT) cases in whom trancecatheter arterial chemoembolization (TACE) had been performed in advance of radiotherapy were manually image-matched based on contrast, Lipiodol used in the TACE as the marker of the tumor, and the relative coordinates of the isocenter obtained by contrast matching, defined as the reference coordinate. The target positioning difference between diaphragm matching and bone matching were evaluated by using relative coordinates of the isocenter from the reference obtained for each matching technique. RESULTS The target positioning error using diaphragm matching and bone matching was 1.31±0.83 and 3.10±2.80 mm in the cranial-caudal (C-C) direction, 1.04±0.95 and 1.62±1.02 mm in the anterior-posterior (A-P) direction, and 0.93±1.19 and 1.12±0.94 mm in the left-right (L-R) direction, respectively. The positioning error due to diaphragm matching was significantly smaller than for bone matching in the C-C direction (p

The purpose of this study is to compare the daily living consciousness among three different hill tribes （Lahi Nyi，Lo Mi Akha and Mlabri）living in northern Thailand. The subjects were asked to answer questions by interview from December 2006 to January 2007 and the results obtained were statistically analyzed using SPSS. With respect to“pleasure in daily life”，most of people answered“chat”and/or“TV”besides people between 10 and 19 years old，“sports”，while adults，“travel”or“festival”. Forty-one to 71% of people between 10 and 19 years old answered to obtain daily information from school. Most subjects in three tribes worked“for the family”. However，in females of Mlabri，people between 10 and 19 years old （about 33%）answered“happy to be able to work”and over 40’s（40%）did“natural obligation”. The subjects mostly considered that traditions supported people’s lives and majority of them answered“yes”on psychological factors. They seemed to satisfy themselves or the relationship to other people when they felt less stress or slept well. Mlabri seemed to have different daily living consciousness and views on psychological factors from other two tribes. This might be related to their living style which they worked as laborers in the fields of other tribes and earned some money. The results also indicated that there were some differences be fields of other tribes and earned some money. The results also indicated that there were some differences be tween people between 10 and 19 years old and adults as well as those among three tribes. The traditional life style and probably daily living consciousness and views on psychological factors of people between 10 and 19 years old will change gradually by their growing up to obtain liberal education and a lot of information from mass-media and so on.

1日の食事の中で最も食事内容が整っていると考えられる夕食に関する調査を行い, 日常の調理を担当している女子学生について以下のことが示唆された。1. 夕食の形態は, 自宅で作った食事の場合が週に4.8回であり, 週に1～2回は外食あるいはインスタントや冷凍のご飯もの・麺類・パスタなどが利用されていた。2. 夕食の主食は, 白飯が週に5.1回であったが, ほとんど毎日に白飯を食する者は半数程度であった。3. 夕食の主食が白飯以外の場合には, 単品摂取傾向にあり, 食事内容も整っていなかった。4. 夕食の副食では, 生野菜・サラダ, 野菜の炒め物の摂取頻度が高く, 素材では魚, 調理法では揚げ物の摂取頻度が極めて低かった。摂取頻度が低い食品や料理を食べない理由ならびに作らない理由では,「面倒」,「作り方がわからない」が多かった。5.女子学生が作る料理は, 肉料理と野菜料理が多く, 大豆料理は非常に少なかった。6.以上の調理の実態から, (1)主食の概念を認識させること, (2)野菜, いも, 大豆, 魚等の調理法を扱いやすい形から習得させること, (3)調理に「慣れる」ことにより作る「面倒感」を軽減させることが視点として捉えられた。このことから, 調理学実習を効果的に進めるための方法や具体的な内容を検討した。

Image-guided radiotherapy (IGRT) based on bone matching can produce large target-positioning errors because of expiration breath-hold reproducibility during stereotactic body radiation therapy (SBRT) for liver tumors. Therefore, the feasibility of diaphragm-based 3D image matching between planning computed tomography (CT) and pretreatment cone-beam CT was investigated.In 59 liver SBRT cases, Lipiodol uptake after transarterial chemoembolization was defined as a tumor marker. Further, the relative isocenter coordinate that was obtained by Lipiodol matching was defined as the reference coordinate. The distance between the relative isocenter coordinate and reference coordinate, which was obtained from diaphragm matching and bone matching techniques, was defined as the target positioning error. Furthermore, the target positioning error between liver matching and Lipiodol matching was evaluated.The positioning errors in all directions by the diaphragm matching were significantly smaller than those obtained by using by the bone matching technique (p 0.05). Further, the positioning errors in the A-P and C-C directions that were obtained by using liver matching were significantly smaller than those obtained by using bone matching (p 0.05). The estimated PTV margins calculated by the formula proposed by van Herk for diaphragm matching, liver matching, and bone matching were 5.0 mm, 5.0 mm, and 11.6 mm in the C-C direction; 3.6 mm, 2.4 mm, and 6.9 mm in the A-P direction; and 2.6 mm, 4.1 mm, and 4.6 mm in the L-R direction, respectively.Diaphragm matching-based IGRT may be an alternative image matching technique for determining liver tumor positions in patients.

A nutritional survey was carried out among residents (39 males and 46 females) of Dzong village in the northern area of the Gandaki region of Nepal. The results were compared with our previous findings. The mean body mass index value was under 21 for both sexes, but the mean percentage of body fat of females (17-19 years old, 25.8 +/- 9.4%; 20-29 years old, 31.0 +/- 8.4%) was higher than that of males (17-19 years old, 12.0 +/- 1.0%; 50-59 years old, 24.4 +/- 7.6%). Most serum nutritional markers for both sexes were generally at normal levels although the iron levels were lower and packed red cell volume levels were higher than normal. As determined by results of the 24-hr dietary recall survey, the main food groups consumed by both sexes were cereals, potatoes, pulses, meats and vegetables. The mean daily intake of nutrients was similar for both sexes, with a few exceptions. The relatively high serum TG levels of the subjects may have been due to the high consumption of carbohydrate-laden cereals. The amounts of food consumed were not adequate, resulting in a latent and chronic deficiency of nutrients, especially calcium and iron. These results suggest that improvements in the nutritional status of this group of people are necessary.

The food consumption and serum nutritional status of people living in the Kathmandu valley, Nepal, were examined to obtain actual data for comparison with our previous findings.A dietary survey of 45 males and 60 females was carried out in March 1997 by the 24-hr dietary recall method and nutrient intake was calculated from food tables of India and Japan. Fasting venous blood samples were obtained and serum biochemical parameters were measured using clinical kits.The mean body mass index values was at about the same level in both sexes, although the mean percentage body fat of females was higher than that of males, and vice versa for packed red cell volume. The main foods consumed by both sexes, were rice, potatoes, meats, milkdairy products and vegetables, with a difference in the amounts consumed. Females did not drink alcoholic beverages. The mean daily intakes of energy, protein, lipids, iron and vitamin B group for the males were higher than those for the females, while those of vitamins A and C for the males were lower than those for the females. The mean values of serum biochemical parameters for both sexes were generally at the normal levels, but those of ALT and TG were at the higher end of the normal range. Differences of correlation between food groups and between serum parameters were observed depending on the sex, however, no clear relationship between food and nutrient intake and serum biochemical parameters were observed.The present food intake study revealed that the amounts of food consumption for both sexes, especially for the females, were mostly insufficient although the serum parameters were at the normal levels. The energy intake of both sexes was lower than that of estimated requirements and those in Terai region. The relatively high serum TG level of the subjects may be due to the consumption of large amounts of cereals containing much carbohydrate. Our findings suggested a marked influence on food consumption by food price and income in spite of the easier food availability in the city, and also lack of knowledge about nutrients and health, thus there is need for improvement of the nutritional status of this group of people.

Autoxidation of triacylglycerol (TG) oil occurred most rapidly, whereas oils containing tocopherol (Toc) showed a slower increase compared to the ordinary TG oil. Autoxidation of oils was apparently delayed by addition of Toc and vitamin C (VC), and the effect of these antioxidants was greater in diacylglycerol (DG) oil than in TG oil. On the other hand, there was no apparent difference between DG and TG oils in the presence of Toc only. The ΔE values (color difference) of TG oils were higher than those of DG oils, and the values were lower in the oils containing both Toc and VC than in those containing only Toc. The carbonyl value (COV) of TG oil increased with aeration time and tended to be lower without Toc than with Toc. The peroxide value (POV) of DG oil did not change with aeration time, whereas POV of TG oil increased with aeration time and the amount of Toc. COV and the p-anisidin value (ANV) increased with the number of uses, however, the values of DG oils containing Toc tended to be lower than those of the other samples. The dehydration rate, weight decrease and moisture content tended to decrease with the number of uses, which might contribute to the oily or greasy taste of fried food. COV, ANV and the acid value (AV) showed significant correlation with each other, but not with oil absorption, dehydration rate, weight decrease or moisture content.

Purpose To evaluate in healthy volunteers the reproducibility of organ position using a voluntary breath-hold method with a spirometer and the feasibility of this method for extracranial stereotactic radiotherapy in a clinical setting. Methods and materials For this study, 5 healthy volunteers were enrolled. After training sessions, they held their breath at the end-inspiration and the end-expiration phase under spirometer-based monitoring. Computed tomography (CT) scans were performed twice at each respiratory phase, with a 10-min interval, on 2 separate days. The total number of CT scans was four at each respiratory phase. After CT volume data were transferred to a three-dimensional treatment-planning system, digitally reconstructed radiographs (DRRs) were calculated for anterior–posterior and left–right beams. Verification was performed with DRRs relative to the diaphragm position, bony landmarks, and the isocenter in each healthy volunteer at each respiratory phase. To evaluate intrafraction reproducibility, we measured the distance between diaphragm position and bony landmarks. To evaluate interfraction reproducibility, we measured the distance between diaphragm position and the isocenter. Reproducibility and setup error were defined as the average value of the differences between each DRR with regard to the first DRR. Results Intrafraction reproducibility of the caudal–cranial direction was 4.0 ± 3.5 mm at the end-inspiration phase and 2.2 ± 2.0 mm at the end-expiration phase. Interfraction reproducibility of the caudal–cranial direction was 5.1 ± 4.8 mm at the end-inspiration phase and 2.1 ± 1.8 mm at the end-expiration phase. The end-expiration phase was more stable than the end-inspiration phase. Conclusions The voluntary breath-hold method with a spirometer is feasible, with relatively good reproducibility. We are encouraged about the use of this technique clinically for extracranial stereotactic radiotherapy.

Deep-frying oil properties of diacylglycerol-rich cooking oil (DG oil) were examined so as to assess the extent of thermal oxidative stability. The results obtained were compared with those of triacylglycerol-rich cooking oil (TG oil). Dehydration and oil absorption of food materials using DG oil were lower than those of TG oil. Color difference (⊿E value)of both oils increased with the number of uses, but ⊿E value of DG oil was higher than that of TG oil. Moisture content of "koromo" using DG oil was higher than that of TG oil. Carbonyl, p-anisidin and acid values of both oils increased with the number of uses. The immediate evaluation of fried foods after frying using both oils were better than those of 120 minutes' later ones. The present findings indicate that the thermal oxidation of DG oil during deep-frying is basically the same as that of TG oil. DG oil can be used for deep-frying oil in the same way as TG oil.

Serum nutritional components and food intake were examined in Nepalese (127 males and 163 females aged 4 to 72 years) living in a remote hilly village (area A and B, area A is located at a relatively lower altitude and is warmer) in the eastern region of Nepal. Mean values of height and weight for the groups covering ages 4 to 19 of both sexes and in both areas increased with age. The mean BMI value for each age group was mostly under 22, and the BMI correlated with age, and with systolic and diastolic blood pressure. The mean values of serum components were about the same levels in both sexes. Mean values of triglyceride (TG) of over 150 mg/dl were found in males 20–50 years old and in females over 50 years old in area A, and generally the mean values of TG of the subjects tended to be in the higher range of normal. The main foods consumed in both areas were rice, maize, potatoes, pulses, milk and dairy products, and vegetables, with a difference in the amounts consumed. Milk and dairy products were almost the sole food source of animal origin. The rather higher serum TG levels of the subjects may be due to large amounts of consumption of cereals containing a lot of carbohydrate, which transformed into lipids in the metabolic pathway. The present food intake study revealed that the amounts of food consumed were not adequate resulting in a latent and chronic deficiency of nutrients, especially such as calcium (Ca), iron (Fe), and fat-soluble vitamins. These results suggest that improvement of the nutritional status is needed in this people group.

タイ北部山岳少数民族110人(男65人, 女45人, 15～59歳)及び4～6年生の小学生145人(男子72人, 女子73人)を対象に2003年8月に食生活と保健要因への認識についてアンケート調査を行った。食品の摂取頻度を比較すると, 米の「毎日摂取」は男女各々91%と99%, 家族97%と95%で, 野菜類は小学生72%と79%, 家族63%と88%であったが, その他の食品の摂取頻度は低かった。欠食状況を比較すると, 「欠食しない」は男女各々小学生74%と80%で, 家族男女とも91%よりも喫食率が低かった(小学生と家族間差, 男p

兵庫, 奈良, 岡山の大学に通う19～24歳の大学生 (男子329名, 女子406名) を対象に健康と食生活に関するアンケート調査を実施した.1) 調査対象者の多くは健康に興味・関心をもっており, それらに関する知識の情報源は「テレビ・ラジオ」が多かった. しかし, 健康よりも男子では「遊び」「恋愛」に, 女子では「美容・ファッション」「遊び」に対する興味・関心の方が強かった.2) 健康のために心がけて摂取している食品群は「乳類・乳製品」, 「緑黄色野菜」や「淡色野菜」の野菜類で, 健康食品は「足りない栄養を補う」ためであったが, 利用頻度は低かった.3) 健康のために重要視するのは「睡眠時間」, 「栄養バランス」で, 「運動」は少なく, また, 女子では「特に運動をしていない」が約43%存在した.4) 外食の多くは昼食と夕食で, 男子では「洋食定食」を女子では「洋食一品料理」を選択し, 男女差があった.5)「健康に興味・関心がある」者ほど日常の食事に気をっけ, 積極的に情報を得ており, 食生活の自己評価が高かった. 自己評価の高い者ほど外食や市販菓子の摂取頻度が低かった.6) 食生活を充実させるという「強い意志」が食生活改善に必要であるとの回答が多かったことから, 若者では健康・栄養に関する知識があり, 健康の大切さを認識していてもそのための実践が伴わない者が多いことが示唆された.

This study examined the levels of serum protein fractionation, immunoglobulin (Ig) and antistreptolysin O (ASO) of people (91 males and 84 females aged 10-68 years) living in the Terai region of southern Nepal, as there has previously been no information available about them.Blood samples were collected early in the morning after overnight fasting. Serum protein fractionation was carried out by cellulose-acetate electrophoresis. IgG, IgA, IgM and ASO were measured by immuno-turbidimetry with clinical kits.The mean proportion of albumin (Alb) was rather low due to increased globulin (Glb). The Alb level of males was significantly higher than that of females, while the male γ-Glb level was significantly lower than that of females. The mean values of IgG, IgM and ASO for males were lower than those values for females, although the difference was significant only for the IgM value. The mean values of IgM for female age groups of 30-39 years or less were significantly higher than those for the corresponding male age groups. Age correlated positively with IgA, and negatively with ASO in both sexes. γ-Glb and IgG correlated significantly with TP, AlB, α(1)-Glb and IgA in both sexes. ASO correlated with β-Glb and IgA in males, and with γ-Glb and IgG in females.The fact that the level of γ-Glb, a major component of serum globulin, was high suggested exposure to a highly bacterial and viral environment. These results point to the need to prevent infectious diseases as well as improve their nutritional status, especially for children and young adults.

DG油を使用して焼成したシフォンケーキおよびキャロットケーキの性状をTG油使用のものと比較検討した.焼成後の比容積はシフォンケーキではDG油使用のものがTG油のものより有意に小さかったが, キャロットケーキでは両油間に差がなかった. 電子顕微鏡による内部組織の観察ではDG油使用のシフォンケーキはTG油使用のものに比べて気泡が小さく, 不均一であった. 焼成した2種類のケーキともDG油使用では表面への油粒子の吸着がみられた.DG油使用のシフォンケーキでは外観, 色 (断面) 以外はDG油使用の評価が有意に低かったがDG油使用のキャロットケーキでは外観, 色に高い評価を得た. これらの結果は電子顕微鏡による内部組織の結果と一致した.

Deep-frying oil properties of diacylglycerol-rich cooking oil (DG oil) were examined so as to assess the extent of thermally oxidative deterioration. The results obtained were compared with those for triacylglycerol-rich oil (TG oil). Autoxidation of DG oil at 50°C was much slower compared to TG oil. The viscosity of DG oil exceeded that of TG oil and both these parameters increased with the heating of either oil. Acid value (AV) of fresh DG oil (0.49) was higher than that of TG oil (0.11). AV, carbonyl and p-anisidin values of DG and TG oil increased with the number of uses. It follows from the present findings that the thermal oxidation of DG oil during deep-frying is basically the same as that of TG oil.

アメリカ西部, カリフォルニア州および近郊に居住する男子48名, 女子146名を対象に排便習慣と健康に対する意識調査を実施した.1) 食品群別摂取量に対する意識は男女とも「普通」が多かったが, 女子の方が肉類, 嗜好飲料類の摂取量を「少量」, 野菜類, 果実類を「多量」と答えた割合が多かった.2) 男子に「欠食しない」が多かった. 男女とも4人のうち3人が健康に適した食生活を「している」, 「大体している」と答え, 望ましい1日の食品摂取量を知っていた.3) 便秘と健康に関連性が「あると思う」が男子の約1/3, 女子の約半数であった. 男女とも約半数が排便は「便意のあるときでよい」とえた.4) 排便頻度と食物繊維を多く含む食品群の摂取量に対する意識には有意な関連性が認められなかった. 排便頻度が低い (週に3回以下, 便秘傾向) ほど排便は「便意のあるときでよい」の割合が多かったことから, 排便に対する認識が低い傾向があった. 男子では排便頻度が高いほど排便に要する時間が長かったが, 女子ではその逆であった.

A questionnaire survey of the usage of frying oils in households was carried out and the following results were obtained. 1)About 60% of the subjects used receptacles with filters to store used frying oil and kept it in a cool, dark place. Fresh oil was added to the used oil by about half of the subjects, which was significantly more than other responses(p

The carbonyl value (COV) and p-anicidine value (AnV) of frying oil increased with the number of uses whether or not fresh oil was added to used oil. The acid value(AV)increased from 0.16(fresh oil)to 1.08 with the number of uses, while AV did not increase when fresh oil was added to the used oil. The amounts of C18:2 and C18:3 acids tended to decrease with the number of uses. Judging from the values of COV, AnV and AV, no deterioration of frying oil was noted in this study. The fried foods were evaluated by a sensory test, however, personal preference had a great influence on the results and the effect of the addition of fresh oil to the used ones was not clear

Intestinal helminth infection and its effect on vitamin A, retinol and β-carotene, was studied in 224 [145 children (aged less than 15 years) of Okharpauwa Village Development Committee (VDC) (Nuwakot district) and 79 inhabitants (mainly adults) of Boya VDC (Bhojpur district)] subjects living at an altitude of 2000 m. Direct smear technique in duplicate was applied to detect helminth eggs. Most common helminth detected was Ascaris lumbricoides followed by Trichuris trichiura in Okharpauwa VDC and by hookworm in Boya VDC, respectively. Mixed helminth infections were relatively low (7.3% in Okharpauwa VDC and 11.1% in Boya VDC). The retinol and β-carotene were estimated by high-performance liquid chromatography (HPLC). The helminth eggs positive children of both sexes in Okharpauwa VDC had significantly lower serum retinol concentration compared with their helminth eggs negative counterparts (P 0.05) but in β-carotene level (P

A questionnaire survey of the consciousness of health and dietary style was conducted among 507 female students.Many students were found to be interested in maintaining good health, but they were more interested in "love", "amusement or pleasure" and "fashion". Most of the students obtained information concerning health and nutrition from mass media sources. Most students considered that the most important factor for good health was "sleep", not "exercise". Foods which students tried to eat were milk and dairy products and colored vegetables. They identified foods offering easily available, good balanced nutrients as being "healthy" foods. They preferred mostly "a la carte" or "fast foods" when they ate out with the choice varying with the cost and how they were feeling at the time. Not much consideration was given to a balanced diet or calorie intake. Students who were more interested in their health paid more attention to balanced diets (p

This study examined serum protein and iron status of people aged 10 to 72 years living in the Itahari district (an industrial district, 40 males and 32 females) and in the Chitwan district (an agricultural district, 89 males and 82 females) in the Terai region of southern Nepal. The relationship between the results and food and nutrient intakes was also investigated. The mean values of weight were very low in both groups, which led to a low body mass index, 18–20. The mean values of serum total protein (TP) for the residents in the Chitwan district were higher than those of the Itahari (p

Changes in weights, moisture contents, hardness and lipid components of soybeans soaked in deaerated (dissolved oxygen concentration, 0.5ppm) and distilled water for 0.5 to 24 hours at 20℃ were examined. Swelling of 110 to 120% of soybeans was obtained 10 and 15 to 16 hours in deaerated and distilled water, respectively. This means that swelling time using deaerated water was about two-thirds of that of distilled water. Changes in weights and hardness of soybeans during soaking showed the same tendency to that of moisture contents in both water. The average lipid contents and its composition were not significantly different between two kinds of water. The proportion of phospholipids of soybeans soaked in deaerated water for up to 12 hours was greater than that soaked in distilled water, whereas there were no differences in the amounts of free fatty acids and fatty acid compositions between two kinds of water. Among peroxide value (POV), carbonyl value (COV) and 2-thiobarbituric acid value (TBAV), POV showed a significant difference between deaerated and distilled water (p

Purpose: SBRT combining transarterial chemoembolization with Lipiodol is expected to improve local control. Our showed that the dose enhancement effect in the Lipiodol with 10X flattening filter free (FFF) was inserted. This study was to investigate the energy fluence variations of electron in the Lipiodol using flattened (FF) and FFF beams. Methods: FF and FFF for 6X and 10X beams by TrueBeam were used in this study. The Lipiodol (3 X 3 X 3 cm3) was located at the depth of 5 cm in water, the dose enhancement factor (DEF) and energy fluence were calculated by Monte Carlo (MC) calculations (PHITS). Results: DEFs with FF and FFF of 6X were 17.1% and 24.3% at rebuild-up region in the Lipiodol (5.3cm depth), 7.0% and 17.0% at the center of Lipiodol (6.5cm depth), and −13.2% and −8.2% at behind Lipiodol (8.3cm depth). DEFs with FF and FFF of 10X were 21.7% and 15.3% at rebuild-up region, 8.2% and 10.5% at the center of Lipiodol, and −14.0% and −8.6% at behind Lipiodol. Spectral results showed that the FFF beam contained more low-energy (0–0.3MeV) component of electrons than FF beam, and FF beam contained more high-energy (over 0.3MeV) electrons than FFF beam in Lipiodol. Behind the Lipiodol, build-down effect with FF beam was larger than FFF beam because FF beam contained more high energy electrons. The difference of DEFs between FFF and FF beams for 6X were larger than for 10X. This is because 10X beam contained more high-energy electrons. Conclusion: It was found that the 6XFFF beam gives the largest change of energy fluence and the largest DEF in this study. These phenomena are mainly caused by component of low-energy electrons, and this energy is almost correspond to the boundary of photo electronic dominant and Compton scattering dominant region for photon beams.

Lipids of seven edible pulses in Nepal were examined. Total lipid content range was determined as 1.814.7 %. Major components of total lipids were triacylglycerols, constituting 7576 % of total lipids of soybeans and chick pea. The amounts of phospholipids present in grams ranged from 4447 %. Pigeon pea and yellow gram contained greater amounts of free fatty acids compared with the other species of pulses. Fatty acid compositions of soybean and chick pea were virtually the same, in contrast pigeon pea which contained less C18 : 1 and more C16 : 0. Black gram contained the most C18 : 3, over 50 % of the total. The lipids of pigeon pea and grams containing large amounts of free fatty acids showed very high TBAV and COV. It follows from the present results that pluses, split and without seed coat, may possibly undergo oxidation more rapidly.

The dietary nutrient intake of persons aged 10–72 years (23 males and 30 females) was investigated using the 24-hour recall method living southeastern Nepal. The mean daily consumption of food averaged 433 and 437 g of cereal, 25 and 20 g of fat, 59 and 60 g of colored vegetable for males and females, respectively. For the majority of the subjects, milk and dairy product (249 and 213 g for males and females, respectively) was almost the sole source of food of animal origin. The levels of energy intake (2427 and 2275 kcal for males and females, respectively), protein (63.0 and 57.3 g), and vitamin B 1 (2.16 and 2.04 mg) were related to the level of consumption of cereal (r=0.89, r=0.77 and r=90, p 2 (1.06 and 0.80 mg) were correlated with the protein intake (r=0.57, r=0.87 and r=0.60, p

Introduction The purpose of this research is to require suitable numbers of verification times and patients for calculating the setup margin (SM) in radiotherapy. Methods 1) This simulation was performed using the standard normal distribution random number. The simulation used the seven levels of verification from 5 to 35 in 5 steps, and 35 patients. 2) The setup error in prostate radiotherapy at three hospitals was analyzed. Systematic error and random error were calculated from each patient's average value and standard deviation. Furthermore, we used the formula of J Stroom to calculate SM. Suitable numbers of verification times and patients were obtained from statistical analysis of the simulated results. Results 1) In the results of our simulations using random number, SM converged on 1.0 to 1.3 mm, regardless of the number of patients, when there were more than 15 verification times; 2) The results of clinical data were slightly different from the standard normal distribution, and more than 15 verification times and over 15 patients were required. Conclusions In conclusion, calculation of the SM in radiotherapy required more than 15 verification times and over 15 patients.

This study examined the physical status (72 males and 69 females) and serum distribution of lipids, protein, and Ca (60 males and 57 females) of people aged 1 to 72 years living in southeastern Nepal. The mean values of height and weight increased with age to adolescence and were the same for both sexes in childhood. Males were taller than females above the 15-19-year age group. There were large weight differences among individuals, with adult males tending to be heavier than adult females. The average body mass index increased with age (r=0.72, p

Purpose: Stereotactic body radiotherapy (SBRT) combining transarterial chemoembolization (TACE) with Lipiodol is expected to improve local control. This study aims to evaluate the impact of Lipiodol on dose distribution by comparing the dosimetric performance of the Acuros XB (AXB) algorithm, anisotropic analytical algorithm (AAA), and Monte Carlo (MC) method using a virtual heterogeneous phantom and a treatment plan for liver SBRT after TACE. Methods: The dose distributions calculated using AAA and AXB algorithm, both in Eclipse (ver. 11; Varian Medical Systems, Palo Alto, CA), and EGSnrc-MC were compared. First, the inhomogeneity correction accuracy of the AXB algorithm and AAA was evaluated by comparing the percent depth dose (PDD) obtained from the algorithms with that from the MC calculations using a virtual inhomogeneity phantom, which included water and Lipiodol. Second, the dose distribution of a liver SBRT patient treatment plan was compared between the calculation algorithms. Results In the virtual phantom, compared with the MC calculations, AAA underestimated the doses just before and in the Lipiodol region by 5.1% and 9.5%, respectively, and overestimated the doses behind the region by 6.0%. Furthermore, compared with the MC calculations, the AXB algorithm underestimated the doses just before and in the Lipiodol region bymore » 4.5% and 10.5%, respectively, and overestimated the doses behind the region by 4.2%. In the SBRT plan, the AAA and AXB algorithm underestimated the maximum doses in the Lipiodol region by 9.0% in comparison with the MC calculations. In clinical cases, the dose enhancement in the Lipiodol region can approximately 10% increases in tumor dose without increase of dose to normal tissue. Conclusion: The MC method demonstrated a larger increase in the dose in the Lipiodol region than the AAA and AXB algorithm. Notably, dose enhancement were observed in the tumor area; this may lead to a clinical benefit.« less