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Sample records for guided stereotactic high

  1. CT and Ultrasound Guided Stereotactic High Intensity Focused Ultrasound (HIFU)

    SciTech Connect

    Wood, Bradford J.; Frenkel, V.; Viswanathan, A.; Dromi, S.; Oh, K.; Kam, A.; Li, K. C. P.; Yanof, J.; Bauer, C.; Kruecker, J.; Seip, R.

    2006-05-08

    To demonstrate the feasibility of CT and B-mode Ultrasound (US) targeted HIFU, a prototype coaxial focused ultrasound transducer was registered and integrated to a CT scanner. CT and diagnostic ultrasound were used for HIFU targeting and monitoring, with the goals of both thermal ablation and non-thermal enhanced drug delivery. A 1 megahertz coaxial ultrasound transducer was custom fabricated and attached to a passive position-sensing arm and an active six degree-of-freedom robotic arm via a CT stereotactic frame. The outer therapeutic transducer with a 10 cm fixed focal zone was coaxially mounted to an inner diagnostic US transducer (2-4 megahertz, Philips Medical Systems). This coaxial US transducer was connected to a modified commercial focused ultrasound generator (Focus Surgery, Indianapolis, IN) with a maximum total acoustic power of 100 watts. This pre-clinical paradigm was tested for ability to heat tissue in phantoms with monitoring and navigation from CT and live US. The feasibility of navigation via image fusion of CT with other modalities such as PET and MRI was demonstrated. Heated water phantoms were tested for correlation between CT numbers and temperature (for ablation monitoring). The prototype transducer and integrated CT/US imaging system enabled simultaneous multimodality imaging and therapy. Pre-clinical phantom models validated the treatment paradigm and demonstrated integrated multimodality guidance and treatment monitoring. Temperature changes during phantom cooling corresponded to CT number changes. Contrast enhanced or non-enhanced CT numbers may potentially be used to monitor thermal ablation with HIFU. Integrated CT, diagnostic US, and therapeutic focused ultrasound bridges a gap between diagnosis and therapy. Preliminary results show that the multimodality system may represent a relatively inexpensive, accessible, and simple method of both targeting and monitoring HIFU effects. Small animal pre-clinical models may be translated to large

  2. Role of high-field intraoperative magnetic resonance imaging on a multi-image fusion-guided stereotactic biopsy of the basal ganglia: A case report.

    PubMed

    Sun, Xiang; Chen, Zhijuan; Yang, Shuyuan; Zhang, Jianning; Yue, Shuyuan; Wang, Zengguang; Yang, Weidong

    2015-01-01

    The aim of the present case study was to investigate the advantages of intraoperative magnetic resonance imaging (iMRI) on the real-time guidance and monitoring of a stereotactic biopsy. The study describes a patient with intracranial lesions, which were examined by conventional MRI and diffusion tensor imaging using a 1.5T intraoperative MRI system. The digital and pre-operative positron emission/computed tomography image data were transferred to a BrainLAB planning workstation, and a variety of images were automatically fused. The BrainLAB software was then used to reconstruct the corticospinal tract (CST) and create a three-dimensional display of the anatomical association between the CST and the brain lesions. A Leksell surgical planning workstation was used to identify the ideal target site and a reasonable needle track for the biopsy. The 1.5T iMRI was used to effectively monitor the intracranial condition during the brain biopsy procedure. Post-operatively, the original symptoms of the patient were not aggravated and no further neurological deficits were apparent. The histopathological diagnosis of non-Hodgkin's B-cell lymphoma was made. Using high-field iMRI, the multi-image fusion-guided stereotactic brain biopsy allows for a higher positive rate of biopsy and a lower incidence of complications. The approach of combining multi-image fusion images with the frame-based stereotactic biopsy may be clinically useful for intracranial lesions of deep functional areas.

  3. Stereotactic Image-Guided Intensity Modulated Radiotherapy Using the HI-ART II Helical Tomotherapy System

    SciTech Connect

    Holmes, Timothy W. Hudes, Richard; Dziuba, Sylwester; Kazi, Abdul; Hall, Mark; Dawson, Dana

    2008-07-01

    The highly integrated adaptive radiation therapy (HI-ART II) helical tomotherapy unit is a new radiotherapy machine designed to achieve highly precise and accurate treatments at all body sites. The precision and accuracy of the HI-ART II is similar to that provided by stereotactic radiosurgery systems, hence the historical distinction between external beam radiotherapy and stereotactic procedures based on differing precision requirements is removed for this device. The objectives of this work are: (1) to describe stereotactic helical tomotherapy processes (SRS, SBRT); (2) to show that the precision and accuracy of the HI-ART meet the requirements defined for SRS and SBRT; and (3) to describe the clinical implementation of a stereotactic image-guided intensity modulated radiation therapy (IG-IMRT) system that incorporates optical motion management.

  4. Peripheral nervous system injury after high-dose single-fraction image-guided stereotactic radiosurgery for spine tumors.

    PubMed

    Stubblefield, Michael D; Ibanez, Katarzyna; Riedel, Elyn R; Barzilai, Ori; Laufer, Ilya; Lis, Eric; Yamada, Yoshiya; Bilsky, Mark H

    2017-03-01

    OBJECTIVE The object of this study was to determine the percentage of high-dose (1800-2600 cGy) single-fraction stereotactic radiosurgery (SF-SRS) treatments to the spine that result in peripheral nervous system (PNS) injury. METHODS All patients treated with SF-SRS for primary or metastatic spine tumors between January 2004 and May 2013 and referred to the Rehabilitation Medicine Service for evaluation and treatment of neuromuscular, musculoskeletal, or functional impairments or pain were retrospectively identified. RESULTS Five hundred fifty-seven SF-SRS treatments in 447 patients resulted in 14 PNS injuries in 13 patients. All injures resulted from SF-SRS delivered to the cervical or lumbosacral spine at 2400 cGy. The overall percentage of SF-SRS treatments resulting in PNS injury was 2.5%, increasing to 4.5% when the thoracic spine was excluded from analysis. The median time to symptom onset following SF-SRS was 10 months (range 4-32 months). The plexus (cervical, brachial, and/or lumbosacral) was affected clinically and/or electrophysiologically in 12 (86%) of 14 cases, the nerve root in 2 (14%) of 14, and both in 6 (43%) of 14 cases. All patients experienced pain and most (93%) developed weakness. Peripheral nervous system injuries were CTCAE Grade 1 in 14% of cases, 2 in 64%, and 3 in 21%. No dose relationship between SF-SRS dose and PNS injury was detected. CONCLUSIONS Single-fraction SRS to the spine can result in PNS injury with major implications for function and quality of life.

  5. An image guided small animal stereotactic radiotherapy system

    PubMed Central

    Sha, Hao; Udayakumar, Thirupandiyur S.; Johnson, Perry B.; Dogan, Nesrin; Pollack, Alan; Yang, Yidong

    2016-01-01

    Small animal radiotherapy studies should be performed preferably on irradiators capable of focal tumor irradiation and healthy tissue sparing. In this study, an image guided small animal arc radiation treatment system (iSMAART) was developed which can achieve highly precise radiation targeting through the utilization of onboard cone beam computed tomography (CBCT) guidance. The iSMAART employs a unique imaging and radiation geometry where animals are positioned upright. It consists of a stationary x-ray tube, a stationary flat panel detector, and a rotatable and translational animal stage. System performance was evaluated in regards to imaging, image guidance, animal positioning, and radiation targeting using phantoms and tumor bearing animals. The onboard CBCT achieved good signal, contrast, and sub-millimeter spatial resolution. The iodine contrast CBCT accurately delineated orthotopic prostate tumors. Animal positioning was evaluated with ∼0.3 mm vertical displacement along superior-inferior direction. The overall targeting precision was within 0.4 mm. Stereotactic radiation beams conformal to tumor targets can be precisely delivered from multiple angles surrounding the animal. The iSMAART allows radiobiology labs to utilize an image guided precision radiation technique that can focally irradiate tumors while sparing healthy tissues at an affordable cost. PMID:26958942

  6. High Dose-Per-Fraction Irradiation of Limited Lung Volumes Using an Image-Guided, Highly Focused Irradiator: Simulating Stereotactic Body Radiotherapy Regimens in a Small-Animal Model

    SciTech Connect

    Cho, Jaeho; Kodym, Reinhard; Seliounine, Serguei

    2010-07-01

    Purpose: To investigate the underlying biology associated with stereotactic body radiotherapy (SBRT), both in vivo models and image-guided, highly focal irradiation systems are necessary. Here, we describe such an irradiation system and use it to examine normal tissue toxicity in a small-animal model at lung volumes similar to those associated with human therapy. Methods and Materials: High-dose radiation was delivered to a small volume of the left lung of C3H/HeJCr mice using a small-animal stereotactic irradiator. The irradiator has a collimation mechanism to produce focal radiation beams, an imaging subsystem consisting of a fluorescent screen coupled to a charge-coupled device camera, and a manual positioning stage. Histopathologic examination and micro-CT were used to evaluate the radiation response. Results: Focal obliteration of the alveoli by fibrous connective tissue, hyperplasia of the bronchiolar epithelium, and presence of a small number of inflammatory cells are the main reactions to low-volume/high-dose irradiation of the mouse lung. The tissue response suggested a radiation dose threshold for early phase fibrosis lying between 40 and 100 Gy. The irradiation system satisfied our requirements of high-dose-rate, small beam diameter, and precise localization and verification. Conclusions: We have established an experimental model and image-guided animal irradiation system for the study of high dose per fraction irradiations such as those used with SBRT at volumes analogous to those used in human beings. It will also allow the targeting of specific anatomical structures of the thorax or ultimately, orthotopic tumors of the lung.

  7. Robotic System for MRI-Guided Stereotactic Neurosurgery

    PubMed Central

    Li, Gang; Cole, Gregory A.; Shang, Weijian; Harrington, Kevin; Camilo, Alex; Pilitsis, Julie G.; Fischer, Gregory S.

    2015-01-01

    Stereotaxy is a neurosurgical technique that can take several hours to reach a specific target, typically utilizing a mechanical frame and guided by preoperative imaging. An error in any one of the numerous steps or deviations of the target anatomy from the preoperative plan such as brain shift (up to 20 mm), may affect the targeting accuracy and thus the treatment effectiveness. Moreover, because the procedure is typically performed through a small burr hole opening in the skull that prevents tissue visualization, the intervention is basically “blind” for the operator with limited means of intraoperative confirmation that may result in reduced accuracy and safety. The presented system is intended to address the clinical needs for enhanced efficiency, accuracy, and safety of image-guided stereotactic neurosurgery for Deep Brain Stimulation (DBS) lead placement. The work describes a magnetic resonance imaging (MRI)-guided, robotically actuated stereotactic neural intervention system for deep brain stimulation procedure, which offers the potential of reducing procedure duration while improving targeting accuracy and enhancing safety. This is achieved through simultaneous robotic manipulation of the instrument and interactively updated in situ MRI guidance that enables visualization of the anatomy and interventional instrument. During simultaneous actuation and imaging, the system has demonstrated less than 15% signal-to-noise ratio (SNR) variation and less than 0.20% geometric distortion artifact without affecting the imaging usability to visualize and guide the procedure. Optical tracking and MRI phantom experiments streamline the clinical workflow of the prototype system, corroborating targeting accuracy with 3-axis root mean square error 1.38 ± 0.45 mm in tip position and 2.03 ± 0.58° in insertion angle. PMID:25376035

  8. False-negative results after stereotactically guided vacuum biopsy.

    PubMed

    Peter, D; Grünhagen, J; Wenke, R; Schäfer, F K W; Schreer, I

    2008-01-01

    The purpose of this study was to determine the false negative rate of stereotactically guided vacuum biopsy (VB). Data of patients with benign lesions in VB were evaluated retrospectively during a median follow-up period of 21 months. A total of 404 VB were considered benign and representative and were recommended for follow-up. Of these 404 lesions, 195 were completely removed radiologically. Follow-up data were available for 354/404 patients (87.6%), with intervals ranging from 3 to 66 months (median 21, mean 22.4). Reintervention or surgery was necessary in 13/354 (3.7%) cases. Of these cases, 5/354 (1.4%) turned out to be false negatives. Four of these cases showed large areas of microcalcifications or several clusters, and only partial removal was possible due to the size of the lesions. Although VB is an accurate procedure for diagnosing nonpalpable breast lesions with a low cancer miss rate, we consider the exclusion of malignancy in cases of disseminated microcalcifications or several clusters as a limitation. The radiologic-pathologic correlation in these cases is a challenge, particularly in terms of the residuals. Strict follow-up of benign lesions is essential to avoid delayed cancer diagnosis.

  9. Reliability of the Bony Anatomy in Image-Guided Stereotactic Radiotherapy of Brain Metastases

    SciTech Connect

    Guckenberger, Matthias Baier, Kurt; Guenther, Iris; Richter, Anne; Wilbert, Juergen; Sauer, Otto; Vordermark, Dirk; Flentje, Michael

    2007-09-01

    Purpose: To evaluate whether the position of brain metastases remains stable between planning and treatment in cranial stereotactic radiotherapy (SRT). Methods and Materials: Eighteen patients with 20 brain metastases were treated with single-fraction (17 lesions) or hypofractionated (3 lesions) image-guided SRT. Median time interval between planning and treatment was 8 days. Before treatment a cone-beam CT (CBCT) and a conventional CT after application of i.v. contrast were acquired. Setup errors using automatic bone registration (CBCT) and manual soft-tissue registration of the brain metastases (conventional CT) were compared. Results: Tumor size was not significantly different between planning and treatment. The three-dimensional setup error (mean {+-} SD) was 4.0 {+-} 2.1 mm and 3.5 {+-} 2.2 mm according to the bony anatomy and the lesion itself, respectively. A highly significant correlation between automatic bone match and soft-tissue registration was seen in all three directions (r {>=} 0.88). The three-dimensional distance between the isocenter according to bone match and soft-tissue registration was 1.7 {+-} 0.7 mm, maximum 2.8 mm. Treatment of intracranial pressure with steroids did not influence the position of the lesion relative to the bony anatomy. Conclusion: With a time interval of approximately 1 week between planning and treatment, the bony anatomy of the skull proved to be an excellent surrogate for the target position in image-guided SRT.

  10. MRI-guided stereotactic amygdalohippocampectomy: a single center experience

    PubMed Central

    Vojtěch, Zdeněk; Malíková, Hana; Krámská, Lenka; Liščák, Roman; Vladyka, Vilibald

    2015-01-01

    Background This paper presents our experience of stereotactic radiofrequency amygdalohippocampectomy performed for intractable mesial temporal lobe epilepsy. Methods The article describes the cases of 61 patients who were treated during the period from 2004 to 2010. Mean postoperative follow-up was 5.3 years. Neuropsychological results were obtained for a subset of 31 patients. Results At their last postsurgical visit, 43 (70.5%) patients were Engel class I, six (9.8%) class II, nine (14.8%) class III, and three (4.9%) class IV. The surgery was complicated by four intracranial hematomas. One of them caused acute hydrocephalus and was treated by shunting and resolved without sequelae, while another caused transitory aphasia. The remaining hematomas were asymptomatic. There were two cases of meningitis which required antibiotic treatment. One patient committed suicide due to postoperative depression. After the procedure, we performed open epilepsy surgery and rethermolesions in three and two patients, respectively (8.2%). Patients showed increases in their mean full scale, verbal, and performance intelligence quotient (IQ) scores of 4, 3, and 4 IQ points, respectively (P<0.05). Five (17.2%), four (13.8%), and four (13.3%) patients improved their full scale, verbal, and performance IQ scores, respectively. No significant changes were found in memory performance, with a mean increase of 1, 3, and 0 memory quotient points in global, verbal, and visual memory, respectively (P<0.05). Global memory improved in three (10.3%) patients, verbal memory in one (3.4%), and one patient (3.3%) showed deterioration in visual memory. Conclusion Stereotactic radiofrequency amygdalohippocampectomy offers a safe, effective, and less aggressive treatment modality in cases of well-defined mesial temporal lobe epilepsy. Seizure outcome is comparable with the results of conventional epilepsy surgery and cognitive results could be even better. PMID:25709460

  11. Image-Guided Stereotactic Spine Radiosurgery on a Conventional Linear Accelerator

    SciTech Connect

    Wang Jiazhu Rice, Roger; Mundt, Arno; Sandhu, Ajay; Murphy, Kevin

    2010-04-01

    Stereotactic radiosurgery for spinal metastasis consists of a high radiation dose delivered to the tumor in 1 to 5 fractions. Due to the high radiation dose in a single or fewer treatments, the precision of tumor localization and dose delivery is of great concern. Many groups have published their experiences of spinal radiosurgery with the use of CyberKnife System (Accuray Inc.). In this study, we report in detail our approach to stereotactic spine radiosurgery (SSRS) using a conventional linear accelerator (Varian Trilogy), utilizing the features of kilovolt on-board imaging (kV-OBI) and cone beam computed tomography (CBCT) for image guidance. We present our experience in various aspects of the SSRS procedure, including patient simulation and immobilization, intensity-modulated radiation treatment (IMRT) planning and beam selection, portal dosimetry for patient planning quality assurance (QA), and the use of image guidance in tumor localization prior to and during treatment delivery.

  12. Image-guided stereotactic spine radiosurgery on a conventional linear accelerator.

    PubMed

    Wang, Jia-Zhu; Rice, Roger; Mundt, Arno; Sandhu, Ajay; Murphy, Kevin

    2010-01-01

    Stereotactic radiosurgery for spinal metastasis consists of a high radiation dose delivered to the tumor in 1 to 5 fractions. Due to the high radiation dose in a single or fewer treatments, the precision of tumor localization and dose delivery is of great concern. Many groups have published their experiences of spinal radiosurgery with the use of CyberKnife System (Accuray Inc.). In this study, we report in detail our approach to stereotactic spine radiosurgery (SSRS) using a conventional linear accelerator (Varian Trilogy), utilizing the features of kilovolt on-board imaging (kV-OBI) and cone beam computed tomography (CBCT) for image guidance. We present our experience in various aspects of the SSRS procedure, including patient simulation and immobilization, intensity-modulated radiation treatment (IMRT) planning and beam selection, portal dosimetry for patient planning quality assurance (QA), and the use of image guidance in tumor localization prior to and during treatment delivery.

  13. Real-Time Magnetic Resonance-Guided Stereotactic Laser Amygdalohippocampotomy for Mesial Temporal Lobe Epilepsy

    PubMed Central

    Willie, Jon T.; Laxpati, Nealen G.; Drane, Daniel L.; Gowda, Ashok; Appin, Christina; Hao, Chunhai; Brat, Daniel J.; Helmers, Sandra L.; Saindane, Amit; Nour, Sherif G.; Gross, Robert E.

    2014-01-01

    Background Open surgery effectively treats mesial temporal lobe epilepsy (MTLE), but carries risks of neurocognitive deficits, which may be reduced with minimally invasive alternatives. Objective To describe technical and clinical outcomes of stereotactic laser amygdalohippocampotomy (SLAH) with real-time magnetic resonance thermal imaging (MRTI) guidance. Methods Under general anesthesia and utilizing standard stereotactic methods, 13 adult patients with intractable MTLE (with and without mesial temporal sclerosis, MTS) prospectively underwent insertion of a saline-cooled fiber-optic laser applicator into amygdalohippocampal structures from an occipital trajectory. Computer-controlled laser ablation was performed during continuous MRTI followed by confirmatory contrast-enhanced anatomic imaging and volumetric reconstruction. Clinical outcomes were determined from seizure diaries. Results A mean 60% volume of the amygdalohippocampal complex was ablated in 13 patients (9 with MTS) undergoing 15 procedures. Median hospitalization was one day. With follow-up ranging from 5-26 (median 14) months, 77% (10/13) of patients achieved meaningful seizure reduction, of which 54% (7/13) were free of disabling seizures. Of patients with preoperative MTS, 67% (6/9) achieved seizure freedom. All recurrences were observed by<6 months. Variances in ablation volume and length did not account for individual clinical outcomes. Whereas no complications of laser therapy itself were observed, one significant complication, a visual field defect, resulted from deviated insertion of a stereotactic aligning rod, which was corrected prior to ablation. Conclusion Real-time MR-guided SLAH is a technically novel, safe, and effective alternative to open surgery. Further evaluation with larger cohorts over time is warranted. PMID:24618797

  14. Frameless Image-Guided Intracranial Stereotactic Radiosurgery: Clinical Outcomes for Brain Metastases

    SciTech Connect

    Breneman, John C. Steinmetz, Ryan; Smith, Aaron; Lamba, Michael; Warnick, Ronald E.

    2009-07-01

    Purpose: After preclinical investigations confirming the accuracy of target localization by frameless image-guided radiosurgery, we report the clinical outcomes of patients with brain metastases who underwent frameless radiosurgery. Methods and Materials: Between 2005 and 2006, 53 patients underwent frameless stereotactic radiosurgery using a linear accelerator equipped with on-board image guidance for the treatment of 158 brain metastases. The radiation doses were delivered in a single fraction (dose range, 12-22 Gy; median, 18). Patients were followed with magnetic resonance imaging scans at 2-3-month intervals. Progression-free survival was the primary study endpoint. Results: With a median follow-up of 38 weeks (range, 14-112), the overall survival rate was 70% at 6 months, 44% at 1 year, 29% at 18 months, and 16% at 24 months. Local control was achieved in 90% of 168 treated lesions at 6 months, 80% at 12 months, 78% at 18 months, and 78% at 24 months. Local control tended to be improved in lesions treated with {>=}18 Gy and for lesions <0.2 cm{sup 3}. Adverse events occurred in 5 patients (9.6%). No evidence of imaging changes on post-stereotactic radiosurgery scans was found to suggest mistargeting of a radiation isocenter. Conclusion: The clinical outcomes after frameless stereotactic radiosurgery were comparable to those after frame-based radiosurgery techniques. Given its significant advantages in terms of patient comfort, ability to use fractionated treatment regimens, and convenience in scheduling of personnel and equipment resources, frameless radiosurgery will likely become a common technique for intracranial radiosurgery.

  15. Effect of image-guided hypofractionated stereotactic radiotherapy on peripheral non-small-cell lung cancer

    PubMed Central

    Wang, Shu-wen; Ren, Juan; Yan, Yan-li; Xue, Chao-fan; Tan, Li; Ma, Xiao-wei

    2016-01-01

    The objective of this study was to compare the effects of image-guided hypofractionated radiotherapy and conventional fractionated radiotherapy on non-small-cell lung cancer (NSCLC). Fifty stage- and age-matched cases with NSCLC were randomly divided into two groups (A and B). There were 23 cases in group A and 27 cases in group B. Image-guided radiotherapy (IGRT) and stereotactic radiotherapy were conjugately applied to the patients in group A. Group A patients underwent hypofractionated radiotherapy (6–8 Gy/time) three times per week, with a total dose of 64–66 Gy; group B received conventional fractionated radiotherapy, with a total dose of 68–70 Gy five times per week. In group A, 1-year and 2-year local failure survival rate and 1-year local failure-free survival rate were significantly higher than in group B (P<0.05). The local failure rate (P<0.05) and distant metastasis rate (P>0.05) were lower in group A than in group B. The overall survival rate of group A was significantly higher than that of group B (P=0.03), and the survival rate at 1 year was 87% vs 63%, (P<0.05). The median survival time of group A was longer than that of group B. There was no significant difference in the incidence of complications between the two groups (P>0.05). Compared with conventional fractionated radiation therapy, image-guided hypofractionated stereotactic radiotherapy in NSCLC received better treatment efficacy and showed good tolerability. PMID:27574441

  16. Versatility of the Novalis system to deliver image-guided stereotactic body radiation therapy (SBRT) for various anatomical sites.

    PubMed

    Teh, Bin S; Paulino, Arnold C; Lu, Hsin H; Chiu, J Kam; Richardson, Susan; Chiang, Stephen; Amato, Robert; Butler, E Brian; Bloch, Charles

    2007-08-01

    Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) programs to treat brain tumors were implemented when we first acquired the Brainlab Novalis system in 2003. Two years later, we started an extra-cranial stereotactic radio-ablation or more appropriately a stereotactic body radiation therapy (SBRT) program using the Brainlab Novalis image-guided system at The Methodist Hospital in Houston, Texas. We hereby summarize our initial experience with this system in delivering image-guided SBRT to a total of 80 patients during our first year of clinical implementation, from February 2005 to January 2006. Over 100 lesions in more than 20 distinct anatomical sites were treated. These include all levels of spine from cervical, thoracic, lumbar, and sacral lesions. Spinal lesions encompass intramedullary, intradural, extradural, or osseous compartments. Also treated were lesions in other bony sites including orbit, clavicle, scapula, humerus, sternum, rib, femur, and pelvis (ilium, ischium, and pubis). Primary or metastatic lesions located in the head and neck, supraclavicular region, axilla, mediastinum, lung (both central and peripheral), abdominal wall, liver, kidney, para-aortic lymph nodes, prostate, and pelvis were also treated. In addition to primary radiotherapy, SBRT program using the Brainlab Novalis system allows re-irradiation for recurrence and "boost" after conventional treatment to various anatomical sites. Treating these sites safely and efficaciously requires knowledge in radiation tolerance, fraction size, total dose, biologically equivalent dose (BED), prior radiotherapy, detailed dose volume histograms (DVH) of normal tissues, and the radiosensitive/radioresistant nature of the tumor. Placement of radio-opaque markers (Visicoil, Radiomed) in anatomical sites not in close proximity to bony landmarks (e.g., kidney and liver) helps in measuring motion and providing image guidance during each treatment fraction. Tumor/organ motion

  17. Can galactography-guided stereotactic, 11-gauge, vacuum-assisted breast biopsy of intraductal lesions serve as an alternative to surgical biopsy?

    PubMed

    Reiner, Caecilia S; Helbich, Thomas H; Rudas, Margaretha; Ponhold, Lothar; Riedl, Christopher C; Kropf, Nina; Fuchsjäger, Michael H

    2009-12-01

    The purpose of this study was to determine the value of galactography-guided, stereotactic, vacuum-assisted breast biopsy (VABB) for the assessment of intraductal breast lesions and its potential as a therapeutic tool that could eliminate the need for surgical excision. Eighteen patients (median age 64 years, range 37-80) with nipple discharge and galactography-verified intraductal lesions underwent galactography-guided, stereotactic, 11-gauge VABB followed by surgery. Histopathology findings from VABB and subsequent surgery were compared. Underestimation and false-negative rates were assessed. After VABB, histopathology revealed invasive ductal carcinoma (IDC) in three (17%), ductal carcinoma in situ (DCIS) in six (33%), high-risk lesions in six (33%) and benign lesions in three (17%) cases. After surgical biopsy, histopathology confirmed the previously established diagnosis in 11 lesions (61%). The underestimation rate for high-risk lesions and DCIS was 50% (6/12). The false-negative rate was 7% (1/14). Histopathology examination after surgery showed that not a single lesion had been completely removed at VABB. Galactography-guided VABB is a feasible diagnostic tool. However, its value as a therapeutic procedure is limited because of the high number of underestimated and missed lesions and because of the histopathological detection of lesions' remnants in every case. Surgical excision should be the therapeutic gold standard in cases of pathological nipple discharge and galactography abnormalities.

  18. Deep inspiration breath-hold technique guided by an opto- electronic system for extracranial stereotactic treatments.

    PubMed

    Garibaldi, Cristina; Catalano, Gianpiero; Baroni, Guido; Tagaste, Barbara; Riboldi, Marco; Spadea, Maria Francesca; Ciocca, Mario; Cambria, Raffaella; Serafini, Flavia; Orecchia, Roberto

    2013-07-08

    The purpose of this work was to evaluate the intrapatient tumor position reproducibility in a deep inspiration breath-hold (DIBH) technique based on two infrared optical tracking systems, ExacTrac and ELITETM, in stereotactic treatment of lung and liver lesions. After a feasibility study, the technique was applied to 15 patients. Each patient, provided with a real-time visual feedback of external optical marker displacements, underwent a full DIBH, a free-breathing (FB), and three consecutive DIBH CT-scans centered on the lesion to evaluate the tumor position reproducibility. The mean reproducibility of tumor position during repeated DIBH was 0.5 ± 0.3 mm in laterolateral (LL), 1.0 ± 0.9 mm in anteroposterior (AP), and 1.4 ± 0.9 mm in craniocaudal (CC) direction for lung lesions, and 1.0 ± 0.6 mm in LL, 1.1 ± 0.5 mm in AP, and 1.2 ± 0.4 mm in CC direction for liver lesions. Intra- and interbreath-hold reproducibility during treatment, as determined by optical markers displacements, was below 1 mm and 3 mm, respectively, in all directions for all patients. Optically-guided DIBH technique provides a simple noninvasive method to minimize breathing motion for collaborative patients. For each patient, it is important to ensure that the tumor position is reproducible with respect to the external markers configuration.

  19. CT-Guided Fiducial Placement for CyberKnife Stereotactic Radiosurgery: An Initial Experience

    SciTech Connect

    Sotiropoulou, Evangelia; Stathochristopoulou, Irene; Stathopoulos, Konstantinos; Verigos, Kosmas; Salvaras, Nikolaos; Thanos, Loukas

    2010-06-15

    CyberKnife frameless image-guided radiosurgery has become a widely used system for parenchymal extracranial lesions. Gold fiducials are required for the planning and aiming of CyberKnife therapy. We report our initial experience and describe the technique of positioning tumor markers, under CT guidance. We conducted a retrospective review of 105 patients who were referred for CyberKnife stereotactic radiosurgery at Iatropolis CyberKnife Center in Athens. All patients underwent percutaneous fiducial placement via CT guidance. At the desired location, the 18-G needle was advanced into or near the tumor. Data collected included number and locations of fiducials placed and complications experienced to date. One hundred five patients underwent fiducial placement under CT guidance and a total number of 319 gold seeds were implanted. We experienced one episode of pneumothorax that required drainage, one mild pneumothorax, and three episodes of perifocal pulmonary hemorrhage. In conclusion, fiducial implantation under CT guidance appears to be a safe and efficient procedure, as long as it is performed by an experienced interventional radiologist.

  20. Cone-beam Computed Tomography-guided Stereotactic Liver Punctures: A Phantom Study

    SciTech Connect

    Toporek, Grzegorz Wallach, Daphne Weber, Stefan; Bale, Reto; Widmann, Gerlig

    2013-12-15

    Purpose: Images from computed tomography (CT), combined with navigation systems, improve the outcomes of local thermal therapies that are dependent on accurate probe placement. Although the usage of CT is desired, its availability for time-consuming radiological interventions is limited. Alternatively, three-dimensional images from C-arm cone-beam CT (CBCT) can be used. The goal of this study was to evaluate the accuracy of navigated CBCT-guided needle punctures, controlled with CT scans. Methods: Five series of five navigated punctures were performed on a nonrigid phantom using a liver specific navigation system and CBCT volumetric dataset for planning and navigation. To mimic targets, five titanium screws were fixed to the phantom. Target positioning accuracy (TPE{sub CBCT}) was computed from control CT scans and divided into lateral and longitudinal components. Additionally, CBCT-CT guidance accuracy was deducted by performing CBCT-to-CT image coregistration and measuring TPE{sub CBCT-CT} from fused datasets. Image coregistration was evaluated using fiducial registration error (FRE{sub CBCT-CT}) and target registration error (TRE{sub CBCT-CT}). Results: Positioning accuracies in lateral directions pertaining to CBCT (TPE{sub CBCT} = 2.1 {+-} 1.0 mm) were found to be better to those achieved from previous study using CT (TPE{sub CT} = 2.3 {+-} 1.3 mm). Image coregistration error was 0.3 {+-} 0.1 mm, resulting in an average TRE of 2.1 {+-} 0.7 mm (N = 5 targets) and average Euclidean TPE{sub CBCT-CT} of 3.1 {+-} 1.3 mm. Conclusions: Stereotactic needle punctures might be planned and performed on volumetric CBCT images and controlled with multidetector CT with positioning accuracy higher or similar to those performed using CT scanners.

  1. Magnetic Resonance-Guided Laser-Induced Thermal Therapy for Recurrent Brain Metastases in the Motor Strip After Stereotactic Radiosurgery

    PubMed Central

    Halpern, Casey H; Grant, Gerald A; Deb, Sayantan; Li, Gordon H

    2016-01-01

    The authors report a challenging case of a brain metastasis located in the motor cortex, which was not responsive to radiosurgery. Use of a novel technique, magnetic resonance-guided laser-induced thermotherapy (MRgLITT), resulted in the complete obliteration of the lesion without adverse effects or evidence of tumor recurrence at follow-up. This case illustrates that MRgLITT may provide a viable alternative for patients with brain metastases refractory to radiosurgery or in deep locations, where both stereotactic radiosurgery (SRS) and surgical resection may be ineffective.   PMID:28083463

  2. Image-Guided Robotic Stereotactic Body Radiation Therapy for Liver Metastases: Is There a Dose Response Relationship?

    SciTech Connect

    Vautravers-Dewas, Claire; Dewas, Sylvain; Bonodeau, Francois; Adenis, Antoine; Lacornerie, Thomas; Penel, Nicolas; Lartigau, Eric; Mirabel, Xavier

    2011-11-01

    Purpose: To evaluate the outcome, tolerance, and toxicity of stereotactic body radiotherapy, using image-guided robotic radiation delivery, for the treatment of patients with unresectable liver metastases. Methods and Material: Patients were treated with real-time respiratory tracking between July 2007 and April 2009. Their records were retrospectively reviewed. Metastases from colorectal carcinoma and other primaries were not necessarily confined to liver. Toxicity was evaluated using National Cancer Institute Common Criteria for Adverse Events version 3.0. Results: Forty-two patients with 62 metastases were treated with two dose levels of 40 Gy in four Dose per Fraction (23) and 45 Gy in three Dose per Fraction (13). Median follow-up was 14.3 months (range, 3-23 months). Actuarial local control for 1 and 2 years was 90% and 86%, respectively. At last follow-up, 41 (66%) complete responses and eight (13%) partial responses were observed. Five lesions were stable. Nine lesions (13%) were locally progressed. Overall survival was 94% at 1 year and 48% at 2 years. The most common toxicity was Grade 1 or 2 nausea. One patient experienced Grade 3 epidermitis. The dose level did not significantly contribute to the outcome, toxicity, or survival. Conclusion: Image-guided robotic stereotactic body radiation therapy is feasible, safe, and effective, with encouraging local control. It provides a strong alternative for patients who cannot undergo surgery.

  3. Image-guided stereotactic radiotherapy in 4 dogs with intracranial neoplasia.

    PubMed

    Moon, Alaina Burkard; Heller, Heidi Barnes; Forrest, Lisa

    2016-05-01

    The purpose of this study was to describe the use, and side effects, of a novel stereotactic radiotherapy protocol using TomoTherapy(®) in 4 dogs with confirmed or suspected primary extra-axial intracranial neoplasia. Three fractions of 8 Gy were prescribed. Acute side effects were noted in 1 dog; no late effects were noted.

  4. Image-Guided Localization Accuracy of Stereoscopic Planar and Volumetric Imaging Methods for Stereotactic Radiation Surgery and Stereotactic Body Radiation Therapy: A Phantom Study

    SciTech Connect

    Kim, Jinkoo; Jin, Jian-Yue; Walls, Nicole; Nurushev, Teamour; Movsas, Benjamin; Chetty, Indrin J.; Ryu, Samuel

    2011-04-01

    Purpose: To evaluate the positioning accuracies of two image-guided localization systems, ExacTrac and On-Board Imager (OBI), in a stereotactic treatment unit. Methods and Materials: An anthropomorphic pelvis phantom with eight internal metal markers (BBs) was used. The center of one BB was set as plan isocenter. The phantom was set up on a treatment table with various initial setup errors. Then, the errors were corrected using each of the investigated systems. The residual errors were measured with respect to the radiation isocenter using orthogonal portal images with field size 3 x 3 cm{sup 2}. The angular localization discrepancies of the two systems and the correction accuracy of the robotic couch were also studied. A pair of pre- and post-cone beam computed tomography (CBCT) images was acquired for each angular correction. Then, the correction errors were estimated by using the internal BBs through fiducial marker-based registrations. Results: The isocenter localization errors ({mu} {+-}{sigma}) in the left/right, posterior/anterior, and superior/inferior directions were, respectively, -0.2 {+-} 0.2 mm, -0.8 {+-} 0.2 mm, and -0.8 {+-} 0.4 mm for ExacTrac, and 0.5 {+-} 0.7 mm, 0.6 {+-} 0.5 mm, and 0.0 {+-} 0.5 mm for OBI CBCT. The registration angular discrepancy was 0.1 {+-} 0.2{sup o} between the two systems, and the maximum angle correction error of the robotic couch was 0.2{sup o} about all axes. Conclusion: Both the ExacTrac and the OBI CBCT systems showed approximately 1 mm isocenter localization accuracies. The angular discrepancy of two systems was minimal, and the robotic couch angle correction was accurate. These positioning uncertainties should be taken as a lower bound because the results were based on a rigid dosimetry phantom.

  5. Comparison of Effects Between Central and Peripheral Stage I Lung Cancer Using Image-Guided Stereotactic Body Radiotherapy via Helical Tomotherapy.

    PubMed

    He, Jian; Huang, Yan; Shi, Shiming; Hu, Yong; Zeng, Zhaochong

    2015-12-01

    Lung cancer is a common malignant tumor with high morbidity and mortality. Here we compared the effects and outcome between central and peripheral stage I lung cancer using image-guided stereotactic body radiotherapy. From June 2011 to July 2013, a total of 33 patients with stage I lung cancer were enrolled. A total of 50 Gy in 10 fractions or 60 Gy in 10 fractions was delivered in the central arm (n = 18), while 50 Gy in 5 fractions in the peripheral arm (n = 15). Statistical analyses were performed using logistic regression analysis and Kaplan-Meier method. The mean follow-up time was 38.1 months. Three-month, 1-, 2-, and 3-year overall response rates were 66.7%, 83.3%, 61.1%, and 72.2% and 66.7%, 80%, 80%, and 80% in the central and peripheral arms, respectively. Three-year local control rates (94.4% vs 93.3%, P = .854), regional control rates (94.4% vs 86.7%, P = .412), and distant control rates (64.2% vs 61.7%, P = .509) had no differences between the central and the peripheral arms. Grade 2 radiation pneumonitis was observed in 6 of 18 patients in the central arm and in 1 of 15 patients in the peripheral arm (P = .92). Grade 2 radiation esophagitis was 5.7% in the central arm, while none occurred in the peripheral arm (P = .008). Five (15.1%) of all patients felt slight fatigue during radiotherapy. Other major complications were not observed. In conclusion, helical image-guided stereotactic body radiotherapy for central stage I lung cancer is safe and effective compared to peripheral stage I lung cancer.

  6. Touch Imprint Cytology and Stereotactically-Guided Core Needle Biopsy of Suspicious Breast Lesions: 15-Year Follow-up

    PubMed Central

    Schulz-Wendtland, R.; Fasching, P. A.; Bani, M. R.; Lux, M. P.; Jud, S.; Rauh, C.; Bayer, C.; Wachter, D. L.; Hartmann, A.; Beckmann, M. W.; Uder, M.; Loehberg, C. R.

    2016-01-01

    Introduction: Stereotactically-guided core needle biopsies (CNB) of breast tumours allow histological examination of the tumour without surgery. Touch imprint cytology (TIC) of CNB promises to be useful in providing same-day diagnosis for counselling purposes and for planning future surgery. Having addressed the issue of accuracy of immediate microscopic evaluation of TIC, we wanted to re-examine the usefulness of this procedure in light of the present health care climate of cost containment by incorporating the surgical 15-year follow-up data and outcome. Patients and Methods: From January until December 1996 we performed TIC in core needle biopsies of 173 breast tumours in 169 patients, consisting of 122 malignant and 51 benign tumours. Histology of core needle biopsies was proven by surgical histology in all malignant and in 5 benign tumours. Surgical breast biopsy was not performed in 46 patients with 46 benign lesions, as the histological result from the core needle biopsy and the result of the TIC were in agreement with the suspected diagnosis from the complementary breast diagnostics. A 15-year follow-up of these patients followed in 2013 and follow-up data was collected from 40 women. Results: In the 15-year follow-up of the 40 benign lesions primarily confirmed using CNB and TIC, a diagnostic sensitivity, specificity, positive and negative predictive value and accuracy of 100 % was found. Conclusion: TIC and stereotactically guided CNB showed excellent long-term follow-up in patients with benign breast lesions. The use of TIC to complement CNB can therefore provide immediate cytological diagnosis of breast lesions. PMID:26855442

  7. Outcomes and Toxicity for Hypofractionated and Single-Fraction Image-Guided Stereotactic Radiosurgery for Sarcomas Metastasizing to the Spine

    SciTech Connect

    Folkert, Michael R.; Bilsky, Mark H.; Tom, Ashlyn K.; Oh, Jung Hun; Alektiar, Kaled M.; Laufer, Ilya; Tap, William D.; Yamada, Yoshiya

    2014-04-01

    Purpose: Conventional radiation treatment (20-40 Gy in 5-20 fractions, 2-5 Gy per fraction) for sarcoma metastatic to the spine provides subtherapeutic doses, resulting in poor durable local control (LC) (50%-77% at 1 year). Hypofractionated (HF) and/or single-fraction (SF) image-guided stereotactic radiosurgery (IG-SRS) may provide a more effective means of managing these lesions. Methods and Materials: Patients with pathologically proven high-grade sarcoma metastatic to the spine treated with HF and SF IG-SRS were included. LC and overall survival (OS) were analyzed by the use of Kaplan-Meier statistics. Univariate and multivariate analyses were performed by the use of Cox regression with competing-risks analysis; all confidence intervals are 95%. Toxicities were assessed according to Common Terminology Criteria for Adverse Events, version 4.0. Results: From May 2005 to November 11, 2012, 88 patients with 120 discrete metastases received HF (3-6 fractions; median dose, 28.5 Gy; n=52, 43.3%) or SF IG-SRS (median dose, 24 Gy; n=68, 56.7%). The median follow-up time was 12.3 months. At 12 months, LC was 87.9% (confidence interval [CI], 81.3%-94.5%), OS was 60.6% (CI, 49.6%-71.6%), and median survival was 16.9 months. SF IG-SRS demonstrated superior LC to HF IG-SRS (12-month LC of 90.8% [CI, 83%-98.6%] vs 84.1% [CI, 72.9%-95.3%] P=.007) and retained significance on multivariate analysis (P=.030, hazard ratio 0.345; CI, 0.132-0.901]. Treatment was well tolerated, with 1% acute grade 3 toxicity, 4.5% chronic grade 3 toxicity, and no grade >3 toxicities. Conclusions: In the largest series of metastatic sarcoma to the spine to date, IG-SRS provides excellent LC in the setting of an aggressive disease with low radiation sensitivity and poor prognosis. Single-fraction IG-SRS is associated with the highest rates of LC with minimal toxicity.

  8. Five-Year Outcomes of High-Dose Single-Fraction Spinal Stereotactic Radiosurgery

    SciTech Connect

    Moussazadeh, Nelson; Lis, Eric; Katsoulakis, Evangelia; Kahn, Sweena; Svoboda, Marek; DiStefano, Natalie M.; McLaughlin, Lily; Bilsky, Mark H.; Yamada, Yoshiya; Laufer, Ilya

    2015-10-01

    Purpose: To characterize local tumor control and toxicity risk in very long-term survivors (>5 years) after high-dose spinal image guided, intensity modulated radiation therapy delivered as single-dose stereotactic radiosurgery (SRS). Previously published spinal SRS outcome analyses have included a heterogeneous population of cancer patients, mostly with short survival. This is the first study reporting the long-term tumor control and toxicity profiles after high-dose single-fraction spinal SRS. Methods and Materials: The study population included all patients treated from June 2004 to July 2009 with single-fraction spinal SRS (dose 24 Gy) who had survived at least 5 years after treatment. The endpoints examined included disease progression, surgical or radiation retreatment, in-field fracture development, and radiation-associated toxicity, scored using the Radiation Therapy Oncology Group radiation morbidity scoring criteria and the Common Terminology Criteria for Adverse Events, version 4.0. Local control and fracture development were assessed using Kaplan-Meier analysis. Results: Of 278 patients, 31 (11.1%), with 36 segments treated for spinal tumors, survived at least 5 years after treatment and were followed up radiographically and clinically for a median of 6.1 years (maximum 102 months). The histopathologic findings for the 5-year survivors included radiation-resistant metastases in 58%, radiation-sensitive metastases in 22%, and primary bone tumors in 19%. In this selected cohort, 3 treatment failures occurred at a median of 48.6 months, including 2 recurrences in the radiation field and 1 patient with demonstrated progression at the treatment margins. Ten lesions (27.8%) were associated with acute grade 1 cutaneous or gastrointestinal toxicity. Delayed toxicity ≥3 months after treatment included 8 cases (22.2%) of mild neuropathy, 2 (5.6%) of gastrointestinal discomfort, 8 (22.2%) of dermatitides, and 3 (8.3%) of myalgias/myositis. Thirteen

  9. Robotic Image-Guided Stereotactic Radiotherapy, for Isolated Recurrent Primary, Lymph Node or Metastatic Prostate Cancer

    SciTech Connect

    Jereczek-Fossa, Barbara Alicja; Beltramo, Giancarlo; Fariselli, Laura; Fodor, Cristiana; Santoro, Luigi; Vavassori, Andrea; Zerini, Dario; Gherardi, Federica; Ascione, Carmen; Bossi-Zanetti, Isa; Mauro, Roberta; Bregantin, Achille; Bianchi, Livia Corinna; De Cobelli, Ottavio; Orecchia, Roberto

    2012-02-01

    Purpose: To evaluate the outcome of robotic CyberKnife (Accuray, Sunnyvale, CA)-based stereotactic radiotherapy (CBK-SRT) for isolated recurrent primary, lymph node, or metastatic prostate cancer. Methods and Materials: Between May 2007 and December 2009, 34 consecutive patients/38 lesions were treated (15 patients reirradiated for local recurrence [P], 4 patients reirradiated for anastomosis recurrence [A], 16 patients treated for single lymph node recurrence [LN], and 3 patients treated for single metastasis [M]). In all but 4 patients, [{sup 11}C]choline positron emission tomography/computed tomography was performed. CBK-SRT consisted of reirradiation and first radiotherapy in 27 and 11 lesions, respectively. The median CBK-SRT dose was 30 Gy in 4.5 fractions (P, 30 Gy in 5 fractions; A, 30 Gy in 5 fractions; LN, 33 Gy in 3 fractions; and M, 36 Gy in 3 fractions). In 18 patients (21 lesions) androgen deprivation was added to CBK-SRT (median duration, 16.6 months). Results: The median follow-up was 16.9 months. Acute toxicity included urinary events (3 Grade 1, 2 Grade 2, and 2 Grade 3 events) and rectal events (1 Grade 1 event). Late toxicity included urinary events (3 Grade 1, 2 Grade 2, and 2 Grade 3 events) and rectal events (1 Grade 1 event and 1 Grade 2 event). Biochemical response was observed in 32 of 38 evaluable lesions. Prostate-specific antigen stabilization was seen for 4 lesions, and in 2 cases prostate-specific antigen progression was reported. The 30-month progression-free survival rate was 42.6%. Disease progression was observed for 14 lesions (5, 2, 5, and 2 in Groups P, A, LN, and M respectively). In only 3 cases, in-field progression was seen. At the time of analysis (May 2010), 19 patients are alive with no evidence of disease and 15 are alive with disease. Conclusions: CyberKnife-based stereotactic radiotherapy is a feasible approach for isolated recurrent primary, lymph node, or metastatic prostate cancer, offering excellent in-field tumor

  10. [Assessment of overall spatial accuracy in image guided stereotactic body radiotherapy using a spine registration method].

    PubMed

    Nakazawa, Hisato; Uchiyama, Yukio; Komori, Masataka; Hayashi, Naoki

    2014-06-01

    Stereotactic body radiotherapy (SBRT) for lung and liver tumors is always performed under image guidance, a technique used to confirm the accuracy of setup positioning by fusing planning digitally reconstructed radiographs with X-ray, fluoroscopic, or computed tomography (CT) images, using bony structures, tumor shadows, or metallic markers as landmarks. The Japanese SBRT guidelines state that bony spinal structures should be used as the main landmarks for patient setup. In this study, we used the Novalis system as a linear accelerator for SBRT of lung and liver tumors. The current study compared the differences between spine registration and target registration and calculated total spatial accuracy including setup uncertainty derived from our image registration results and the geometric uncertainty of the Novalis system. We were able to evaluate clearly whether overall spatial accuracy is achieved within a setup margin (SM) for planning target volume (PTV) in treatment planning. After being granted approval by the Hospital and University Ethics Committee, we retrospectively analyzed eleven patients with lung tumor and seven patients with liver tumor. The results showed the total spatial accuracy to be within a tolerable range for SM of treatment planning. We therefore regard our method to be suitable for image fusion involving 2-dimensional X-ray images during the treatment planning stage of SBRT for lung and liver tumors.

  11. Fiducial migration following small peripheral lung tumor image-guided CyberKnife stereotactic radiosurgery

    NASA Astrophysics Data System (ADS)

    Strulik, Konrad L.; Cho, Min H.; Collins, Brian T.; Khan, Noureen; Banovac, Filip; Slack, Rebecca; Cleary, Kevin

    2008-03-01

    To track respiratory motion during CyberKnife stereotactic radiosurgery in the lung, several (three to five) cylindrical gold fiducials are implanted near the planned target volume (PTV). Since these fiducials remain in the human body after treatment, we hypothesize that tracking fiducial movement over time may correlate with the tumor response to treatment and pulmonary fibrosis, thereby serving as an indicator of treatment success. In this paper, we investigate fiducial migration in 24 patients through examination of computed tomography (CT) volume images at four time points: pre-treatment, three, six, and twelve month post-treatment. We developed a MATLAB based GUI environment to display the images, identify the fiducials, and compute our performance measure. After we semi-automatically segmented and detected fiducial locations in CT images of the same patient over time, we identified them according to their configuration and introduced a relative performance measure (ACD: average center distance) to detect their migration. We found that the migration tended to result in a movement towards the fiducial center of the radiated tissue area (indicating tumor regression) and may potentially be linked to the patient prognosis.

  12. [Setup accuracy of stereotactic body radiation therapy (SBRT) using virtual isocenter in image-guided radiation therapy (IGRT)].

    PubMed

    Nakazawa, Hisato; Uchiyama, Yukio; Komori, Masataka; Hagiwara, Masahiro; Mori, Yoshimasa

    2012-01-01

    We use Novalis Body system for stereotactic body radiation therapy (SBRT) in lung and liver tumors. Novalis system is dedicated to SBRT with image-guided patient setup system ExacTrac. The spinal bone is the main landmark in patient setup during SBRT using ExacTrac kV X-ray system. When the target tumor is located laterally distant from the spinal bone at the midline, it is difficult to ensure the accuracy of the setup, especially if there are rotational gaps (yaw, pitch and roll) in the setup. For this, we resolve the problem by using a virtual isocenter (VIC) different from isocenter (IC) .We evaluated the setup accuracy in a rand phantom by using VIC and checked the setup errors using rand phantom and patient cases by our original method during the setup for IC. The accuracy of setup using VIC was less than 1.0 mm. Our original method was useful for checking patient setup when VIC used.

  13. Intrafraction Variation of Mean Tumor Position During Image-Guided Hypofractionated Stereotactic Body Radiotherapy for Lung Cancer

    SciTech Connect

    Shah, Chirag; Grills, Inga S.; Kestin, Larry L.; McGrath, Samuel; Ye Hong; Martin, Shannon K.; Yan Di

    2012-04-01

    Purpose: Prolonged delivery times during daily cone-beam computed tomography (CBCT)-guided lung stereotactic body radiotherapy (SBRT) introduce concerns regarding intrafraction variation (IFV) of the mean target position (MTP). The purpose of this study was to evaluate the magnitude of the IFV-MTP and to assess target margins required to compensate for IFV and postonline CBCT correction residuals. Patient, treatment, and tumor characteristics were analyzed with respect to their impact on IFV-MTP. Methods and Materials: A total of 126 patients with 140 tumors underwent 659 fractions of lung SBRT. Dose prescribed was 48 or 60 Gy in 12 Gy fractions. Translational target position correction of the MTP was performed via onboard CBCT. IFV-MTP was measured as the difference in MTP between the postcorrection CBCT and the posttreatment CBCT excluding residual error. Results: IFV-MTP was 0.2 {+-} 1.8 mm, 0.1 {+-} 1.9 mm, and 0.01 {+-} 1.5 mm in the craniocaudal, anteroposterior, and mediolateral dimensions and the IFV-MTP vector was 2.3 {+-} 2.1 mm. Treatment time and excursion were found to be significant predictors of IFV-MTP. An IFV-MTP vector greater than 2 and 5 mm was seen in 40.8% and 7.2% of fractions, respectively. IFV-MTP greater than 2 mm was seen in heavier patients with larger excursions and longer treatment times. Significant differences in IFV-MTP were seen between immobilization devices. The stereotactic frame immobilization device was found to be significantly less likely to have an IFV-MTP vector greater than 2 mm compared with the alpha cradle, BodyFIX, and hybrid immobilization devices. Conclusions: Treatment time and respiratory excursion are significantly associated with IFV-MTP. Significant differences in IFV-MTP were found between immobilization devices. Target margins for IFV-MTP plus post-correction residuals are dependent on immobilization device with 5-mm uniform margins being acceptable for the frame immobilization device.

  14. Image guided respiratory gated hypofractionated Stereotactic Body Radiation Therapy (H-SBRT) for liver and lung tumors: Initial experience.

    PubMed

    Wurm, R E; Gum, F; Erbel, S; Schlenger, L; Scheffler, D; Agaoglu, D; Schild, R; Gebauer, B; Rogalla, P; Plotkin, M; Ocran, K; Budach, V

    2006-01-01

    To evaluate our initial experience with image guided respiratory gated H-SBRT for liver and lung tumors. The system combines a stereoscopic x-ray imaging system (ExacTrac X-Ray 6D) with a dedicated conformal stereotactic radiosurgery and radiotherapy linear accelerator (Novalis) and ExacTrac Adaptive Gating for dynamic adaptive treatment. Moving targets are located and tracked by x-ray imaging of implanted fiducial markers defined in the treatment planning computed tomography (CT). The marker position is compared with the position in verification stereoscopic x-ray images, using fully automated marker detection software. The required shift for a correct, gated set-up is calculated and automatically applied. We present our acceptance testing and initial experience in patients with liver and lung tumors. For treatment planning CT and Fluorodeoxyglucose-Positron Emission Tomography (FDG-PET) as well as magnetic resonance imaging (MRI) taken at free breathing and expiration breath hold with internal and external fiducials present were used. Patients were treated with 8-11 consecutive fractions to a dose of 74.8-79.2 Gy. Phantom tests demonstrated targeting accuracy with a moving target to within +/-1 mm. Inter- and intrafractional patient set-up displacements, as corrected by the gated set-up and not detectable by a conventional set-up, were up to 30 mm. Verification imaging to determine target location during treatment showed an average marker position deviation from the expected position of up to 4 mm on real patients. This initial evaluation shows the accuracy of the system and feasibility of image guided real-time respiratory gated H-SBRT for liver and lung tumors.

  15. Probabilities of Radiation Myelopathy Specific to Stereotactic Body Radiation Therapy to Guide Safe Practice

    SciTech Connect

    Sahgal, Arjun; Weinberg, Vivian; Ma, Lijun; Chang, Eric; Chao, Sam; Muacevic, Alexander; Gorgulho, Alessandra; Soltys, Scott; Gerszten, Peter C.; Ryu, Sam; Angelov, Lilyana; Gibbs, Iris; Wong, C. Shun; Larson, David A.

    2013-02-01

    Purpose: Dose-volume histogram (DVH) results for 9 cases of post spine stereotactic body radiation therapy (SBRT) radiation myelopathy (RM) are reported and compared with a cohort of 66 spine SBRT patients without RM. Methods and Materials: DVH data were centrally analyzed according to the thecal sac point maximum (Pmax) volume, 0.1- to 1-cc volumes in increments of 0.1 cc, and to the 2 cc volume. 2-Gy biologically equivalent doses (nBED) were calculated using an {alpha}/{beta} = 2 Gy (units = Gy{sub 2/2}). For the 2 cohorts, the nBED means and distributions were compared using the t test and Mann-Whitney test, respectively. Significance (P<.05) was defined as concordance of both tests at each specified volume. A logistic regression model was developed to estimate the probability of RM using the dose distribution for a given volume. Results: Significant differences in both the means and distributions at the Pmax and up to the 0.8-cc volume were observed. Concordant significance was greatest for the Pmax volume. At the Pmax volume the fit of the logistic regression model, summarized by the area under the curve, was 0.87. A risk of RM of 5% or less was observed when limiting the thecal sac Pmax volume doses to 12.4 Gy in a single fraction, 17.0 Gy in 2 fractions, 20.3 Gy in 3 fractions, 23.0 Gy in 4 fractions, and 25.3 Gy in 5 fractions. Conclusion: We report the first logistic regression model yielding estimates for the probability of human RM specific to SBRT.

  16. Salvage image-guided intensity modulated or stereotactic body reirradiation of local recurrence of prostate cancer

    PubMed Central

    Jereczek-Fossa, B A; Fodor, C; Bazzani, F; Maucieri, A; Ronchi, S; Ferrario, S; Colangione, S P; Gerardi, M A; Caputo, M; Cecconi, A; Gherardi, F; Vavassori, A; Comi, S; Cambria, R; Garibaldi, C; Cattani, F; De Cobelli, O; Orecchia, R

    2015-01-01

    Objective: To retrospectively evaluate external beam reirradiation (re-EBRT) delivered to the prostate/prostatic bed for local recurrence, after radical or adjuvant/salvage radiotherapy (RT). Methods: 32 patients received re-EBRT between February 2008 and October 2013. All patients had clinical/radiological local relapse in the prostate or prostatic bed and no distant metastasis. re-EBRT was delivered with selective RT technologies [stereotactic RT including CyberKnifeTM (Accuray, Sunnyvale, CA); image-guidance and intensity-modulated RT etc.]. Toxicity was evaluated using the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria. Biochemical control was assessed according to the Phoenix definition (NADIR + 2 ng ml−1). Results: Acute urinary toxicity: G0, 24 patients; G1, 6 patients; G2, 2 patients. Acute rectal toxicity: G0, 28 patients; G1, 2 patients; and G2, 1 patient. Late urinary toxicity (evaluated in 30 cases): G0, 23 patients; G1, 6 patients; G2, 1 patient. Late renal toxicity: G0, 25 patients; G1, 5 patients. A mean follow-up of 21.3 months after re-EBRT showed that 13 patients were free of cancer, 3 were alive with biochemical relapse and 12 patients were alive with clinically evident disease. Four patients had died: two of disease progression and two of other causes. Conclusion: re-EBRT using modern technology is a feasible approach for local prostate cancer recurrence offering 2-year tumour control in about half of the patients. Toxicity of re-EBRT is low. Future studies are needed to identify the patients who would benefit most from this treatment. Advances in knowledge: Our series, based on experience in one hospital alone, shows that re-EBRT for local relapse of prostate cancer is feasible and offers a 2-year cure in about half of the patients. PMID:26055506

  17. Dosimetric characterization of an image-guided stereotactic small animal irradiator

    NASA Astrophysics Data System (ADS)

    Pidikiti, R.; Stojadinovic, S.; Speiser, M.; Song, K. H.; Hager, F.; Saha, D.; Solberg, T. D.

    2011-04-01

    Small animal irradiation provides an important tool used by preclinical studies to assess and optimize new treatment strategies such as stereotactic ablative radiotherapy. Characterization of radiation beams that are clinically and geometrically scaled for the small animal model is uniquely challenging for orthovoltage energies and minute field sizes. The irradiator employs a commercial x-ray device (XRAD 320, Precision x-ray, Inc.) with a custom collimation system to produce 1-10 mm diameter beams and a 50 mm reference beam. Absolute calibrations were performed using the AAPM TG-61 methodology. Beam's half-value layer (HVL) and timer error were measured with an ionization chamber. Percent depth dose (PDD), output factors (OFs) and off-axis ratios were measured using radiochromic film, a diode and a pinpoint ionization chamber at 19.76 and 24.76 cm source-to-surface distance (SSD). PDD measurements were also compared with Monte Carlo (MC) simulations. In-air and in-water absolute calibrations for the reference 50 mm diameter collimator at 19.76 cm SSD were measured as 20.96 and 20.79 Gy min-1, respectively, agreeing within 0.8%. The HVL at 250 kVp and 15 mAs was measured to be 0.45 mm Cu. The reference field PDD MC simulation results agree with measured data within 3.5%. PDD data demonstrate typical increased penetration with increasing field size and SSD. For collimators larger than 5 mm in diameter, OFs measured using film, an ion chamber and a diode were within 3% agreement.

  18. Dosimetric characterization of an image-guided stereotactic small animal irradiator.

    PubMed

    Pidikiti, R; Stojadinovic, S; Speiser, M; Song, K H; Hager, F; Saha, D; Solberg, T D

    2011-04-21

    Small animal irradiation provides an important tool used by preclinical studies to assess and optimize new treatment strategies such as stereotactic ablative radiotherapy. Characterization of radiation beams that are clinically and geometrically scaled for the small animal model is uniquely challenging for orthovoltage energies and minute field sizes. The irradiator employs a commercial x-ray device (XRAD 320, Precision x-ray, Inc.) with a custom collimation system to produce 1-10 mm diameter beams and a 50 mm reference beam. Absolute calibrations were performed using the AAPM TG-61 methodology. Beam's half-value layer (HVL) and timer error were measured with an ionization chamber. Percent depth dose (PDD), output factors (OFs) and off-axis ratios were measured using radiochromic film, a diode and a pinpoint ionization chamber at 19.76 and 24.76 cm source-to-surface distance (SSD). PDD measurements were also compared with Monte Carlo (MC) simulations. In-air and in-water absolute calibrations for the reference 50 mm diameter collimator at 19.76 cm SSD were measured as 20.96 and 20.79 Gy min(-1), respectively, agreeing within 0.8%. The HVL at 250 kVp and 15 mAs was measured to be 0.45 mm Cu. The reference field PDD MC simulation results agree with measured data within 3.5%. PDD data demonstrate typical increased penetration with increasing field size and SSD. For collimators larger than 5 mm in diameter, OFs measured using film, an ion chamber and a diode were within 3% agreement.

  19. Integral test phantom for dosimetric quality assurance of image guided and intensity modulated stereotactic radiotherapy

    SciTech Connect

    Letourneau, Daniel; Keller, Harald; Sharpe, Michael B.; Jaffray, David A.

    2007-05-15

    The objective of this work is to develop a dosimetric phantom quality assurance (QA) of linear accelerators capable of cone-beam CT (CBCT) image guided and intensity-modulated radiotherapy (IG-IMRT). This phantom is to be used in an integral test to quantify in real-time both the performance of the image guidance and the dose delivery systems in terms of dose localization. The prototype IG-IMRT QA phantom consisted of a cylindrical imaging phantom (CatPhan) combined with an array of 11 radiation diodes mounted on a 10 cm diameter disk, oriented perpendicular to the phantom axis. Basic diode response characterization was performed for 6 and 18 MV photons. The diode response was compared to planning system calculations in the open and penumbrae regions of simple and complex beam arrangements. The clinical use of the QA phantom was illustrated in an integral test of an IG-IMRT treatment designed for a clinical spinal radiosurgery case. The sensitivity of the phantom to multileaf collimator (MLC) calibration and setup errors in the clinical setting was assessed by introducing errors in the IMRT plan or by displacing the phantom. The diodes offered good response linearity and long-term reproducibility for both 6 and 18 MV. Axial dosimetry of coplanar beams (in a plane containing the beam axes) was made possible with the nearly isoplanatic response of the diodes over 360 deg. of gantry (usually within {+-}1%). For single beam geometry, errors in phantom placement as small as 0.5 mm could be accurately detected (in gradient {>=}1%/mm). In clinical setting, MLC systematic errors of 1 mm on a single MLC bank introduced in the IMRT plan were easily detectable with the QA phantom. The QA phantom demonstrated also sufficient sensitivity for the detection of setup errors as small as 1 mm for the IMRT delivery. These results demonstrated that the prototype can accurately and efficiently verify the entire IG-IMRT process. This tool, in conjunction with image guidance capabilities

  20. Implementation of Feedback-Guided Voluntary Breath-Hold Gating for Cone Beam CT-Based Stereotactic Body Radiotherapy

    SciTech Connect

    Peng Yong; Vedam, Sastry; Chang, Joe Y.; Gao Song; Sadagopan, Ramaswamy; Bues, Martin; Balter, Peter

    2011-07-01

    Purpose: To analyze tumor position reproducibility of feedback-guided voluntary deep inspiration breath-hold (FGBH) gating for cone beam computed tomography (CBCT)-based stereotactic body radiotherapy (SBRT). Methods and materials: Thirteen early-stage lung cancer patients eligible for SBRT with tumor motion of >1cm were evaluated for FGBH-gated treatment. Multiple FGBH CTs were acquired at simulation, and single FGBH CBCTs were also acquired prior to each treatment. Simulation CTs and treatment CBCTs were analyzed to quantify reproducibility of tumor positions during FGBH. Benefits of FGBH gating compared to treatment during free breathing, as well treatment with gating at exhalation, were examined for lung sparing, motion margins, and reproducibility of gross tumor volume (GTV) position relative to nonmoving anatomy. Results: FGBH increased total lung volumes by 1.5 times compared to free breathing, resulting in a proportional drop in total lung volume receiving 10 Gy or more. Intra- and inter-FGBH reproducibility of GTV centroid positions at simulation were 1.0 {+-} 0.5 mm, 1.3 {+-} 1.0 mm, and 0.6 {+-} 0.4 mm in the anterior-posterior (AP), superior-inferior (SI), and left-right lateral (LR) directions, respectively, compared to more than 1 cm of tumor motion at free breathing. During treatment, inter-FGBH reproducibility of the GTV centroid with respect to bony anatomy was 1.2 {+-} 0.7 mm, 1.5 {+-} 0.8 mm, and 1.0 {+-} 0.4 mm in the AP, SI, and LR directions. In addition, the quality of CBCTs was improved due to elimination of motion artifacts, making this technique attractive for poorly visualized tumors, even with small motion. Conclusions: The extent of tumor motion at normal respiration does not influence the reproducibility of the tumor position under breath hold conditions. FGBH-gated SBRT with CBCT can improve the reproducibility of GTV centroids, reduce required margins, and minimize dose to normal tissues in the treatment of mobile tumors.

  1. Defining the Optimal Planning Target Volume in Image-Guided Stereotactic Radiosurgery of Brain Metastases: Results of a Randomized Trial

    SciTech Connect

    Kirkpatrick, John P.; Wang, Zhiheng; Sampson, John H.; McSherry, Frances; Herndon, James E.; Allen, Karen J.; Duffy, Eileen; Hoang, Jenny K.; Chang, Zheng; Yoo, David S.; Kelsey, Chris R.; Yin, Fang-Fang

    2015-01-01

    Purpose: To identify an optimal margin about the gross target volume (GTV) for stereotactic radiosurgery (SRS) of brain metastases, minimizing toxicity and local recurrence. Methods and Materials: Adult patients with 1 to 3 brain metastases less than 4 cm in greatest dimension, no previous brain radiation therapy, and Karnofsky performance status (KPS) above 70 were eligible for this institutional review board–approved trial. Individual lesions were randomized to 1- or 3- mm uniform expansion of the GTV defined on contrast-enhanced magnetic resonance imaging (MRI). The resulting planning target volume (PTV) was treated to 24, 18, or 15 Gy marginal dose for maximum PTV diameters less than 2, 2 to 2.9, and 3 to 3.9 cm, respectively, using a linear accelerator–based image-guided system. The primary endpoint was local recurrence (LR). Secondary endpoints included neurocognition Mini-Mental State Examination, Trail Making Test Parts A and B, quality of life (Functional Assessment of Cancer Therapy-Brain), radionecrosis (RN), need for salvage radiation therapy, distant failure (DF) in the brain, and overall survival (OS). Results: Between February 2010 and November 2012, 49 patients with 80 brain metastases were treated. The median age was 61 years, the median KPS was 90, and the predominant histologies were non–small cell lung cancer (25 patients) and melanoma (8). Fifty-five, 19, and 6 lesions were treated to 24, 18, and 15 Gy, respectively. The PTV/GTV ratio, volume receiving 12 Gy or more, and minimum dose to PTV were significantly higher in the 3-mm group (all P<.01), and GTV was similar (P=.76). At a median follow-up time of 32.2 months, 11 patients were alive, with median OS 10.6 months. LR was observed in only 3 lesions (2 in the 1 mm group, P=.51), with 6.7% LR 12 months after SRS. Biopsy-proven RN alone was observed in 6 lesions (5 in the 3-mm group, P=.10). The 12-month DF rate was 45.7%. Three months after SRS, no significant change in

  2. Pathological characteristics of spine metastases treated with high-dose single-fraction stereotactic radiosurgery.

    PubMed

    Katsoulakis, Evangelia; Laufer, Ilya; Bilsky, Mark; Agaram, Narasimhan P; Lovelock, Michael; Yamada, Yoshiya

    2017-01-01

    OBJECTIVE Spine radiosurgery is increasingly being used to treat spinal metastases. As patients are living longer because of the increasing efficacy of systemic agents, appropriate follow-up and posttreatment management for these patients is critical. Tumor progression after spine radiosurgery is rare; however, vertebral compression fractures are recognized as a more common posttreatment effect. The use of radiographic imaging alone posttreatment may makeit difficult to distinguish tumor progression from postradiation changes such as fibrosis. This is the largest series from a prospective database in which the authors examine histopathology of samples obtained from patients who underwent surgical intervention for presumed tumor progression or mechanical pain secondary to compression fracture. The majority of patients had tumor ablation and resulting fibrosis rather than tumor progression. The aim of this study was to evaluate tumor histopathology and characteristics of patients who underwent pathological sampling because of radiographic tumor progression, fibrosis, or collapsed vertebrae after receiving high-dose single-fraction stereotactic radiosurgery. METHODS Between January 2005 and January 2014, a total of 582 patients were treated with linear accelerator-based single-fraction (18-24 Gy) stereotactic radiosurgery. The authors retrospectively identified 30 patients (5.1%) who underwent surgical intervention for 32 lesions with vertebral cement augmentation for either mechanical pain or instability secondary to vertebral compression fracture (n = 17) or instrumentation (n = 15) for radiographic tumor progression. Radiation and surgical treatment, histopathology, and long-term outcomes were reviewed. Survival and time to recurrence were calculated using the Kaplan-Meier method. RESULTS The mean age at the time of radiosurgery was 59 years (range 36-80 years). The initial pathological diagnoses were obtained for all patients and primarily included radioresistant

  3. Hypofractionated Stereotactic Radiation Therapy in Recurrent High-Grade Glioma: A New Challenge

    PubMed Central

    Navarria, Pierina; Ascolese, Anna Maria; Tomatis, Stefano; Reggiori, Giacomo; Clerici, Elena; Villa, Elisa; Maggi, Giulia; Bello, Lorenzo; Pessina, Federico; Cozzi, Luca; Scorsetti, Marta

    2016-01-01

    Purpose The aim of this study was to evaluate outcomes of hypofractionated stereotactic radiation therapy (HSRT) in patients re-treated for recurrent high-grade glioma. Materials and Methods From January 2006 to September 2013, 25 patients were treated. Six patients underwent radiation therapy alone, while 19 underwent combined treatment with surgery and/or chemotherapy. Only patients with Karnofsky Performance Status (KPS) > 70 and time from previous radiotherapy greater than 6 months were re-irradiated. The mean recurrent tumor volume was 35 cm3 (range, 2.46 to 116.7 cm3), and most of the patients (84%) were treated with a total dose of 25 Gy in five fractions (range, 20 to 50 Gy in 5-10 fractions). Results The median follow-up was 18 months (range, 4 to 36 months). The progression-free survival (PFS) at 1 and 2 years was 72% and 34% and the overall survival (OS) 76% and 50%, respectively. No severe toxicity was recorded. In univariate and multivariate analysis extent of resection at diagnosis significantly influenced PFS and OS (p < 0.01). Patients with smaller recurren tumor volume treated had better local control and survival. Indeed, the 2-year PFS was 40% (≤ 50 cm3) versus 11% (p=0.1) and the 2-year OS 56% versus 33% (> 50 cm3), respectively (p=0.26). Conclusion In our experience, HSRT could be a safe and feasible therapeutic option for recurrent high grade glioma even in patients with larger tumors. We believe that a multidisciplinary evaluation is mandatory to assure the best treatment for selected patients. Local treatment should also be considered as part of an integrated approach. PMID:25761491

  4. Use of Frameless Stereotactic Neuronavigation and O-arm for Transoral Transpalatal Odontoidectomy to Treat a Very High Basilar Invagination

    PubMed Central

    Moorthy, Skanda; Raheja, Amol; Agrawal, Deepak

    2016-01-01

    Frameless stereotactic neuronavigation system has been in wide use since many years for precise localization of cranial tumors and navigation for spinal instrumentation. We present its usage in the localization of odontoid process in a very high basilar invagination for a transoral transpalatal resection of the same. We discuss the technical aspects of assembly of neuronavigation system, O-arm and Mayfield head frame on Allen spine system to achieve precise and accurate localization of high riding odontoid process through an extremely narrow operative corridor. PMID:28163511

  5. High-dose MVCT image guidance for stereotactic body radiation therapy

    SciTech Connect

    Westerly, David C.; Schefter, Tracey E.; Kavanagh, Brian D.; Chao, Edward; Lucas, Dan; Flynn, Ryan T.; Miften, Moyed

    2012-08-15

    Purpose: Stereotactic body radiation therapy (SBRT) is a potent treatment for early stage primary and limited metastatic disease. Accurate tumor localization is essential to administer SBRT safely and effectively. Tomotherapy combines helical IMRT with onboard megavoltage CT (MVCT) imaging and is well suited for SBRT; however, MVCT results in reduced soft tissue contrast and increased image noise compared with kilovoltage CT. The goal of this work was to investigate the use of increased imaging doses on a clinical tomotherapy machine to improve image quality for SBRT image guidance. Methods: Two nonstandard, high-dose imaging modes were created on a tomotherapy machine by increasing the linear accelerator (LINAC) pulse rate from the nominal setting of 80 Hz, to 160 Hz and 300 Hz, respectively. Weighted CT dose indexes (wCTDIs) were measured for the standard, medium, and high-dose modes in a 30 cm solid water phantom using a calibrated A1SL ion chamber. Image quality was assessed from scans of a customized image quality phantom. Metrics evaluated include: contrast-to-noise ratios (CNRs), high-contrast spatial resolution, image uniformity, and percent image noise. In addition, two patients receiving SBRT were localized using high-dose MVCT scans. Raw detector data collected after each scan were used to reconstruct standard-dose images for comparison. Results: MVCT scans acquired using a pitch of 1.0 resulted in wCTDI values of 2.2, 4.7, and 8.5 cGy for the standard, medium, and high-dose modes respectively. CNR values for both low and high-contrast materials were found to increase with the square root of dose. Axial high-contrast spatial resolution was comparable for all imaging modes at 0.5 lp/mm. Image uniformity was improved and percent noise decreased as the imaging dose increased. Similar improvements in image quality were observed in patient images, with decreases in image noise being the most notable. Conclusions: High-dose imaging modes are made possible on a

  6. [Stereotactic radiotherapy for pelvic tumors].

    PubMed

    Mazeron, R; Fumagalli, I

    2014-01-01

    Extracranial stereotactic radiotherapy is booming. The development and spread of dedicated accelerators coupled with efficient methods of repositioning can now allow treatments of mobile lesions with moderate size, with high doses per fraction. Intuitively, except for the prostate, pelvic tumours, often requiring irradiation of regional lymph node drainage, lend little to this type of treatment. However, in some difficult circumstances, such as boost or re-radiation, stereotactic irradiation condition is promising and clinical experiences have already been reported.

  7. Feasibility of CT-based intraoperative 3D stereotactic image-guided navigation in the upper cervical spine of children 10 years of age or younger: initial experience.

    PubMed

    Kovanda, Timothy J; Ansari, Shaheryar F; Qaiser, Rabia; Fulkerson, Daniel H

    2015-07-24

    OBJECT Rigid screw fixation may be technically difficult in the upper cervical spine of young children. Intraoperative stereotactic navigation may potentially assist a surgeon in precise placement of screws in anatomically challenging locations. Navigation may also assist in defining abnormal anatomy. The object of this study was to evaluate the authors' initial experience with the feasibility and accuracy of this technique, both for resection and for screw placement in the upper cervical spine in younger children. METHODS Eight consecutive pediatric patients 10 years of age or younger underwent upper cervical spine surgery aided by image-guided navigation. The demographic, surgical, and clinical data were recorded. Screw position was evaluated with either an intraoperative or immediately postoperative CT scan. RESULTS One patient underwent navigation purely for guidance of bony resection. A total of 14 navigated screws were placed in the other 7 patients, including 5 C-2 pedicle screws. All 14 screws were properly positioned, defined as the screw completely contained within the cortical bone in the expected trajectory. There were no immediate complications associated with navigation. CONCLUSIONS Image-guided navigation is feasible within the pediatric cervical spine and may be a useful surgical tool for placing screws in a patient with small, often difficult bony anatomy. The authors describe their experience with their first 8 pediatric patients who underwent navigation in cervical spine surgery. The authors highlight differences in technique compared with similar navigation in adults.

  8. On-Board Imaging Validation of Optically Guided Stereotactic Radiosurgery Positioning System for Conventionally Fractionated Radiotherapy for Paranasal Sinus and Skull Base Cancer

    SciTech Connect

    Maxim, Peter G.; Loo, Billy W.; Murphy, James D.; Chu, Karen P.M.; Hsu, Annie; Le, Quynh-Thu

    2011-11-15

    Purpose: To evaluate the positioning accuracy of an optical positioning system for stereotactic radiosurgery in a pilot experience of optically guided, conventionally fractionated, radiotherapy for paranasal sinus and skull base tumors. Methods and Materials: Before each daily radiotherapy session, the positioning of 28 patients was set up using an optical positioning system. After this initial setup, the patients underwent standard on-board imaging that included daily orthogonal kilovoltage images and weekly cone beam computed tomography scans. Daily translational shifts were made after comparing the on-board images with the treatment planning computed tomography scans. These daily translational shifts represented the daily positional error in the optical tracking system and were recorded during the treatment course. For 13 patients treated with smaller fields, a three-degree of freedom (3DOF) head positioner was used for more accurate setup. Results: The mean positional error for the optically guided system in patients with and without the 3DOF head positioner was 1.4 {+-} 1.1 mm and 3.9 {+-} 1.6 mm, respectively (p <.0001). The mean positional error drifted 0.11 mm/wk upward during the treatment course for patients using the 3DOF head positioner (p = .057). No positional drift was observed in the patients without the 3DOF head positioner. Conclusion: Our initial clinical experience with optically guided head-and-neck fractionated radiotherapy was promising and demonstrated clinical feasibility. The optically guided setup was especially useful when used in conjunction with the 3DOF head positioner and when it was recalibrated to the shifts using the weekly portal images.

  9. Esophageal Toxicity From High-Dose, Single-Fraction Paraspinal Stereotactic Radiosurgery

    SciTech Connect

    Cox, Brett W.; Jackson, Andrew; Hunt, Margie; Bilsky, Mark; Yamada, Yoshiya

    2012-08-01

    Purpose: To report the esophageal toxicity from single-fraction paraspinal stereotactic radiosurgery (SRS) and identify dosimetric and clinical risk factors for toxicity. Methods and Materials: A total of 204 spinal metastases abutting the esophagus (182 patients) were treated with high-dose single-fraction SRS during 2003-2010. Toxicity was scored using the National Cancer Institute Common Toxicity Criteria for Adverse Events, version 4.0. Dose-volume histograms were combined to generate a comprehensive atlas of complication incidence that identifies risk factors for toxicity. Correlation of dose-volume factors with esophageal toxicity was assessed using Fisher's exact test and logistic regression. Clinical factors were correlated with toxicity. Results: The median dose to the planning treatment volume was 24 Gy. Median follow-up was 12 months (range, 3-81). There were 31 (15%) acute and 24 (12%) late esophageal toxicities. The rate of grade {>=}3 acute or late toxicity was 6.8% (14 patients). Fisher's exact test resulted in significant median splits for grade {>=}3 toxicity at V12 = 3.78 cm{sup 3} (relative risk [RR] 3.7, P=.05), V15 = 1.87 cm{sup 3} (RR 13, P=.0013), V20 = 0.11 cm{sup 3} (RR 6, P=0.01), and V22 = 0.0 cm{sup 3} (RR 13, P=.0013). The median split for D2.5 cm{sup 3} (14.02 Gy) was also a significant predictor of toxicity (RR 6; P=.01). A highly significant logistic regression model was generated on the basis of D2.5 cm{sup 3}. One hundred percent (n = 7) of grade {>=}4 toxicities were associated with radiation recall reactions after doxorubicin or gemcitabine chemotherapy or iatrogenic manipulation of the irradiated esophagus. Conclusions: High-dose, single-fraction paraspinal SRS has a low rate of grade {>=}3 esophageal toxicity. Severe esophageal toxicity is minimized with careful attention to esophageal doses during treatment planning. Iatrogenic manipulation of the irradiated esophagus and systemic agents classically associated with radiation

  10. Predictors of Local Control After Single-Dose Stereotactic Image-Guided Intensity-Modulated Radiotherapy for Extracranial Metastases

    SciTech Connect

    Greco, Carlo; Zelefsky, Michael J.; Lovelock, Michael; Fuks, Zvi; Hunt, Margie; Rosenzweig, Kenneth; Zatcky, Joan; Kim, Balem; Yamada, Yoshiya

    2011-03-15

    Purpose: To report tumor local control after treatment with single-dose image-guided intensity-modulated radiotherapy (SD-IGRT) to extracranial metastatic sites. Methods and Materials: A total of 126 metastases in 103 patients were treated with SD-IGRT to prescription doses of 18-24 Gy (median, 24 Gy) between 2004 and 2007. Results: The overall actuarial local relapse-free survival (LRFS) rate was 64% at a median follow-up of 18 months (range, 2-45 months). The median time to failure was 9.6 months (range, 1-23 months). On univariate analysis, LRFS was significantly correlated with prescription dose (p = 0.029). Stratification by dose into high (23 to 24 Gy), intermediate (21 to 22 Gy), and low (18 to 20 Gy) dose levels revealed highly significant differences in LRFS between high (82%) and low doses (25%) (p < 0.0001). Overall, histology had no significant effect on LRFS (p = 0.16). Renal cell histology displayed a profound dose-response effect, with 80% LRFS at the high dose level (23 to 24 Gy) vs. 37% with low doses ({<=}22 Gy) (p = 0.04). However, for patients who received the high dose level, histology was not a statistically significant predictor of LRFS (p = 0.90). Target organ (bone vs. lymph node vs. soft tissues) (p = 0.5) and planning target volume size (p = 0.55) were not found to be associated with long-term LRFS probability. Multivariate Cox regression analysis confirmed prescription dose to be a significant predictor of LRFS (p = 0.003). Conclusion: High-dose SD-IGRT is a noninvasive procedure resulting in high probability of local tumor control. Single-dose IGRT may be effectively used to locally control metastatic deposits regardless of histology and target organ, provided sufficiently high doses (> 22 Gy) of radiation are delivered.

  11. Clinical Feasibility of Using an EPID in cine Mode for Image-Guided Verification of Stereotactic Body Radiotherapy

    SciTech Connect

    Berbeco, Ross I.

    2007-09-01

    Purpose: To introduce a novel method for monitoring tumor location during stereotactic body radiotherapy (SBRT) while the treatment beam is on by using a conventional electronic portal imaging device (EPID). Methods and Materials: In our clinic, selected patients were treated under a phase I institutional review board-approved SBRT protocol for limited hepatic metastases from solid tumors. Before treatment planning multiple gold fiducial markers were implanted on the periphery of the tumor. During treatment the EPID was used in cine mode to collect the exit radiation and produce a sequence of images for each field. An in-house program was developed for calculating the location of the fiducials and their relative distance to the planned locations. Results: Three case studies illustrate the utility of the technique. Patient A exhibited a systematic shift of 4 mm during one of the treatment beams. Patient B showed an inferior drift of the target of approximately 1 cm from the time of setup to the end of the fraction. Patient C had a poor setup on the first day of treatment that was quantified and accounted for on subsequent treatment days. Conclusions: Target localization throughout each treatment beam can be quickly assessed with the presented technique. Treatment monitoring with an EPID in cine mode is shown to be a clinically feasible and useful tool.

  12. Outcome of Elderly Patients with Meningioma after Image-Guided Stereotactic Radiotherapy: A Study of 100 Cases

    PubMed Central

    Budach, Volker; Graaf, Lukas; Gollrad, Johannes; Badakhshi, Harun

    2015-01-01

    Introduction. Incidence of meningioma increases with age. Surgery has been the mainstay treatment. Elderly patients, however, are at risk of severe morbidity. Therefore, we conducted this study to analyze long-term outcomes of linac-based fractionated stereotactic radiotherapy (FSRT) for older adults (aged ≥65 years) with meningioma and determine prognostic factors. Materials and Methods. Between October 1998 and March 2009, 100 patients (≥65, median age, 71 years) were treated with FSRT for meningioma. Two patients were lost to follow-up. Eight patients each had grade I and grade II meningiomas, and five patients had grade III meningiomas. The histology was unknown in 77 cases (grade 0). Results. The median follow-up was 37 months, and 3-year, 5-year, and 10-year progression-free survival (PFS) rates were 93.7%, 91.1%, and 82%. Patients with grade 0/I meningioma showed 3- and 5-year PFS rates of 98.4% and 95.6%. Patients with grade II or III meningiomas showed 3-year PFS rates of 36%. 93.8% of patients showed local tumor control. Multivariate analysis did not indicate any significant prognostic factors. Conclusion. FSRT may play an important role as a noninvasive and safe method in the clinical management of older patients with meningioma. PMID:26101778

  13. Hypofractionated stereotactic body radiotherapy for primary and metastatic liver tumors using the novalis image-guided system: preliminary results regarding efficacy and toxicity.

    PubMed

    Iwata, Hiromitsu; Shibamoto, Yuta; Hashizume, Chisa; Mori, Yoshimasa; Kobayashi, Tatsuya; Hayashi, Naoki; Kosaki, Katsura; Ishikawa, Tetsuya; Kuzuya, Teiji; Utsunomiya, Setsuo

    2010-12-01

    www.tcrt.org The purpose of this study was to evaluate the efficacy and toxicity of stereotactic body radiotherapy (SBRT) for primary and metastatic liver tumors using the Novalis image-guided radiotherapy system. After preliminarily treating liver tumors using the Novalis system from July 2006, we started a protocol-based study in February 2008. Eighteen patients (6 with primary hepatocellular carcinoma and 12 with metastatic liver tumor) were treated with 55 or 50 Gy, depending upon their planned dose distribution and liver function, delivered in 10 fractions over 2 weeks. Four non-coplanar and three coplanar static beams were used. Patient age ranged from 54 to 84 years (median: 72 years). The Child-Pugh classification was Grade A in 17 patients and Grade B in 1. Tumor diameter ranged from 12 to 35 mm (median: 23 mm). Toxicities were evaluated according to the Common Terminology Criteria of Adverse Events version 4.0, and radiation-induced liver disease (RILD) was defined by Lawrence's criterion. The median follow-up period was 14.5 months. For all patients, the 1-year overall survival and local control rates were 94% and 86%, respectively. A Grade 1 liver enzyme change was observed in 5 patients, but no RILD or chronic liver dysfunction was observed. SBRT using the Novalis image-guided system is safe and effective for treating primary and metastatic liver tumors. Further investigation of SBRT for liver tumors is warranted. In view of the acceptable toxicity observed with this protocol, we have moved to a new protocol to shorten the overall treatment time and escalate the dose.

  14. Better Object Recognition and Naming Outcome With MRI-Guided Stereotactic Laser Amygdalohippocampotomy for Temporal Lobe Epilepsy

    PubMed Central

    Drane, Daniel L.; Loring, David W.; Voets, Natalie L.; Price, Michele; Ojemann, Jeffrey G.; Willie, Jon T.; Saindane, Amit M.; Phatak, Vaishali; Ivanisevic, Mirjana; Millis, Scott; Helmers, Sandra L.; Miller, John W.; Meador, Kimford J.; Gross, Robert E.

    2015-01-01

    SUMMARY OBJECTIVES Temporal lobe epilepsy (TLE) patients experience significant deficits in category-related object recognition and naming following standard surgical approaches. These deficits may result from a decoupling of core processing modules (e.g., language, visual processing, semantic memory), due to “collateral damage” to temporal regions outside the hippocampus following open surgical approaches. We predicted stereotactic laser amygdalohippocampotomy (SLAH) would minimize such deficits because it preserves white matter pathways and neocortical regions critical for these cognitive processes. METHODS Tests of naming and recognition of common nouns (Boston Naming Test) and famous persons were compared with nonparametric analyses using exact tests between a group of nineteen patients with medically-intractable mesial TLE undergoing SLAH (10 dominant, 9 nondominant), and a comparable series of TLE patients undergoing standard surgical approaches (n=39) using a prospective, non-randomized, non-blinded, parallel group design. RESULTS Performance declines were significantly greater for the dominant TLE patients undergoing open resection versus SLAH for naming famous faces and common nouns (F=24.3, p<.0001, η2=.57, & F=11.2, p<.001, η2=.39, respectively), and for the nondominant TLE patients undergoing open resection versus SLAH for recognizing famous faces (F=3.9, p<.02, η2=.19). When examined on an individual subject basis, no SLAH patients experienced any performance declines on these measures. In contrast, 32 of the 39 undergoing standard surgical approaches declined on one or more measures for both object types (p<.001, Fisher’s exact test). Twenty-one of 22 left (dominant) TLE patients declined on one or both naming tasks after open resection, while 11 of 17 right (non-dominant) TLE patients declined on face recognition. SIGNIFICANCE Preliminary results suggest 1) naming and recognition functions can be spared in TLE patients undergoing SLAH, and 2

  15. GammaPod—A new device dedicated for stereotactic radiotherapy of breast cancer

    PubMed Central

    Yu, Cedric X.; Shao, Xinyu; Zhang, Jin; Regine, William; Zheng, Mike; Yu, Ying S.; Deng, Jianchun; Duan, Zhengcheng

    2013-01-01

    Purpose: This paper introduces a new external beam radiotherapy device named GammaPod that is dedicated for stereotactic radiotherapy of breast cancer. Methods: The design goal of the GammaPod as a dedicated system for treating breast cancer is the ability to deliver ablative doses with sharp gradients under stereotactic image guidance. Stereotactic localization of the breast is achieved by a vacuum-assisted breast immobilization cup with built-in stereotactic frame. Highly focused radiation is achieved at the isocenter due to the cross-firing from 36 radiation arcs generated by rotating 36 individual Cobalt-60 beams. The dedicated treatment planning system optimizes an optimal path of the focal spot using an optimization algorithm borrowed from computational geometry such that the target can be covered by 90%–95% of the prescription dose and the doses to surrounding tissues are minimized. The treatment plan is intended to be delivered with continuous motion of the treatment couch. In this paper the authors described in detail the gamma radiation unit, stereotactic localization of the breast, and the treatment planning system of the GammaPod system. Results: A prototype GammaPod system was installed at University of Maryland Medical Center and has gone through a thorough functional, geometric, and dosimetric testing. The mechanical and functional performances of the system all meet the functional specifications. Conclusions: An image-guided breast stereotactic radiotherapy device, named GammaPod, has been developed to deliver highly focused and localized doses to a target in the breast under stereotactic image guidance. It is envisioned that the GammaPod technology has the potential to significantly shorten radiation treatments and even eliminate surgery by ablating the tumor and sterilizing the tumor bed simultaneously. PMID:23635251

  16. GammaPod-A new device dedicated for stereotactic radiotherapy of breast cancer

    SciTech Connect

    Yu, Cedric X.; Shao Xinyu; Deng Jianchun; Duan Zhengcheng; Zhang Jin; Zheng, Mike; Yu, Ying S.; Regine, William

    2013-05-15

    Purpose: This paper introduces a new external beam radiotherapy device named GammaPod that is dedicated for stereotactic radiotherapy of breast cancer. Methods: The design goal of the GammaPod as a dedicated system for treating breast cancer is the ability to deliver ablative doses with sharp gradients under stereotactic image guidance. Stereotactic localization of the breast is achieved by a vacuum-assisted breast immobilization cup with built-in stereotactic frame. Highly focused radiation is achieved at the isocenter due to the cross-firing from 36 radiation arcs generated by rotating 36 individual Cobalt-60 beams. The dedicated treatment planning system optimizes an optimal path of the focal spot using an optimization algorithm borrowed from computational geometry such that the target can be covered by 90%-95% of the prescription dose and the doses to surrounding tissues are minimized. The treatment plan is intended to be delivered with continuous motion of the treatment couch. In this paper the authors described in detail the gamma radiation unit, stereotactic localization of the breast, and the treatment planning system of the GammaPod system. Results: A prototype GammaPod system was installed at University of Maryland Medical Center and has gone through a thorough functional, geometric, and dosimetric testing. The mechanical and functional performances of the system all meet the functional specifications. Conclusions: An image-guided breast stereotactic radiotherapy device, named GammaPod, has been developed to deliver highly focused and localized doses to a target in the breast under stereotactic image guidance. It is envisioned that the GammaPod technology has the potential to significantly shorten radiation treatments and even eliminate surgery by ablating the tumor and sterilizing the tumor bed simultaneously.

  17. A Pilot Study of Hypofractionated Stereotactic Radiation Therapy and Sunitinib in Previously Irradiated Patients With Recurrent High-Grade Glioma

    SciTech Connect

    Wuthrick, Evan J.; Curran, Walter J.; Camphausen, Kevin; Lin, Alexander; Glass, Jon; Evans, James; Andrews, David W.; Axelrod, Rita; Shi, Wenyin; Werner-Wasik, Maria; Haacke, E. Mark; Hillman, Gilda G.; Dicker, Adam P.

    2014-10-01

    Purpose/Objective(s): Angiogenic blockade with irradiation may enhance the therapeutic ratio of radiation therapy (RT) through vascular normalization. We sought to determine the safety and toxicity profile of continuous daily-dosed sunitinib when combined with hypofractionated stereotactic RT (fSRT) for recurrent high-grade gliomas (rHGG). Methods and Materials: Eligible patients had malignant high-grade glioma that recurred or progressed after primary surgery and RT. All patients received a minimum of a 10-day course of fSRT, had World Health Organization performance status of 0 to 1, and a life expectancy of >3 months. During fSRT, sunitinib was administered at 37.5 mg daily. The primary endpoint was acute toxicity, and response was assessed via serial magnetic resonance imaging. Results: Eleven patients with rHGG were enrolled. The fSRT doses delivered ranged from 30 to 42 Gy in 2.5- to 3.75-Gy fractions. The median follow-up time was 40 months. Common acute toxicities included hematologic disorders, fatigue, hypertension, and elevated liver transaminases. Sunitinib and fSRT were well tolerated. One grade 4 mucositis toxicity occurred, and no grade 4 or 5 hypertensive events or intracerebral hemorrhages occurred. One patient had a nearly complete response, and 4 patients had stable disease for >9 months. Two patients (18%) remain alive and progression-free >3 years from enrollment. The 6-month progression-free survival was 45%. Conclusions: Sunitinib at a daily dose of 37.5 mg given concurrently with hypofractionated stereotactic reirradiation for rHGG yields acceptable toxicities and an encouraging 6-month progression-free survival.

  18. Indirect Tumor Cell Death After High-Dose Hypofractionated Irradiation: Implications for Stereotactic Body Radiation Therapy and Stereotactic Radiation Surgery

    SciTech Connect

    Song, Chang W.; Lee, Yoon-Jin; Griffin, Robert J.; Park, Inhwan; Koonce, Nathan A.; Hui, Susanta; Kim, Mi-Sook; Dusenbery, Kathryn E.; Sperduto, Paul W.; Cho, L. Chinsoo

    2015-09-01

    Purpose: The purpose of this study was to reveal the biological mechanisms underlying stereotactic body radiation therapy (SBRT) and stereotactic radiation surgery (SRS). Methods and Materials: FSaII fibrosarcomas grown subcutaneously in the hind limbs of C3H mice were irradiated with 10 to 30 Gy of X rays in a single fraction, and the clonogenic cell survival was determined with in vivo–in vitro excision assay immediately or 2 to 5 days after irradiation. The effects of radiation on the intratumor microenvironment were studied using immunohistochemical methods. Results: After cells were irradiated with 15 or 20 Gy, cell survival in FSaII tumors declined for 2 to 3 days and began to recover thereafter in some but not all tumors. After irradiation with 30 Gy, cell survival declined continuously for 5 days. Cell survival in some tumors 5 days after 20 to 30 Gy irradiation was 2 to 3 logs less than that immediately after irradiation. Irradiation with 20 Gy markedly reduced blood perfusion, upregulated HIF-1α, and increased carbonic anhydrase-9 expression, indicating that irradiation increased tumor hypoxia. In addition, expression of VEGF also increased in the tumor tissue after 20 Gy irradiation, probably due to the increase in HIF-1α activity. Conclusions: Irradiation of FSaII tumors with 15 to 30 Gy in a single dose caused dose-dependent secondary cell death, most likely by causing vascular damage accompanied by deterioration of intratumor microenvironment. Such indirect tumor cell death may play a crucial role in the control of human tumors with SBRT and SRS.

  19. Image-Guidance for Stereotactic Body Radiation Therapy

    SciTech Connect

    Fuss, Martin . E-mail: fussm@ohsu.edu; Boda-Heggemann, Judit; Papanikolau, Nikos; Salter, Bill J.

    2007-07-01

    The term stereotactic body radiation therapy (SBRT) describes a recently introduced external beam radiation paradigm by which small lesions outside the brain are treated under stereotactic conditions, in a single or few fractions of high-dose radiation delivery. Similar to the treatment planning and delivery process for cranial radiosurgery, the emphasis is on sparing of adjacent normal tissues through the creation of steep dose gradients. Thus, advanced methods for assuring an accurate relationship between the target volume position and radiation beam geometry, immediately prior to radiation delivery, must be implemented. Such methods can employ imaging techniques such as planar (e.g., x-ray) or volumetric (e.g., computed tomography [CT]) approaches and are commonly summarized under the general term image-guided radiation therapy (IGRT). This review summarizes clinical experience with volumetric and ultrasound based image-guidance for SBRT. Additionally, challenges and potential limitations of pre-treatment image-guidance are presented and discussed.

  20. Correlation between heterogeneity index (HI) and gradient index (GI) for high dose stereotactic radiotherapy/radiosurgery (SRT/SRS)

    NASA Astrophysics Data System (ADS)

    Tas, B.; Durmus, I. F.; Okumus, A.; Uzel, O. E.

    2017-02-01

    To evaluate between Heterogeneity Index (HI) and Gradient Index (GI) correlation for high dose Stereotactic radiotherapy (SRT) / Stereotactic radiosurgery (SRS) using Versa HD® lineer accelerator. Nine patients with single metastasis were used in this study. Patient's treatment planning were performed using Monaco5.1® Treatment planning system (TPS) with non-coplanar 6MV Flattening filter free (FFF) beams by partial Volumetric modulated arc therapy (VMAT) tecnique for each patient. We determined three different size of metastasis catagory which are less than 1cc, between 1cc and 5cc and larger than 5cc volume. Also, three different HI were calculated for each patients. These are 1.10, 1.20 and 1.30. Mean GI was determined 8.57±2.2 for 1.10 HI, 7.23±1.7 for 1.20 HI and 6.0±1.1 for 1.30 HI for less than 1cc metastasis. Then GI was determined 4.77±0.4 for 1.10 HI, 4.37±0.3 for 1.20 HI and 3.97±0.3 for 1.30 HI for between 1cc and 5cc metastasis. Finally, GI was determined 4.00±0.5 for 1.10 HI,3.63±0.5 for 1.20 HI and 3.27±0.4 for 1.30 HI for larger than 5cc metastasis. These results show that GI depends on significantly size and HI of metastasis especially for less than 1cc.

  1. Results for local control and functional outcome after linac-based image-guided stereotactic radiosurgery in 190 patients with vestibular schwannoma

    PubMed Central

    Badakhshi, Harun; Graf, Reinhold; Böhmer, Dirk; Synowitz, Michael; Wiener, Edzard; Budach, Volker

    2014-01-01

    Background We assessed local control (LC) and functional outcome after linac-based stereotactic radiosurgery (SRS) for vestibular schwannoma (VS). Methods Between 1998 and 2008, 190 patients with VS were treated with SRS. All patients had tumors <2 cm diameter. Patients received 13.5 Gy prescribed to the 80th isodose at the tumor margin. The primary endpoint was LC. Secondary endpoints were symptomatic control and morbidity. Results Median follow-up was 40 months. LC was achieved in 88% of patients. There were no acute reactions exceeding Grade I. Trigeminal nerve dysfunction was present in 21.6% (n = 41) prior to SRS. After treatment, 85% (n = 155) had no change, 4.4,% (n = 8) had a relief of symptoms, 10.4% (n = 19) had new symptoms. Facial nerve dysfunction was present in some patients prior to treatment, e.g. paresis (12.6%; n = 24) and dysgeusia (0.5%; n = 1). After treatment 1.1% (n = 2) reported improvement and 6.1% (n = 11) experienced new symptoms. Hearing problems before SRS were present in 69.5% of patients (n = 132). After treatment, 62.6% (n = 144) had no change, 10.4% (n = 19) experienced improvement and 26.9% (n = 49) became hearing impaired. Conclusion This series of SRS for small VS provided similar LC rates to microsurgery; thus, it is effective as a non-invasive, image-guided procedure. The functional outcomes observed indicate the safety and effectiveness of linac-based SRS. Patients may now be informed of the clinical equivalence of SRS to microsurgery. PMID:23979079

  2. Safety and Efficacy of Stereotactic Body Radiation Therapy in the Treatment of Pulmonary Metastases from High Grade Sarcoma

    PubMed Central

    Mehta, Niraj; Selch, Michael; Lee, Jay M.; Eilber, Fritz C.; Chmielowski, Bartosz; Agazaryan, Nzhde; Steinberg, Michael

    2013-01-01

    Introduction. Patients with high-grade sarcoma (HGS) frequently develop metastatic disease thus limiting their long-term survival. Lung metastases (LM) have historically been treated with surgical resection (metastasectomy). A potential alternative for controlling LM could be stereotactic body radiation therapy (SBRT). We evaluated the outcomes from our institutional experience utilizing SBRT. Methods. Sixteen consecutive patients with LM from HGS were treated with SBRT between 2009 and 2011. Routine radiographic and clinical follow-up was performed. Local failure was defined as CT progression on 2 consecutive scans or growth after initial shrinkage. Radiation pneumonitis and radiation esophagitis were scored using Common Toxicity Criteria (CTC) version 3.0. Results. All 16 patients received chemotherapy, and a subset (38%) also underwent prior pulmonary metastasectomy. Median patient age was 56 (12–85), and median follow-up time was 20 months (range 3–43). A total of 25 lesions were treated and evaluable for this analysis. Most common histologies were leiomyosarcoma (28%), synovial sarcoma (20%), and osteosarcoma (16%). Median SBRT prescription dose was 54 Gy (36–54) in 3-4 fractions. At 43 months, local control was 94%. No patient experienced G2-4 radiation pneumonitis, and no patient experienced radiation esophagitis. Conclusions. Our retrospective experience suggests that SBRT for LM from HGS provides excellent local control and minimal toxicity. PMID:24198717

  3. Red Shell: Defining a High-Risk Zone of Normal Tissue Damage in Stereotactic Body Radiation Therapy

    SciTech Connect

    Yang, Jun; Fowler, Jack F.; Lamond, John P.; Lanciano, Rachelle; Feng Jing; Brady, Luther W.

    2010-07-01

    Purpose: To define a volume of tissue just outside of the clinical target volume (CTV) or planning target volume (PTV) in stereotactic body radiation therapy (SBRT) that receives doses appreciably above the tolerance level and in which other critical tissue structures must be avoided. Methods and Materials: We define the tissue between the borders of the CTV and PTV as the Inner Red Shell. The tissue surrounding the PTV that receives higher than the local tissue tolerance is defined as the Outer Red Shell. Contributing factors to the volume of the Red Shell include the prescription dose, dose gradient and PTV size, together with the type of tissue and its tolerance are discussed. An illustrative example and two clinical cases are reported. Results: The volume of Red Shell increases with higher prescription dose, slower dose fall-off, larger PTV volume, and higher tissue radiosensitivity. Avoidance of proximal critical serial organs may alter the volume and shape of the Red Shell after repeated, detailed treatment planning. Conclusion: Rather than defining tolerance and toxicity as simply a dose level received by the tissues, the volume of tissue receiving risk levels above tolerance can be quantified as the 'cost' of SBRT. This concept may be adopted in other techniques offering ablative and high-dose gradients. Further consideration should be given to collecting clinical data for refining the choice of constraint doses, especially in parts of the brain, lung, liver, and kidney.

  4. Performance evaluation of a CyberKnife® G4 image-guided robotic stereotactic radiosurgery system

    NASA Astrophysics Data System (ADS)

    Antypas, Christos; Pantelis, Evaggelos

    2008-09-01

    The aim of the current work was to present the performance evaluation procedures implemented at our department for the commissioning of a G4 CyberKnife system. This system consists of a robotic manipulator, a target-locating system and a lightweight 6-MV linac. Individual quality assurance procedures were performed for each of the CyberKnife subsystems. The system was checked for the mechanical accuracy of its robotic manipulator. The performance of the target-locating system was evaluated in terms of mechanical accuracy of both cameras' alignment and quality assurance tests of the x-ray generators and the flat-panel detectors. The traditional linac 6-MV beam characteristics and beam output parameters were also measured. Results revealed a manipulator mechanical mean accuracy of ~0.1 mm, with individual maximum position uncertainties less than 0.25 mm. The target-locating system mechanical accuracy was found within the acceptance limits. For the most clinically used parameters in the CyberKnife practice, e.g. 100-120 kV and 50-200 ms, kV and exposure time accuracy error were measured as less than 2%, while the precision error of the kV was determined as less than 1%. The acquired images of the ETR grid pattern revealed no geometrical distortion while the critical frequency f50 values for cameras A and B were calculated as 1.5 lp mm-1 and 1.4 lp mm-1, respectively. Dose placement measurements were performed in a head and neck phantom. Results revealed sub-millimeter beam delivery precision whereas the total clinical accuracy of the system was measured equal to 0.44 ± 0.12 mm, 0.29 ± 0.10 mm and 0.53 ± 0.16 mm for the skull, fiducial and Xsight spine tracking methods, respectively. The results of this work certify the G4 CyberKnife SRS system capable of delivering high dose distributions with sub-millimeter accuracy and precision to intracranial and extracranial lesions. Moreover, total clinical accuracy of the investigated G4 system was found to be improved for

  5. Stereotactic (Mammographically Guided) Breast Biopsy

    MedlinePlus

    ... any medications you’re taking, including aspirin and herbal supplements, and whether you have any allergies – especially to ... doctor all medications that you are taking, including herbal supplements, and if you have any allergies, especially to ...

  6. Stereotactic (Mammographically Guided) Breast Biopsy

    MedlinePlus

    ... medical conditions. top of page What does the equipment look like? The specialized mammography machine used in ... can be obtained at different angles. At most facilities, a specially designed examination table will allow you ...

  7. Dosimetric and deformation effects of image-guided interventions during stereotactic body radiation therapy of the prostate using an endorectal balloon

    SciTech Connect

    Jones, Bernard L.; Gan, Gregory; Diot, Quentin; Kavanagh, Brian; Timmerman, Robert D.; Miften, Moyed

    2012-06-15

    Purpose: During stereotactic body radiation therapy (SBRT) for the treatment of prostate cancer, an inflatable endorectal balloon (ERB) may be used to reduce motion of the target and reduce the dose to the posterior rectal wall. This work assessed the dosimetric impact of manual interventions on ERB position in patients receiving prostate SBRT and investigated the impact of ERB interventions on prostate shape. Methods: The data of seven consecutive patients receiving SBRT for the treatment of clinical stage T1cN0M0 prostate cancer enrolled in a multi-institutional, IRB-approved trial were analyzed. The SBRT dose was 50 Gy in five fractions to a planning target volume (PTV) that included the prostate (implanted with three fiducial markers) with a 3-5 mm margin. All plans were based on simulation images that included an ERB inflated with 60 cm{sup 3} of air. Daily kilovoltage cone-beam computed tomography (CBCT) imaging was performed to localize the PTV, and an automated fusion with the planning images yielded displacements required for PTV relocalization. When the ERB volume and/or position were judged to yield inaccurate repositioning, manual adjustment (ERB reinflation and/or repositioning) was performed. Based on all 59 CBCT image sets acquired, a deformable registration algorithm was used to determine the dose received by, displacement of, and deformation of the prostate, bladder (BLA), and anterior rectal wall (ARW). This dose tracking methodology was applied to images taken before and after manual adjustment of the ERB (intervention), and the delivered dose was compared to that which would have been delivered in the absence of intervention. Results: Interventions occurred in 24 out of 35 (69%) of the treated fractions. The direct effect of these interventions was an increase in the prostate radiation dose that included 95% of the PTV (D95) from 9.6 {+-} 1.0 to 10.0 {+-} 0.2 Gy (p = 0.06) and an increase in prostate coverage from 94.0% {+-} 8.5% to 97.8% {+-} 1

  8. Patterns of Failure After Concurrent Bevacizumab and Hypofractionated Stereotactic Radiation Therapy for Recurrent High-Grade Glioma

    SciTech Connect

    Shapiro, Lauren Q.; Beal, Kathryn; Goenka, Anuj; Karimi, Sasan; Iwamoto, Fabio M.; Yamada, Yoshiya; Zhang, Zhigang; Lassman, Andrew B.; Abrey, Lauren E.; Gutin, Philip H.

    2013-03-01

    Purpose: Concurrent bevacizumab with hypofractionated stereotactic radiation therapy (HSRT) is safe and effective for the treatment of recurrent high-grade gliomas (HGG). The objective of this study was to characterize the patterns of failure after this treatment regimen. Methods and Materials: Twenty-four patients with recurrent enhancing HGG were previously treated on an institutional review board-approved protocol of concurrent bevacizumab and reirradiation. Patients received 30 Gy in 5 fractions to the recurrent tumor with HSRT. Brain magnetic resonance imaging (MRI) was performed every 2 cycles, and bevacizumab was continued until clinical or radiographic tumor progression according to the criteria of Macdonald et al. MRI at the time of progression was fused to the HSRT treatment plan, and the location of recurrence was classified on the basis of volume within the 95% isodose line. Outcomes based on patient characteristics, tumor grade, recurrence pattern, and best response to treatment were analyzed by the Kaplan-Meier method. Results: Twenty-two patients experienced either clinical or radiographic progression. Recurrent tumor was enhancing in 15 (71.4%) and nonenhancing in 6 (28.6%) patients. Eleven patients (52.4%) had recurrence within the radiation field, 5 patients (23.8%) had marginal recurrence, and 5 patients had recurrence outside the radiation field. Pattern of enhancement and location of failure did not correlate with overall survival or progression-free survival. Radiographic response was the only variable to significantly correlate with progression-free survival. Conclusions: Despite the promising initial response seen with the addition of HSRT to bevacizumab as salvage treatment for recurrent HGG, approximately half of patients ultimately still experience failure within the radiation field. The rate of local failure with the addition of HSRT seems to be lower than that seen with bevacizumab alone in the salvage setting. Our data underscore the

  9. Fractionated stereotactic radiotherapy plus bevacizumab after response to bevacizumab plus irinotecan as a rescue treatment for high-grade gliomas

    PubMed Central

    Conde-Moreno, Antonio José; García-Gómez, Raquel; Albert-Antequera, María; Almendros-Blanco, Piedad; De Las Peñas-Bataller, Ramón; González-Vidal, Verónica; López-Torrecilla, José Luis; Ferrer-Albiach, Carlos

    2015-01-01

    Aim To evaluate the possibility of implementing a new scheme of rescue treatment after relapse or progression of high-grade glioma (HGG) treated at the first-line with bevacizumab and irinotecan (BVZ+CPT11), evaluating the response and toxicity of associating BVZ and fractionated stereotactic radiotherapy (BVZ+FSRT). Materials and methods We retrospectively analysed data from 59 patients with relapse of HGG. Nine patients with HGG relapse after treatment using the Stupp protocol that were treated with BVZ+CPT11 for progression between July 2007 and August 2012, after which the response was assessed according to the Revised Assessment in Neuro-Oncology (RANO) criteria. BVZ was administered at a dose of 10 mg/kg and FSRT up to a prescribed dose of 30 Gy, 500 cGy per fraction, three days a week. The median follow-up was 38 months. Results The treatment was well-tolerated by all patients. The response after nuclear magnetic resonance imaging (MRI) at 3–6 months was progression in two patients, stable disease in four, and three patients had a partial response. The median overall survival (OS) from diagnosis until death or the last control was 36.8 months. The median progression-free survival (PFS) was 10.8 months. The results from tumour sub-group analysis indicated that the PFS was not statistically significant although it seemed that it was higher in grade-III. The OS was higher in grade-III gliomas. Conclusions The combination of BVZ+FSRT as a second-line HGG relapse rescue treatment is well-tolerated and seems to offer promising results. We believe that multi-centre prospective studies are needed to determine the long-term efficacy and toxicity of this therapeutic approach. PMID:25949228

  10. Tumor Control Outcomes After Hypofractionated and Single-Dose Stereotactic Image-Guided Intensity-Modulated Radiotherapy for Extracranial Metastases From Renal Cell Carcinoma

    SciTech Connect

    Zelefsky, Michael J.; Greco, Carlo; Motzer, Robert; Magsanoc, Juan Martin; Pei Xin; Lovelock, Michael; Mechalakos, Jim; Zatcky, Joan; Fuks, Zvi; Yamada, Yoshiya

    2012-04-01

    Purpose: To report tumor local progression-free outcomes after treatment with single-dose, image-guided, intensity-modulated radiotherapy and hypofractionated regimens for extracranial metastases from renal cell primary tumors. Patients and Methods: Between 2004 and 2010, 105 lesions from renal cell carcinoma were treated with either single-dose, image-guided, intensity-modulated radiotherapy to a prescription dose of 18-24 Gy (median, 24) or hypofractionation (three or five fractions) with a prescription dose of 20-30 Gy. The median follow-up was 12 months (range, 1-48). Results: The overall 3-year actuarial local progression-free survival for all lesions was 44%. The 3-year local progression-free survival for those who received a high single-dose (24 Gy; n = 45), a low single-dose (<24 Gy; n = 14), or hypofractionation regimens (n = 46) was 88%, 21%, and 17%, respectively (high single dose vs. low single dose, p = .001; high single dose vs. hypofractionation, p < .001). Multivariate analysis revealed the following variables were significant predictors of improved local progression-free survival: 24 Gy dose compared with a lower dose (p = .009) and a single dose vs. hypofractionation (p = .008). Conclusion: High single-dose, image-guided, intensity-modulated radiotherapy is a noninvasive procedure resulting in high probability of local tumor control for metastatic renal cell cancer generally considered radioresistant according to the classic radiobiologic ranking.

  11. The Early Result of Whole Pelvic Radiotherapy and Stereotactic Body Radiotherapy Boost for High-Risk Localized Prostate Cancer

    PubMed Central

    Lin, Yu-Wei; Lin, Li-Ching; Lin, Kuei-Li

    2014-01-01

    Purpose: The rationale for hypofractionated radiotherapy in the treatment of prostate cancer is based on the modern understanding of radiobiology and advances in stereotactic body radiotherapy (SBRT) techniques. Whole-pelvis irradiation combined with SBRT boost for high-risk prostate cancer might escalate biologically effective dose without increasing toxicity. Here, we report our 4-year results of SBRT boost for high-risk localized prostate cancer. Methods and Materials: From October 2009 to August 2012, 41 patients newly diagnosed, high-risk or very high-risk (NCCN definition) localized prostate cancer were treated with whole-pelvis irradiation and SBRT boost. The whole pelvis dose was 45 Gy (25 fractions of 1.8 Gy). The SBRT boost dose was 21 Gy (three fractions of 7 Gy). Ninety percent of these patients received hormone therapy. The toxicities of gastrointestinal (GI) and genitourinary (GU) tracts were scored by Common Toxicity Criteria Adverse Effect (CTCAE v3.0). Biochemical failure was defined by Phoenix definition. Results: Median follow-up was 42 months. Mean PSA before treatment was 44.18 ng/ml. Mean PSA level at 3, 6, 12, 18, and 24 months was 0.94, 0.44, 0.13, 0.12, and 0.05 ng/ml, respectively. The estimated 4-year biochemical failure-free survival was 91.9%. Three biochemical failures were observed. GI and GU tract toxicities were minimal. No grade 3 acute GU or GI toxicity was noted. During radiation therapy, 27% of the patient had grade 2 acute GU toxicity and 12% had grade 2 acute GI toxicity. At 3 months, most toxicity scores had returned to baseline. At the last follow-up, there was no grade 3 late GU or GI toxicity. Conclusions: Whole-pelvis irradiation combined with SBRT boost for high-risk localized prostate cancer is feasible with minimal toxicity and encouraging biochemical failure-free survival. Continued accrual and follow-up would be necessary to confirm the biochemical control rate and the toxicity profiles. PMID

  12. Stereotactic Radiosurgery

    MedlinePlus

    ... benign and malignant), blood vessel abnormalities in the brain, defined areas of cancer, certain small tumors in the lungs and liver, ... or months after treatment. These reactions can include cell death in the high radiation dose region due to the ... Phone: 773-577-8750 Fax: 773-577-8738 CareLine: ...

  13. Use of a hemostasis introducer sheath to guide clip delivery during stereotactic directional vacuum-assisted breast biopsy when the biopsy system malfunctions.

    PubMed

    Wang, Jane; Chang, Chun-Ju

    2010-01-01

    Stereotactic directional vacuum-assisted breast biopsy (ST DVAB) is an accurate biopsy method. Marking the biopsy site with a clip is mandatory after ST DVAB, in case excision is required. With the ST DVAB system we use, clip was delivered through the biopsy probe. We report a case with malfunctioning of the ST DVAB system during the procedure, and thus the clip could not be placed through the biopsy probe. To salvage the procedure, we placed the clip to the biopsy site via a hemostasis introducer sheath.

  14. TEACHER'S GUIDE TO HIGH SCHOOL SPEECH.

    ERIC Educational Resources Information Center

    JENKINSON, EDWARD B., ED.

    THIS GUIDE TO HIGH SCHOOL SPEECH FOCUSES ON SPEECH AS ORAL COMPOSITION, STRESSING THE IMPORTANCE OF CLEAR THINKING AND COMMUNICATION. THE PROPOSED 1-SEMESTER BASIC COURSE IN SPEECH ATTEMPTS TO IMPROVE THE STUDENT'S ABILITY TO COMPOSE AND DELIVER SPEECHES, TO THINK AND LISTEN CRITICALLY, AND TO UNDERSTAND THE SOCIAL FUNCTION OF SPEECH. IN ADDITION…

  15. TEACHER'S GUIDE TO HIGH SCHOOL JOURNALISM.

    ERIC Educational Resources Information Center

    JENKINSON, EDWARD B., ED.

    IN AN EFFORT TO TRAIN HIGH SCHOOL STUDENTS TO BECOME INTELLIGENT READERS, LISTENERS, AND VIEWERS OF MASS MEDIA, THE INDIANA STATE DEPARTMENT OF PUBLIC INSTRUCTION PUBLISHED A GUIDE FOR TEACHERS OF JOURNALISM. PART I ESTABLISHES GUIDELINES FOR A FIRST SEMESTER COURSE IN JOURNALISM AND CONTAINS CHAPTERS ON (1) EXPLORING MASS MEDIA, A DISCUSSION OF…

  16. Stereotactic radiosurgery - discharge

    MedlinePlus

    ... pg=stereotactic . Accessed July 22, 2016. Read More Acoustic neuroma Brain tumor - primary - adults Cerebral arteriovenous malformation ... A.M. Editorial team. Related MedlinePlus Health Topics Acoustic Neuroma Arteriovenous Malformations Brain Tumors Childhood Brain Tumors ...

  17. Stereotactic localization and removal of a bullet in the third ventricle causing obstructive hydrocephalus after a cerebral gunshot wound: case report.

    PubMed

    Linskey, M E; Kondziolka, D; Marion, D W

    1994-06-01

    A bullet, lodged in the pineal-posterior region of the third ventricle and causing obstructive hydrocephalus, was removed without damage to critical adjacent vascular structures using stereotactic localization followed by laser-guided stereotactic craniotomy. Stereotactic techniques provided precise target localization and allowed dissection to be restricted to the previously injured missile track, thus avoiding any additional morbidity from the surgical procedure.

  18. Stereotactic body radiotherapy: current strategies and future development

    PubMed Central

    2016-01-01

    Stereotactic body radiotherapy (SBRT) has emerged as the standard treatment for medically inoperable early-staged non-small cell lung cancer (NSCLC). The local control rate after SBRT is over 90%. Some forms of tumour motion management and image-guided radiation delivery techniques are the prerequisites for fulfilment of its goal to deliver a high radiation dose to the tumour target without overdosing surrounding normal tissues. In this review, the current strategies of tumour motion management will be discussed, followed by an overview of various image-guided radiotherapy (RT) systems and devices available for clinical practice. Besides medically inoperable stage I NSCLC, SBRT has also been widely adopted for treatment of oligometastasis involving the lungs. Its possible applications in various other cancer illnesses are under extensive exploration. The progress of SBRT is critically technology-dependent. With advancement of technology, the ideal of personalised, effective and yet safe SBRT is already on the horizon. PMID:27606082

  19. High resolution guided wave pipe inspection

    NASA Astrophysics Data System (ADS)

    Velichko, Alexander; Wilcox, Paul D.

    2009-03-01

    Commercial guided wave inspection systems provide rapid screening of pipes, but limited sizing capability for small defects. However, accurate detection and sizing of small defects is essential for assessing the integrity of inaccessible pipe regions where guided waves provide the only possible inspection mechanism. In this paper an array-based approach is presented that allows guided waves to be focused on both transmission and reception to produce a high resolution image of a length of pipe. In the image, it is shown that a signal to coherent noise ratio of over 40 dB with respect to the reflected signal from a free end of pipe can be obtained, even taking into account typical levels of experimental uncertainty in terms of transducer positioning, wave velocity etc. The combination of an image with high resolution and a 40 dB dynamic range enables the detection of very small defects. It also allows the in-plane shape of defects over a certain size to be observed directly. Simulations are used to estimate the detection and sizing capability of the system for crack-like defects. Results are presented from a prototype system that uses EMATs to fully focus pipe guided wave modes on both transmission and reception in a 12 inch diameter stainless steel pipe. The 40 dB signal to coherent noise ratio is obtained experimentally and a 2 mm diameter (0.08 wavelengths) half-thickness hole is shown to be detectable.

  20. Isocentric stereotactic three-dimensional digitizer for neurosurgery.

    PubMed

    Takizawa, T

    1993-01-01

    A new system has been developed, comprising a frameless isocentric stereotactic mechanism and a three-dimensional (3-D) digitizer for intraoperative spatial monitoring. The 3-D digitizer's multiarticulated arm has three joints related to Cartesian coordinates, two quadrant arcs forming an isocenter system, a microdrive, and a probe holder. The frameless isocentric mechanism is useful for open stereotaxy. Routine CT- or MRI-guided stereotactic surgery is also possible, due to the high level of accuracy of the system. Before surgery, CT and/or MR images are acquired after placing on the scalp three or four external markers. For surgical procedures which require high accuracy, Laitinen's noninvasive CT or MRI localizing markers are used. CT or MR images are entered into a computer using an image scanner, and are stored on a floppy disk. After the patient's head is fixed to the operating table using a Mayfield clamp, the 3-D digitizer is used to read the spatial points and external markers on the scalp or the reference points of Laitinen's localizing markers. During the procedure, the coordinates on the patient's head are automatically entered into the computer and matched with those of the 3-D digitizer and CT/MR images on the CRT display. This system has been used in 22 cases of open craniotomy and 33 cases of burr hole surgery, both carried out using the stereotactic function and the 3-D spatial monitoring function in parallel. Errors in mechanical accuracy of the 3-D digitizer were less than 0.8 mm, and the maximum error during operation was presumed not to exceed 2 mm.

  1. Tumor Control Outcomes Following Hypofractionated and Single-Dose Stereotactic Image-Guided Intensity-Modulated Radiotherapy for Extracranial Metastases from Renal Cell Carcinoma

    PubMed Central

    Zelefsky, Michael J; Greco, Carlo; Motzer, Robert; Magsanoc, Juan Martin; Pei, Xin; Lovelock, Michael; Mechalakos, Jim; Zatcky, Joan; Fuks, Zvi; Yamada, Yoshiya

    2014-01-01

    Purpose To report tumor local progression-free outcomes following treatment with single-dose image-guided intensity-modulated radiotherapy (SD-IGRT) and hypofractionated regimens for extracranial metastases from renal cell primary tumors. Methods and Materials Between 2004 and 2010, a total of 105 lesions from renal cell carcinomas were treated with either SD-IGRT to prescription doses of 18–24 Gy (median, 24 Gy) or hypofractionation (3 or 5 fractions) with prescription doses ranging between 20 and 30 Gy. The median follow-up was 12 months (range, 1–48 months). Results The overall 3-year actuarial local progression-free survival (LPFS) for all lesions was 44%. The 3-year LPFS for those who received high single-dose (24 Gy; n = 45), low single-dose (< 24 Gy; n = 14), and hypofractionation regimens (n = 46) were 88%, 21%, and 17%, respectively (high single dose versus low single dose, p = 0.001; high single dose versus hypofractionation, p < 0.001). Multivariate analysis revealed the following variables as significant predictors of improved LPFS: dose of 24 Gy compared with lower dose (p = 0.009), and single dose versus hypofractionation (p = 0.008). Conclusion High-dose SD-IGRT is a non-invasive procedure resulting in high probability of local tumor control for metastatic renal cell cancers, generally considered radioresistant according to classical radiobiological ranking. PMID:21596489

  2. [Stereotactic ablative irradiation for lung cancer].

    PubMed

    Antoni, D; Srour, I; Noël, G; Mornex, F

    2014-01-01

    Stereotactic radiotherapy for lung cancer is a technique that is now well established in the therapeutic arsenal. Protocols are effective, with very high local control rate and an acceptable rate of survival if one takes into account the patient's age and comorbidities. Complications are rare. This review of the literature analyses the whole process of the therapeutic indications and future prospects.

  3. Imaging for Stereotactic Spine Radiotherapy: Clinical Considerations

    SciTech Connect

    Dahele, Max; Zindler, Jaap D.; Sanchez, Esther; Verbakel, Wilko F.; Kuijer, Joost P.A.; Slotman, Ben J.; Senan, Suresh

    2011-10-01

    There is growing interest in the use of stereotactic body radiation therapy (SBRT) for spinal metastases. With the need for accurate target definition and conformal avoidance of critical normal structures, high-quality multimodal imaging has emerged as a key component at each stage of the treatment process. Multidisciplinary collaboration is necessary to optimize imaging protocols and implement imaging advances into routine patient care.

  4. Optical Tracking Technology in Stereotactic Radiation Therapy

    SciTech Connect

    Wagner, Thomas H. . E-mail: thomas.wagner@orhs.org; Meeks, Sanford L.; Bova, Frank J.; Friedman, William A.; Willoughby, Twyla R.; Kupelian, Patrick A.; Tome, Wolfgang

    2007-07-01

    The last decade has seen the introduction of advanced technologies that have enabled much more precise application of therapeutic radiation. These relatively new technologies include multileaf collimators, 3-dimensional conformal radiotherapy planning, and intensity modulated radiotherapy in radiotherapy. Therapeutic dose distributions have become more conformal to volumes of disease, sometimes utilizing sharp dose gradients to deliver high doses to target volumes while sparing nearby radiosensitive structures. Thus, accurate patient positioning has become even more important, so that the treatment delivered to the patient matches the virtual treatment plan in the computer treatment planning system. Optical and image-guided radiation therapy systems offer the potential to improve the precision of patient treatment by providing a more robust fiducial system than is typically used in conventional radiotherapy. The ability to accurately position internal targets relative to the linac isocenter and to provide real-time patient tracking theoretically enables significant reductions in the amount of normal tissue irradiated. This report reviews the concepts, technology, and clinical applications of optical tracking systems currently in use for stereotactic radiation therapy. Applications of radiotherapy optical tracking technology to respiratory gating and the monitoring of implanted fiducial markers are also discussed.

  5. A novel compound 6D-offset simulating phantom and quality assurance program for stereotactic image-guided radiation therapy system.

    PubMed

    Yuen Kan Ngar, Dennis; Lok-Man Cheung, Michael; Koon-Ming Kam, Michael; Poon, Wai-Sang; Tak-Cheung Chan, Anthony

    2014-11-04

    A comprehensive quality assurance (QA) device cum program was developed for the commissioning and routine testing of the 6D IGRT systems. In this article, both the new QA system and the BrainLAB IGRT system which was added onto a Varian Clinac were evaluated. A novel compound 6D-offset simulating phantom was designed and fabricated in the Prince of Wales Hospital (PWH), Hong Kong. The QA program generated random compound 6D-offset values. The 6D phantom was simply set up and shifted accordingly. The BrainLAB ExacTrac X-ray IGRT system detected the offsets and then corrected the phantom position automatically through the robotic couch. Routine QA works facilitated data analyses of the detection errors, the correction errors, and the correlations. Fifty sets of data acquired in 2011 in PWH were thoroughly analyzed. The 6D component detection errors and correction errors of the IGRT system were all within ± 1 mm and ± 1° individually. Translational and rotational scalar resultant errors were found to be 0.50 ± 0.27 mm and 0.54 ± 0.23°, respectively. Most individual component errors were shown to be independent of their original offset values. The system characteristics were locally established. The BrainLAB 6D IGRT system added onto a regular linac is sufficiently precise for stereotactic RT. This new QA methodology is competent to assure the IGRT system overall integrity. Annual grand analyses are recommended to check local system consistency and for external cross comparison. The target expansion policy of 1.5 mm 3D margin from CTV to PTV is confirmed for this IGRT system currently in PWH.

  6. Image-Guided Stereotactic Body Radiation Therapy in Patients With Isolated Para-Aortic Lymph Node Metastases From Uterine Cervical and Corpus Cancer

    SciTech Connect

    Choi, Chul Won; Cho, Chul Koo Yoo, Seong Yul; Kim, Mi Sook; Yang, Kwang Mo; Yoo, Hyung Jun; Seo, Young Seok; Kang, Jin Kyu; Lee, Dong Han; Lee, Kyung Hee; Lee, Eui Don; Rhu, Sang Young; Choi, Suck Chul; Kim, Moon Hong; Kim, Beob Jong

    2009-05-01

    Purpose: The aims of this study were to evaluate the role of stereotactic body radiation therapy (SBRT) as a local treatment for isolated para-aortic lymph node (PALN) metastases originating from uterine cervical and corpus cancer. Methods and Materials: We retrospectively enrolled 30 patients with isolated PALN metastases originating from uterine cervical and corpus cancer who had received SBRT using the CyberKnife (CK). All patients were shown to have isolated PALN metastases by computed tomography (CT) and/or positron emission tomography (PET)-CT. The overall survival (OS), local control (LC) rate, and disease progression-free survival (DPFS) rate were calculated according to the Kaplan-Meier method. Comparison between prognosis groups was performed using log-rank analysis. Toxicities were also evaluated. Results: The 4-year OS rate was 50.1%, and the median survival time was not reached. The OS rate among symptomatic patients was significantly lower than that among asymptomatic patients (p = 0.002). The 4-year actuarial LC rate was 67.4%. Patients with a planning target volume of {<=}17 ml had significantly higher LC rates (p = 0.009). The 4-year DPFS rate was 45.0%, and the median time to disease progression was 32 months. Small planning target volume was a favorable prognostic factor (p = 0.043). Grade 3 or 4 complications requiring hospitalization were reported in 1 patient at 20 months after SBRT. Conclusion: The OS and LS rates were promising, and the incidence of toxicities was low. Use of SBRT with the CyberKnife is an effective modality for treating isolated PALN metastases in patients with uterine cervical and corpus cancer.

  7. Use of Image-Guided Stereotactic Body Radiation Therapy in Lieu of Intracavitary Brachytherapy for the Treatment of Inoperable Endometrial Neoplasia

    SciTech Connect

    Kemmerer, Eric; Hernandez, Enrique; Ferriss, James S.; Valakh, Vladimir; Miyamoto, Curtis; Li, Shidong; Micaily, Bizhan

    2013-01-01

    Purpose: Retrospective analysis of patients with invasive endometrial neoplasia who were treated with external beam radiation therapy followed by stereotactic body radiation therapy (SBRT) boost because of the inability to undergo surgery or brachytherapy. Methods and Materials: We identified 11 women with stage I-III endometrial cancer with a median age of 78 years that were not candidates for hysterectomy or intracavitary brachytherapy secondary to comorbidities (91%) or refusal (9%). Eight patients were American Joint Committee on Cancer (AJCC) stage I (3 stage IA, 5 stage IB), and 3 patients were AJCC stage III. Patients were treated to a median of 4500 cGy at 180 cGy per fraction followed by SBRT boost (600 cGy per fraction Multiplication-Sign 5). Results: The most common side effect was acute grade 1 gastrointestinal toxicity in 73% of patients, with no late toxicities observed. With a median follow-up of 10 months since SBRT, 5 patients (45%) experienced locoregional disease progression, with 3 patients (27%) succumbing to their malignancy. At 12 and 18 months from SBRT, the overall freedom from progression was 68% and 41%, respectively. Overall freedom from progression (FFP) was 100% for all patients with AJCC stage IA endometrial carcinoma, whereas it was 33% for stage IB at 18 months. The overall FFP was 100% for International Federation of Obstetrics and Gynecology grade 1 disease. The estimated overall survival was 57% at 18 months from diagnosis. Conclusion: In this study, SBRT boost to the intact uterus was feasible, with encouragingly low rates of acute and late toxicity, and favorable disease control in patients with early-stage disease. Additional studies are needed to provide better insight into the best management of these clinically challenging cases.

  8. [Is medical linac suitable for high-precision stereotactic irradiation?: investigations in geometrical accuracies of gantry and couch].

    PubMed

    Kunieda, E; Kitamura, M; Kawaguchi, O; Ohira, T; Shigematsu, N; Tonai, T; Ando, Y; Kubo, A; Kawase, T

    1998-02-01

    Linac-based radiosurgery has many advantages over the gamma knife, including low initial cost and no need of source replacement. On the other hand, most of the medical linacs currently in use were not originally designed to be applied for radiosurgery, and, therefore, careful quality assurance programs are required. In the gantry-head of a linac, a small CCD video camera is mounted in a position optically identical to that of the x-ray source. The video signal from the camera was digitalized to be evaluated for geometrical errors. A metal ball fixed to the stereotactic base frame via XYZ-sliding rods was used as a simulated target. Displacements of the target from the isocenter were measured during rotation of the gantry. Displacements in the gantry-rotation plane were satisfactorily small, while those perpendicular to it were maximal at gantry position angles of 0 degree and 180 degrees. This error night be caused by gravitational vending of the heavy gantry head. Although other major errors of the linac were within one millimeter, the center of coach rotation around the isocenter did not coincide with the center of gantry rotation, probably owing to gravitational vending. Special care should be taken when very small collimators are employed.

  9. SU-E-J-269: Assessing the Precision of Dose Delivery in CBCT-Guided Stereotactic Body Radiation Therapy for Lung and Soft Tissue Metastatic Lesions

    SciTech Connect

    Parsai, S; Dalhart, A; Chen, C; Parsai, E; Pearson, D; Sperling, N; Reddy, K

    2014-06-01

    Purpose: Ensuring reproducibility of target localization is critical to accurate stereotactic body radiation treatment (SBRT) for lung and soft tissue metastatic lesions. To characterize interfraction variability in set-up and evaluate PTV margins utilized for SBRT, daily CBCTs were used to calculate delivered target and OAR doses compared to those expected from planning. Methods: CBCT images obtained prior to each fraction of SBRT for a lung and thyroid metastatic lesion were evaluated. The target CTV/ITV and OARs on each of 8 CBCT data sets were contoured. Using MIM fusion software and Pinnacle{sup 3} RTP system, delivered dose distribution was reconstructed on each CBCT, utilizing translational shifts performed prior to treatment. Actual delivered vs. expected doses received by target CTV/ITV and adjacent critical structures were compared to characterize accuracy of pre-treatment translational shifts and PTV margins. Results: The planned CTV/ITV D95% and V100% were 4595cGy and 91.47% for the lung lesion, and 3010cGy and 96.34% for the thyroid lesion. Based on CBCT analysis, actual mean D95% and V100% for lung ITV were 4542±344.4cGy and 91.54±3.45%; actual mean D95% and V100% for thyroid metastasis CTV were 3005±25.98cGy and 95.20±2.522%. For the lung lesion, ipsilateral lung V20, heart V32 (cc) and spinal cord (.03 cc) max were 110.15cc, 3.33cc, and 1680cGy vs. 110.27±14.79cc, 6.74±3.76cc, and 1711±46.56cGy for planned vs. delivered doses, respectively. For the thyroid metastatic lesion, esophagus V18, trachea (.03 cc) max, and spinal cord (.03 cc) max were 0.35cc, 2555cGy, and 850cGy vs. 0.16±0.13cc, 2147±367cGy, and 838±45cGy for planned vs. delivered treatments, respectively. Conclusion: Minimal variability in SBRT target lesion dose delivered based on pre-treatment CBCT-based translational shifts suggests tighter PTV margins may be considered to further decrease dose to surrounding critical structures. Guidelines for optimal target alignment during

  10. Beavercreek High School English Curriculum Guide, 1975.

    ERIC Educational Resources Information Center

    Beavercreek Local School District, Xenia, OH.

    This curriculum guide is divided into four major sections: English Skills, Writing and Composition Courses, Literature Courses, and Elective Courses. Thirty courses are described, and the guide outlines the general objectives, specific objectives, activities, and resources for each course. The courses include Advanced Composition, Journalism I,…

  11. Neutron guide-split: A high performance guide bundle concept for elliptical guides

    NASA Astrophysics Data System (ADS)

    Holm, Sonja L.; Rasmussen, Nina; Høpfner, Louise; Bertelsen, Mads; Voigt, Jörg; Andersen, Ken H.; Lefmann, Kim

    2015-05-01

    We present a new guide-split concept for transporting cold and thermal neutrons to multiple instruments from a single beam port at a neutron facility without compromising the useful neutron brilliance notably for any of the instruments. Elliptical guides are capable of transporting an almost completely filled phase space within a large divergence (±2° for cold neutrons). It is therefore possible to place several secondary guides side by side pointing in slightly different directions using the end of a primary guide as a virtual source. The instruments placed at the secondary guides hence exploit different parts of the phase space transported by the primary guide. In addition, the resulting kink between the primary and secondary guide eliminates line of sight. Using ray-tracing simulations of three different set-ups (with two, four, and eight secondary guides) we show that it is possible to illuminate at least eight sample positions from one beam port with a brilliance transfer above 90% on each sample on a 150 m long instrument. This has been done for a phase space volume comprised of an area of 1×1 cm2 and a maximum divergence of±0.5° within a wavelength band of 4.25-5.75 Å. We show, by a full virtual experiment, an example of applying the guide-split concept to an instrument proposed for the European Spallation Source, namely a magnetism diffractometer.

  12. [Nationwide implementation of stereotactic radiotherapy: the challenges of initial training and continuing professional education].

    PubMed

    Bibault, J-E; Denis, F; Marchesi, V; Lisbona, A; Noël, G; Mahé, M A

    2014-10-01

    Stereotactic body radiation therapy is a rapidly growing advanced treatment technique that delivers high radiation dose with great precision. The implementation of stereotactic body radiation therapy should be associated with a specific initial training and continuing professional education for radiation oncologists and medical physicists. The creation of a French stereotactic body radiation therapy group gathering radiation oncologists (SFRO and AFCOR) and medical physicists (SFPM) is mandatory in order to create dedicated national guidelines, prospective databases and to promote clinical trials in this field.

  13. The use of high field strength and parallel imaging techniques for MRI-based gel dosimetry in stereotactic radiosurgery

    NASA Astrophysics Data System (ADS)

    Seimenis, I.; Moutsatsos, A.; Petrokokkinos, L.; Kantemiris, I.; Benekos, O.; Efstathopoulos, E.; Papagiannis, P.; Spevacek, V.; Semnicka, J.; Dvorak, P.

    2009-07-01

    The poor clinical acceptance of polymer gel dosimetry for dose verification in stereotactic radio-surgery applications stems, inter alia, from the increased MRI acquisition times needed to meet the associated spatial resolution demands. To examine whether this could be partly alleviated by the employment of 3 Tesla imagers and parallel imaging techniques, a PolyAcrylamide Gel filled tube was irradiated in a Leksell Gamma Knife unit with two single irradiation shots (4 mm and 8 mm) and underwent four different scanning sessions using an optimised, volume selective, 32 echo CPMG pulse sequence: One performed on a 1.5 T imager with 0.5 × 0.5 mm2 in-plane spatial resolution and 0.75 mm slice thickness (scan A), while the rest three on a 3.0 T imager; one with the same spatial resolution as in scan A (scan B) and two with finer in-plane resolution (scans C and D). In scans B and C the sensitivity encoding (SENSE) parallel imaging technique was employed. Relative dose distributions derived by scan A were benchmarked against Monte Carlo and treatment planning system calculations, and then used as the reference for the comparison of 2D relative dose distributions derived by each scan in terms of dose difference and distance-to-agreement criteria (γ index tool). Findings suggest that careful MRI planning based on a figure of merit accounting for scanning time and precision for a given increase in spatial resolution, could facilitate the introduction of polymer gel dosimetry into the clinical setting as a practical quality assurance tool for complex radio-surgery techniques.

  14. Lifework Planning Guide: A Student Guide to High School Planning.

    ERIC Educational Resources Information Center

    Wisconsin State Dept. of Public Instruction, Madison.

    This document is designed to help Wisconsin eighth grade students, their parents, and their teachers plan an individualized course of study in high school that will help these students research their post-high school goals. The document begins by describing the process of lifework planning, which is intended to equip students with the research…

  15. Dynamics of laser-guided alternating current high voltage discharges

    NASA Astrophysics Data System (ADS)

    Daigle, J.-F.; Théberge, F.; Lassonde, P.; Kieffer, J.-C.; Fujii, T.; Fortin, J.; Châteauneuf, M.; Dubois, J.

    2013-10-01

    The dynamics of laser-guided alternating current high voltage discharges are characterized using a streak camera. Laser filaments were used to trigger and guide the discharges produced by a commercial Tesla coil. The streaking images revealed that the dynamics of the guided alternating current high voltage corona are different from that of a direct current source. The measured effective corona velocity and the absence of leader streamers confirmed that it evolves in a pure leader regime.

  16. Stereotactic surgery for eating disorders

    PubMed Central

    Sun, Bomin; Liu, Wei

    2013-01-01

    Eating disorders (EDs) are a group of severely impaired eating behaviors, which include three subgroups: anorexia nervosa (AN), bulimia nervosa (BN), and ED not otherwise specified (EDNOS). The precise mechanism of EDs is still unclear and the disorders cause remarkable agony for the patients and their families. Although there are many available treatment methods for EDs today, such as family therapy, cognitive behavioral therapy, medication, psychotherapy, and so on, almost half of the patients are refractory to all current medical treatment and never fully recover. For treatment-refractory EDs, stereotactic surgery may be an alternative therapy. This review discusses the history of stereotactic surgery, the modern procedures, and the mostly used targets of stereotactic surgery in EDs. In spite of the limited application of stereotactic surgery in ED nowadays, stereotactic lesion and deep brain stimulation (DBS) are promising treatments with the development of modern functional imaging techniques and the increasing understanding of its mechanism in the future. PMID:23682343

  17. Stereotactic surgery for eating disorders.

    PubMed

    Sun, Bomin; Liu, Wei

    2013-01-01

    EATING DISORDERS (EDS) ARE A GROUP OF SEVERELY IMPAIRED EATING BEHAVIORS, WHICH INCLUDE THREE SUBGROUPS: anorexia nervosa (AN), bulimia nervosa (BN), and ED not otherwise specified (EDNOS). The precise mechanism of EDs is still unclear and the disorders cause remarkable agony for the patients and their families. Although there are many available treatment methods for EDs today, such as family therapy, cognitive behavioral therapy, medication, psychotherapy, and so on, almost half of the patients are refractory to all current medical treatment and never fully recover. For treatment-refractory EDs, stereotactic surgery may be an alternative therapy. This review discusses the history of stereotactic surgery, the modern procedures, and the mostly used targets of stereotactic surgery in EDs. In spite of the limited application of stereotactic surgery in ED nowadays, stereotactic lesion and deep brain stimulation (DBS) are promising treatments with the development of modern functional imaging techniques and the increasing understanding of its mechanism in the future.

  18. Compression-refractory breast hematoma secondary to pseudoaneurysm after stereotactically guided vacuum-assisted biopsy: the critical role of urgent surgical evacuation.

    PubMed

    Sun, Simon; Hennessey, Hooman; Kam Nakch, Idris; Alsharif, Shaza; Meterissian, Sarkis; Mesurolle, Benoît

    2014-10-01

    We report the case of a patient who underwent a vacuum-assisted biopsy of amorphous clustered microcalcifications complicated by a large compression-refractory hematoma secondary to pseudoaneurysm formation. Breast sonography was used to identify an actively bleeding vessel and guide compression. However, due to its unresponsiveness to conventional management and rapid progression, the hematoma required surgical evacuation and ligation of the bleeding vessel. This suggests that, in the face of significant intractable bleeding, a heightened awareness of the possible need for surgical intervention should be maintained.

  19. Is robotic arm stereotactic body radiation therapy “virtual high dose ratebrachytherapy” for prostate cancer? An analysis of comparative effectiveness using published data [corrected].

    PubMed

    Zaorsky, Nicholas George; Hurwitz, Mark D; Dicker, Adam P; Showalter, Timothy N; Den, Robert B

    2015-05-01

    High-dose rate brachytherapy (HDR-BT) monotherapy and robotic arm (i.e., CyberKnife) stereotactic body radiation therapy (SBRT) are emerging technologies that have become popular treatment options for prostate cancer. Proponents of both HDR-BT monotherapy and robotic arm SBRT claim that these modalities are as efficacious as intensity-modulated radiation therapy in treating prostate cancer. Moreover, proponents of robotic arm SBRT believe it is more effective than HDR-BT monotherapy because SBRT is non-invasive, touting it as 'virtual HDR-BT.' We perform a comparative effective analysis of the two technologies. The tumor control rates and toxicities of HDR-BT monotherapy and robotic arm SBRT are promising. However, at present, it would be inappropriate to state that HDR-BT monotherapy and robotic arm SBRT are as efficacious or effective as other treatment modalities for prostate cancer, which have stronger foundations of evidence. Studies reporting on these technologies have relatively short follow-up time, few patients and are largely retrospective.

  20. Tomotherapy and stereotactic radiosurgery

    NASA Astrophysics Data System (ADS)

    Soisson, Emilie T.

    Currently, at the University of Wisconsin-Madison, a linear accelerator equipped with circular collimators and a floor stand is used for stereotactic radiosurgery (SRS) delivery. In the interest of providing a more efficient delivery option for patients with multiple brain metastases, a Tomotherapy-based radiosurgery program was developed to serve as an intensity modulated compliment to our existing delivery method. The unique advantage of Tomotherapy over other radiotherapy delivery units is the on board megavoltage CT that can be used for both stereotactic localization and treatment planning. As such, a workflow was designed in which the planning image is acquired on the treatment unit itself and, instead using a patient-frame based coordinate system for stereotactic localization, volumetric imaging is used to precisely locate the target at the time of treatment. Localization and delivery accuracy was found to be comparable to conventional approaches and well within stated tolerances. A Tomotherapy-specific treatment planning technique was also developed using the Tomotherapy treatment planning system that reliably produces plans that achieve both conformal target coverage and sufficiently steep dose falloff into surrounding normal brain. Tomotherapy plans have been compared to conventional circular collimator based plans for both the treatment of brain metastases and arteriovenous malformations in terms of both target conformity and dose to normal brain. To determine the effect of plan differences on patient outcome, clinical data was used to predict the resulting risk of treatment induced symptomatic brain necrosis for both conventional and Tomotherapy based plans. Overall, it was determined that plans generated using the described planning technique are acceptable for radiosurgery. In addition, delivery time for complex cases is comparable to or improved over conventional isocentric approaches. Finally, this work explores the impact of future product

  1. Stereotactic PET atlas of the human brain: Aid for visual interpretation of functional brain images

    SciTech Connect

    Minoshima, S.; Koeppe, R.A.; Frey, A.; Ishihara, M.; Kuhl, D.E.

    1994-06-01

    In the routine analysis of functional brain images obtained by PET, subjective visual interpretation is often used for anatomic localization. To enhance the accuracy and consistency of the anatomic interpretation, a PET stereotactic atlas and localization approach was designed for functional brain images. The PET atlas was constructed from a high-resolution [{sup 18}F]fluorodeoxyglucose (FDG) image set of a normal volunteer (a 41-yr-ld woman). The image set was reoriented stereotactically, according to the intercommissural (anterior and posterior commissures) line and transformed to the standard stereotactic atlas coordinates. Cerebral structures were annotated on the transaxial planes using a proportional grid system and surface-rendered images. The stereotactic localization technique was applied to image sets from patients with Alzheimer`s disease, and areas of functional alteration were localized visually by referring to the PET atlas. Major brain structures were identified on both transaxial planes and surface-rendered images. In the stereotactic system, anatomic correspondence between the PET atlas and stereotactically reoriented individual image sets of patients with Alzheimer`s disease facilitated both indirect and direct localization of the cerebral structures. Because rapid stereotactic alignment methods for PET images are now available for routine use, the PET atlas will serve as an aid for visual interpretation of functional brain images in the stereotactic system. Widespread application of stereotactic localization may be used in functional brain images, not only in the research setting, but also in routine clinical situations. 41 refs., 3 figs.

  2. High Performance Home Building Guide for Habitat for Humanity Affiliates

    SciTech Connect

    Lindsey Marburger

    2010-10-01

    This guide covers basic principles of high performance Habitat construction, steps to achieving high performance Habitat construction, resources to help improve building practices, materials, etc., and affiliate profiles and recommendations.

  3. Geometry, Senior High School Curriculum Guide.

    ERIC Educational Resources Information Center

    Klier, Katherine M., Ed.

    This syllabus presents a fused course in plane, solid, and coordinate geometry for secondary school students. Elementary set theory, logic, and the principles of separation provide unifying threads throughout this approach to geometry. There are actually two curriculum guides included; one for each of two different texts--Henderson, Pingry, and…

  4. Health, An Instructional Guide, Junior High School.

    ERIC Educational Resources Information Center

    Los Angeles City Schools, CA. Div. of Instructional Planning and Services.

    This teacher's guide was designed to be used with a one semester course required during the seventh grade to meet the graduation requirement for health instruction. Broad topics included are: growing and maturing; achieving personal health; food for growth and health; addicting, habit-forming, and other harmful substances; community health; and…

  5. Health Education Resource Guide, Junior High.

    ERIC Educational Resources Information Center

    Federal Way School District 210, WA.

    As part of a health education program for K-12, this curriculum guide for grade eight provides: (1) a short overview of health education; (2) a scope and sequence chart which lists specific topics to teach on mental health, physical health, community health, and safety that are appropriate at different grade levels; (3) a list of objectives; and…

  6. High-dose-rate Three-dimensional Conformal Radiotherapy Combined with Active Breathing Control for Stereotactic Body Radiotherapy of Early-stage Non-small-cell Lung Cancer.

    PubMed

    Wang, Ruozheng; Yin, Yong; Qin, Yonghui; Yu, Jinming

    2015-12-01

    The purpose of this study was to evaluate the feasibility and benefits of using high-dose-rate three-dimensional conformal radiotherapy (3D-CRT) combined with active breathing control (ABC) for stereotactic body radiotherapy (SBRT) of patients with early-stage non-small-cell lung cancer (NSCLC). Eight patients with early-stage NSCLC underwent CT scans under standard free-breathing (FB) and moderately deep inspiration breath-hold (mDIBH) with ABC. Two high-dose-rate 3D-CRT plans (1000 Mu/min) were designed based on the CT scans with FB and mDIBH. The maximal dose (D1%), minimal dose (D99%), conformity index (CI), and homogeneity index (HI) of the planning target volume (PTV), and dose-volume indices of the organs at risk between each plan were compared. The mean PTV volume decreased from 158.04 cm(3) with FB to 76.90 cm(3) with mDIBH (p < 0.05). When mDIBH was used, increases in the affected lung volume (by 47%), contralateral lung volume (by 55%), and total lung volume (by 50%) were observed compared to FB (p < 0.05). The V5-V40 of the affected lung (Vx represented the percentage volume of organs receiving at least the x Gy), V5-V40 and the mean dose for the total lung, V5-V40 and mean dose of the chest wall, and the maximum dose of the spinal cord were less for mDIBH than FB (p < 0.05). There were no significant differences in CI, HI, D1%, or D99% for the PTV between the plans. In conclusion, high-dose-rate 3D-CRT combined with ABC reduced the radiation dose to the lungs and chest wall without affecting the dose distribution in SBRT of early-stage NSCLC patients.

  7. A pilot study of intensity modulated radiation therapy with hypofractionated stereotactic body radiation therapy (SBRT) boost in the treatment of intermediate- to high-risk prostate cancer.

    PubMed

    Oermann, Eric K; Slack, Rebecca S; Hanscom, Heather N; Lei, Sue; Suy, Simeng; Park, Hyeon U; Kim, Joy S; Sherer, Benjamin A; Collins, Brian T; Satinsky, Andrew N; Harter, K William; Batipps, Gerald P; Constantinople, Nicholas L; Dejter, Stephen W; Maxted, William C; Regan, James B; Pahira, John J; McGeagh, Kevin G; Jha, Reena C; Dawson, Nancy A; Dritschilo, Anatoly; Lynch, John H; Collins, Sean P

    2010-10-01

    Clinical data suggest that large radiation fractions are biologically superior to smaller fraction sizes in prostate cancer radiotherapy. The CyberKnife is an appealing delivery system for hypofractionated radiosurgery due to its ability to deliver highly conformal radiation and to track and adjust for prostate motion in real-time. We report our early experience using the CyberKnife to deliver a hypofractionated stereotactic body radiation therapy (SBRT) boost to patients with intermediate- to high-risk prostate cancer. Twenty-four patients were treated with hypofractionated SBRT and supplemental external radiation therapy plus or minus androgen deprivation therapy (ADT). Patients were treated with SBRT to a dose of 19.5 Gy in 3 fractions followed by intensity modulated radiation therapy (IMRT) to a dose of 50.4 Gy in 28 fractions. Quality of life data were collected with American Urological Association (AUA) symptom score and Expanded Prostate Cancer Index Composite (EPIC) questionnaires before and after treatment. PSA responses were monitored; acute urinary and rectal toxicities were assessed using Common Toxicity Criteria (CTC) v3. All 24 patients completed the planned treatment with an average follow-up of 9.3 months. For patients who did not receive ADT, the median pre-treatment PSA was 10.6 ng/ml and decreased in all patients to a median of 1.5 ng/ml by 6 months post-treatment. Acute effects associated with treatment included Grade 2 urinary and gastrointestinal toxicity but no patient experienced acute Grade 3 or greater toxicity. AUA and EPIC scores returned to baseline by six months post-treatment. Hypofractionated SBRT combined with IMRT offers radiobiological benefits of a large fraction boost for dose escalation and is a well tolerated treatment option for men with intermediate- to high-risk prostate cancer. Early results are encouraging with biochemical response and acceptable toxicity. These data provide a basis for the design of a phase II clinical

  8. Failure Mode and Effect Analysis for Delivery of Lung Stereotactic Body Radiation Therapy

    SciTech Connect

    Perks, Julian R.; Stanic, Sinisa; Stern, Robin L.; Henk, Barbara; Nelson, Marsha S.; Harse, Rick D.; Mathai, Mathew; Purdy, James A.; Valicenti, Richard K.; Siefkin, Allan D.; Chen, Allen M.

    2012-07-15

    Purpose: To improve the quality and safety of our practice of stereotactic body radiation therapy (SBRT), we analyzed the process following the failure mode and effects analysis (FMEA) method. Methods: The FMEA was performed by a multidisciplinary team. For each step in the SBRT delivery process, a potential failure occurrence was derived and three factors were assessed: the probability of each occurrence, the severity if the event occurs, and the probability of detection by the treatment team. A rank of 1 to 10 was assigned to each factor, and then the multiplied ranks yielded the relative risks (risk priority numbers). The failure modes with the highest risk priority numbers were then considered to implement process improvement measures. Results: A total of 28 occurrences were derived, of which nine events scored with significantly high risk priority numbers. The risk priority numbers of the highest ranked events ranged from 20 to 80. These included transcription errors of the stereotactic coordinates and machine failures. Conclusion: Several areas of our SBRT delivery were reconsidered in terms of process improvement, and safety measures, including treatment checklists and a surgical time-out, were added for our practice of gantry-based image-guided SBRT. This study serves as a guide for other users of SBRT to perform FMEA of their own practice.

  9. Dosimetry analyses comparing high-dose-rate brachytherapy, administered as monotherapy for localized prostate cancer, with stereotactic body radiation therapy simulated using CyberKnife.

    PubMed

    Fukuda, Shoichi; Seo, Yuji; Shiomi, Hiroya; Yamada, Yuji; Ogata, Toshiyuki; Morimoto, Masahiro; Konishi, Koji; Yoshioka, Yasuo; Ogawa, Kazuhiko

    2014-11-01

    The purpose of this study was to perform dosimetry analyses comparing high-dose-rate brachytherapy (HDR-BT) with simulated stereotactic body radiotherapy (SBRT). We selected six consecutive patients treated with HDR-BT monotherapy in 2010, and a CyberKnife SBRT plan was simulated for each patient using computed tomography images and the contouring set used in the HDR-BT plan for the actual treatment, but adding appropriate planning target volume (PTV) margins for SBRT. Then, dosimetric profiles for PTVs of the rectum, bladder and urethra were compared between the two modalities. The SBRT plan was more homogenous and provided lower dose concentration but better coverage for the PTV. The maximum doses in the rectum were higher in the HDR-BT plans. However, the HDR-BT plan provided a sharper dose fall-off around the PTV, resulting in a significant and considerable difference in volume sparing of the rectum with the appropriate PTV margins added for SBRT. While the rectum D5cm(3) for HDR-BT and SBRT was 30.7 and 38.3 Gy (P < 0.01) and V40 was 16.3 and 20.8 cm(3) (P < 0.01), respectively, SBRT was significantly superior in almost all dosimetric profiles for the bladder and urethra. These results suggest that SBRT as an alternative to HDR-BT in hypofractionated radiotherapy for prostate cancer might have an advantage for bladder and urethra dose sparing, but for the rectum only when proper PTV margins for SBRT are adopted.

  10. Dosimetry analyses comparing high-dose-rate brachytherapy, administered as monotherapy for localized prostate cancer, with stereotactic body radiation therapy simulated using CyberKnife

    PubMed Central

    Fukuda, Shoichi; Seo, Yuji; Shiomi, Hiroya; Yamada, Yuji; Ogata, Toshiyuki; Morimoto, Masahiro; Konishi, Koji; Yoshioka, Yasuo; Ogawa, Kazuhiko

    2014-01-01

    The purpose of this study was to perform dosimetry analyses comparing high-dose-rate brachytherapy (HDR-BT) with simulated stereotactic body radiotherapy (SBRT). We selected six consecutive patients treated with HDR-BT monotherapy in 2010, and a CyberKnife SBRT plan was simulated for each patient using computed tomography images and the contouring set used in the HDR-BT plan for the actual treatment, but adding appropriate planning target volume (PTV) margins for SBRT. Then, dosimetric profiles for PTVs of the rectum, bladder and urethra were compared between the two modalities. The SBRT plan was more homogenous and provided lower dose concentration but better coverage for the PTV. The maximum doses in the rectum were higher in the HDR-BT plans. However, the HDR-BT plan provided a sharper dose fall-off around the PTV, resulting in a significant and considerable difference in volume sparing of the rectum with the appropriate PTV margins added for SBRT. While the rectum D5cm3 for HDR-BT and SBRT was 30.7 and 38.3 Gy (P < 0.01) and V40 was 16.3 and 20.8 cm3 (P < 0.01), respectively, SBRT was significantly superior in almost all dosimetric profiles for the bladder and urethra. These results suggest that SBRT as an alternative to HDR-BT in hypofractionated radiotherapy for prostate cancer might have an advantage for bladder and urethra dose sparing, but for the rectum only when proper PTV margins for SBRT are adopted. PMID:24957754

  11. A high-performance wave guide cryogenic thermal break.

    PubMed

    Melhuish, S J; McCulloch, M A; Piccirillo, L; Stott, C

    2016-10-01

    We describe a high-performance wave guide cryogenic thermal break. This has been constructed both for Ka band, using WR28 wave guide, and Q band, using WR22 wave guide. The mechanical structure consists of a hexapod (Stewart platform) made from pultruded carbon fibre tubing. We present a tentative examination of the cryogenic Young's modulus of this material. The thermal conductivity is measured at temperatures above the range explored by Runyan and Jones, resulting in predicted conductive loads through our thermal breaks of 3.7 mW to 3 K and 17 μK to 1 K.

  12. A high-performance wave guide cryogenic thermal break

    NASA Astrophysics Data System (ADS)

    Melhuish, S. J.; McCulloch, M. A.; Piccirillo, L.; Stott, C.

    2016-10-01

    We describe a high-performance wave guide cryogenic thermal break. This has been constructed both for Ka band, using WR28 wave guide, and Q band, using WR22 wave guide. The mechanical structure consists of a hexapod (Stewart platform) made from pultruded carbon fibre tubing. We present a tentative examination of the cryogenic Young's modulus of this material. The thermal conductivity is measured at temperatures above the range explored by Runyan and Jones, resulting in predicted conductive loads through our thermal breaks of 3.7 mW to 3 K and 17 μK to 1 K.

  13. Stereotactic radiosurgery: comparing different technologies

    PubMed Central

    Schwartz, M

    1998-01-01

    Radiosurgery can be defined as 3-dimensional stereotactic irradiation of small intracranial targets by various radiation techniques. The goal is to deliver, with great accuracy, a large, single fraction dose to a small intracranial target, while minimizing the absorbed dose in the surrounding tissue. This article describes certain technical aspects of radiosurgery and compares the different methods of performing such treatment. The 2 most frequently used types of devices for radiosurgery are units with multiple cobalt sources (e.g., the Gamma Knife) and those based on a linear accelerator. In the former, highly collimated beams of radiation from the cobalt sources intersect at the target. In the latter, the source of a highly collimated beam of high-energy photons directed at the target turns through an arc or set of arcs. The accuracy of target localization, the steepness of fall-off of the radiation dose outside the target and the ability to irradiate an irregularly shaped target are all comparable for these 2 types of devices, despite claims to the contrary. PMID:9526480

  14. [Stereotactic radiosurgery and radiotherapy for brain metastases].

    PubMed

    Tanguy, Ronan; Métellus, Philippe; Mornex, Françoise; Mazeron, Jean-Jacques

    2013-01-01

    Brain metastases management is still controversial even though many trials are trying to define the respective roles of neurosurgery, whole-brain radiotherapy, single-dose stereotactic radiotherapy and fractionated stereotactic radiotherapy. In this article, we review data from trials that examine the role of radiosurgery and fractionated stereotactic radiotherapy in the management of brain metastases.

  15. High voltage design guide. Volume 4: Aircraft

    NASA Astrophysics Data System (ADS)

    Dunbar, W. G.

    1983-01-01

    This report supplies the theoretical background and design techniques needed by an engineer who is designing electrical insulation for high-voltage, high-power components, equipment, and systems for aircraft. A literature survey and abundant bibliography identify references that provide further data on the subjects of partial discharges, corona, field theory and plotting, voids and processes for applying insulation. Both gaseous and solid insulations are treated. Cryogenic and liquid design notes are included. Tests and test equipment for high voltage insulation and equipment are defined. Requirements of test plans and procedures for high-voltage, high-power equipment are identified and illustrated by examples. Suggestions for high-voltage specifications are provided. Very few of the Military and Government specifications deal with system voltages above 10kV, thus most aircraft high-voltage specifications will have to be derived from the power industry specifications and standards produced by ASTM, IEEE, and NEMA.

  16. SU-E-T-620: Dosimetric Compliance Study for a New Prostate Protocol of Combined High Dose Rate Brachytherapy and Stereotactic Body Radiotherapy

    SciTech Connect

    Peng, C; Giaddui, T; Den, R; Harrison, A; Yu, Y

    2014-06-15

    Purpose: To investigate the adherence of treatment plans of prostate cancer patients with the dosimetric compliance criteria of the new in house phase I trial of high dose rate (HDR) brachytherapy combined with stereotactic body radiotherapy (SBRT) for intermediate risk prostate cancer patients. Methods: Ten prostate cancer patients were treated using this trial. They received one fraction of HDR to 15Gy, followed by external beam(EB) boost of 3.2Gy(Level 1, five patients) or 3.94Gy(level 2, five patients) per fraction for 10 or 7 fractions, respectively, both equivalent to EB treatments of 113.5Gy in 2Gy fractions. The EB plans were either IMRT or VMAT plans. DVH analysis was performed to verify the adherence of treatment plans to the dosimetric criteria of the trial. Results: For Level 1 patients, target coverage were adequate, with CTV V32Gy(%) of 99.0±1.0 (mean ± 1 standard deviation), and PTV V31Gy(%) of 99.6±0.3. PTV V32.9Gy(%) is 1.4±3.1 and PTVmax is 32.9±0.2Gy. Rectum, bladder and femoral heads sparing were well within protocol criteria. For Level 2 patients, CTV V27.6Gy(%) is 98.7±1.8; PTV V26.7Gy(%) is 99.0±1.4. PTV V28.4Gy(%) is 1.3±1.4, with three patients having minor deviation from protocol. Again critical structures were spared compliant to the protocol. The analysis of HDR plans show similar results, with adequate dose coverage to the prostate and sparing of critical structures including urethra and rectum. V100(%) and V90(%) of prostate are 96.0±1.1 and 98.9±0.5. Urethra D10(%) is 113.1±2.9. Rectum V80(cc) is 1.4±0.5. Hotspot in prostate is substantially higher than what the protocol specifies. But the criteria for hotspot are only guidelines, serving to lower the dose to urethra . Conclusion: This new high biological equivalent dose prostate trial has been carried out successfully for ten patients. Based on dosimetric analysis, all HDR and external plans were compliant to the protocol criteria, with only minor deviations.

  17. A Teacher's Guide to Folksinging. A Curriculum Guide for a High School Elective in Music Education.

    ERIC Educational Resources Information Center

    New York State Education Dept., Albany. Bureau of Secondary Curriculum Development.

    The material in this teacher's guide for a high school elective course may be used in a variety of curriculum designs--from a mini elective to a full year course. The rationale section explains that folksinging can be a valuable activity in the classroom by: 1) presenting a mirror for the student's personality and by being a useful tool for…

  18. Making Sense of Integrated Science: A Guide for High Schools.

    ERIC Educational Resources Information Center

    Biological Sciences Curriculum Study, Colorado Springs.

    This guide outlines the initial work and includes recommendations for schools and districts on how to implement an integrated science program. Chapters include: (1) "What Is Integrated Science and What Does It Look Like at the High School Level?"; (2) "Coherence in High School Science" (F. James Rutherford); (3) "Thinking about Change: What Will…

  19. The Black Student's Guide to High School Success.

    ERIC Educational Resources Information Center

    Ekeler, William J., Ed.

    The selections in this book offer advice on how to get the most out of a high school education by making intelligent and informed decisions in and out of the classroom. The guide features 15 essays geared to the student, each written by a professional or educator. Each is followed by a short essay by a black high school student about his or her…

  20. Guide to NYC Small High Schools, 2005-2006

    ERIC Educational Resources Information Center

    New Visions for Public Schools, 2005

    2005-01-01

    New Visions for Public Schools has put together "The New York City Guide to Small High Schools" to describe new opportunities in the public high school system: over 200 small secondary schools created over the last five years. These small schools are part of the Department of Education's efforts to create more choices for thousands of…

  1. High Voltage Design Guide. Volume V. Spacecraft

    DTIC Science & Technology

    1983-01-01

    4. W. G. Dunbar, "Skylab High Voltage Systems Corona Assessment", 1 th Electrical/Electronics Insulation Conference, Chicago, Illinois, 1973. 5. 3. F ...and Composition of Interplanetary Dust Particles", Earth Planet, Sci. Lett. 30, pp 234, 1976. 13. D. K. Heier, "Brush/Slip Ring Selection for High...mai. a FEIINrS CATALOG NUMBER - F dAL-TR-82-2057 Volume V _____________ 4. TITLE (mnd S. kettle) U TYPE OF REPORT S, PERIOD COVERED High Voltage Design

  2. Pelvic Nodal Dosing With Registration to the Prostate: Implications for High-Risk Prostate Cancer Patients Receiving Stereotactic Body Radiation Therapy

    SciTech Connect

    Kishan, Amar U. Lamb, James M.; Jani, Shyam S.; Kang, Jung J.; Steinberg, Michael L.; King, Christopher R.

    2015-03-15

    Purpose: To determine whether image guidance with rigid registration (RR) to intraprostatic markers (IPMs) yields acceptable coverage of the pelvic lymph nodes in the context of a stereotactic body radiation therapy (SBRT) regimen. Methods and Materials: Four to seven kilovoltage cone-beam CTs (CBCTs) from 12 patients with high-risk prostate cancer were analyzed, allowing approximation of an SBRT regimen. The nodal clinical target volume (CTV{sub N}) and bladder were contoured on all kilovoltage CBCTs. The V{sub 100} CTV{sub N}, expressed as a ratio to the same parameter on the initial plan, and the magnitude of translational shift between RR to the IPMs versus RR to the pelvic bones, were computed. The ability of a multimodality bladder filling protocol to minimize bladder height variation was assessed in a separate cohort of 4 patients. Results: Sixty-five CBCTs were assessed. The average V{sub 100} CTV{sub N} was 92.6%, but for a subset of 3 patients the average was 80.0%, compared with 97.8% for the others (P<.0001). The average overall and superior–inferior axis magnitudes of the bony-to-fiducial translations were significantly larger in the subgroup with suboptimal nodal coverage (8.1 vs 3.9 mm and 5.8 vs 2.4 mm, respectively; P<.0001). Relative bladder height changes were also significantly larger in the subgroup with suboptimal nodal coverage (42.9% vs 18.5%; P<.05). Use of a multimodality bladder-filling protocol minimized bladder height variation (P<.001). Conclusion: A majority of patients had acceptable nodal coverage after RR to IPMs, even when approximating SBRT. However, a subset of patients had suboptimal nodal coverage. These patients had large bony-to-fiducial translations and large variations in bladder height. Nodal coverage should be excellent if the superior–inferior axis bony-to-fiducial translation and the relative bladder height change (both easily measured on CBCT) are kept to a minimum. Implementation of a strict bladder filling

  3. A Phase II Study of Stereotactic Body Radiation Therapy for Low-Intermediate-High-Risk Prostate Cancer Using Helical Tomotherapy: Dose-Volumetric Parameters Predicting Early Toxicity

    PubMed Central

    Macias, Victor A.; Blanco, Manuel L.; Barrera, Inmaculada; Garcia, Rafael

    2014-01-01

    Endpoint: To assess early urinary (GU) and rectal (GI) toxicities after helical tomotherapy Stereotactic body radiation therapy (SBRT), and to determine their predictive factors. Methods: Since May 2012, 45 prostate cancer patients were treated with eight fractions of 5.48 (low risk, 29%) or 5.65 Gy (intermediate-high risk, 71%) on alternative days over 2.5 weeks. The exclusion criteria were Gleason score 9–10, PSA >40 ng/mL, cT3b-4, IPSS ≥20, and history of acute urinary retention. During the follow-up, a set of potential prognostic factors was correlated with urinary or rectal toxicity. Results: The median follow-up was 13.8 months (2–25 months). There were no grade ≥3 toxicities. Acute grade 2 GU complications were found in a 22.7% of men, but in 2.3% of patients at 1 month, 0% at 6 months, and 0% at 12 months. The correspondent figures for grade 2 GI toxicities were 20.4% (acute), 2.3% (1 month), 3.6% (6 months), and 5% (12 months). Acute GI toxicity was significantly correlated with the rectal volume (>15 cm3) receiving 28 Gy, only when expressed as absolute volume. The age (>72 years old) was a predictor of GI toxicity after 1 month of treatment. No correlation was found, however, between urinary toxicity and the other analyzed variables. IPSS increased significantly at the time of the last fraction and within the first month, returning to the baseline at sixth month. Urinary-related quality of life (IPSS question 8 score), it was not significantly worsen during radiotherapy returning to the baseline levels 1 month after the treatment. At 12 months follow-up patient’s perception of their urinary function improved significantly in comparison with the baseline. Conclusion: Our scheme of eight fractions on alternative days delivered using helical tomotherapy is well tolerated. We recommend using actual volume instead of percentual volume in the treatment planning, and not to exceed 15 cm3 of rectal volume receiving

  4. High-efficiency backlight module with two guiding modes.

    PubMed

    Li, Chang-Yi; Pan, Jui-Wen

    2014-03-10

    We propose a design for a high-efficiency backlight module that does not require a brightness enhancement film (BEF). With the high-efficiency backlight module it is possible to achieve almost the same half-luminance angle as a conventional edge-lit backlight module can achieve. The backlight system is comprised of a crisscross light guide plate (LGP) and one diffuser sheet. The crisscross LGP is composed of a LGP and optically patterned film (OPF). The backlight module allows light to be extracted through the direct guiding mode and top guiding mode, respectively. We controlled arrangement of the microstructures to increase the optical efficiency and the uniformity by two modes. Compared to the conventional edge-lit backlight module, there is a two-fold improvement in both the total optical efficiency and on-axis luminance with the high-efficiency backlight module.

  5. High Voltage Design Guide for Airborne Equipment

    DTIC Science & Technology

    1976-06-01

    500 380 210 140 50 800 770 530 500 360 210 140 85 780 670 530 480 360 220 140 125 870 630 560 520 350 220 140 114 4.1.2 High Voltage Cable. At high...radioactive source of ionizing radiation such as polonium sHould be placed near the equipment under test in the altitude chamber to insure a supply of...electrons in the critical gap volumcs. Polonium is recommenoed because it’is not as hard to handle as other gari~na sources like cobalt 60. 6.1

  6. A novel, integrated PET-guided MRS technique resulting in more accurate initial diagnosis of high-grade glioma.

    PubMed

    Kim, Ellen S; Satter, Martin; Reed, Marilyn; Fadell, Ronald; Kardan, Arash

    2016-06-01

    Glioblastoma multiforme (GBM) is the most common and lethal malignant glioma in adults. Currently, the modality of choice for diagnosing brain tumor is high-resolution magnetic resonance imaging (MRI) with contrast, which provides anatomic detail and localization. Studies have demonstrated, however, that MRI may have limited utility in delineating the full tumor extent precisely. Studies suggest that MR spectroscopy (MRS) can also be used to distinguish high-grade from low-grade gliomas. However, due to operator dependent variables and the heterogeneous nature of gliomas, the potential for error in diagnostic accuracy with MRS is a concern. Positron emission tomography (PET) imaging with (11)C-methionine (MET) and (18)F-fluorodeoxyglucose (FDG) has been shown to add additional information with respect to tumor grade, extent, and prognosis based on the premise of biochemical changes preceding anatomic changes. Combined PET/MRS is a technique that integrates information from PET in guiding the location for the most accurate metabolic characterization of a lesion via MRS. We describe a case of glioblastoma multiforme in which MRS was initially non-diagnostic for malignancy, but when MRS was repeated with PET guidance, demonstrated elevated choline/N-acetylaspartate (Cho/NAA) ratio in the right parietal mass consistent with a high-grade malignancy. Stereotactic biopsy, followed by PET image-guided resection, confirmed the diagnosis of grade IV GBM. To our knowledge, this is the first reported case of an integrated PET/MRS technique for the voxel placement of MRS. Our findings suggest that integrated PET/MRS may potentially improve diagnostic accuracy in high-grade gliomas.

  7. Intracranial stereotactic radiosurgery: concepts and techniques.

    PubMed

    De Salles, Antonio A F; Gorgulho, Alessandra A; Pereira, Julio L B; McLaughlin, Nancy

    2013-10-01

    Stereotactic radiosurgery was conceptualized to treat functional diseases of the brain. The need for devices capable of molding the radiation dose to the nuances of intracranial lesions and yet preserve brain function became a challenge. Several devices capable of performing radiosurgery of high quality became commercially available, each with advantages and disadvantages. Speed of radiosurgery delivery for cost effectiveness and comfort for the patient are currently the main developments in the field. Nuances of these devices, procedural steps of radiosurgery, and the team approach of radiosurgery are discussed in this article.

  8. High School Law Awareness Curriculum Guide, 1980.

    ERIC Educational Resources Information Center

    Seminole County Board of Public Instruction, Sanford, FL.

    Instructional materials, activities, and lesson plans used to teach high school students about the law, the legal process, and the legal system are presented. The materials are intended to be incorporated into the U.S. history curriculum. The following topics are covered: procedure for trial simulation; the Boston Massacre; the debate over…

  9. High Temperature Calibration Furnace System user's guide

    NASA Technical Reports Server (NTRS)

    1994-01-01

    The High Temperature Calibration Furnace System (HTCFS) was developed by Summitec Corporation. It is a high precision instrument providing a constant temperature which can be used to calibrate high temperature thermocouples. Incorporating the many recent technological advances from the fields of optical fiber thermometry, material science, computer systems interfacing, and process control, the engineers at Summitec Corporation have been able to create a system that can reach a steady operating temperature of 1700 C. The precision for the system requires the measurement of temperature to be within 1 C in two hours and within 2 C in 24 hours. As documented, the experimental result shows that this system has been able to stay within .5 C in 5 hours. No other systems commercially available have been able to achieve such high temperature precision. This manual provides an overview of the system design, instructions for instrument setup, and operation procedures. Also included are a vendor list and the source codes for the custom-designed software.

  10. Design guide for high pressure oxygen systems

    NASA Technical Reports Server (NTRS)

    Bond, A. C.; Pohl, H. O.; Chaffee, N. H.; Guy, W. W.; Allton, C. S.; Johnston, R. L.; Castner, W. L.; Stradling, J. S.

    1983-01-01

    A repository for critical and important detailed design data and information, hitherto unpublished, along with significant data on oxygen reactivity phenomena with metallic and nonmetallic materials in moderate to very high pressure environments is documented. This data and information provide a ready and easy to use reference for the guidance of designers of propulsion, power, and life support systems for use in space flight. The document is also applicable to designs for industrial and civilian uses of high pressure oxygen systems. The information presented herein are derived from data and design practices involving oxygen usage at pressures ranging from about 20 psia to 8000 psia equal with thermal conditions ranging from room temperatures up to 500 F.

  11. High Frequency Guided Wave Virtual Array SAFT

    NASA Astrophysics Data System (ADS)

    Roberts, R.; Pardini, A.; Diaz, A.

    2003-03-01

    The principles of the synthetic aperture focusing technique (SAFT) are generalized for application to high frequency plate wave signals. It is shown that a flaw signal received in long-range plate wave propagation can be analyzed as if the signals were measured by an infinite array of transducers in an unbounded medium. It is shown that SAFT-based flaw sizing can be performed with as few as three or less actual measurement positions.

  12. Measurement of Total Scatter Factor for Stereotactic Cones with Plastic Scintillation Detector

    PubMed Central

    Chaudhari, Suresh H; Dobhal, Rishabh; Kinhikar, Rajesh A.; Kadam, Sudarshan S.; Deshpande, Deepak D.

    2017-01-01

    Advanced radiotherapy modalities such as stereotactic radiosurgery (SRS) and image-guided radiotherapy may employ very small beam apertures for accurate localized high dose to target. Accurate measurement of small radiation fields is a well-known challenge for many dosimeters. The purpose of this study was to measure total scatter factors for stereotactic cones with plastic scintillation detector and its comparison against diode detector and theoretical estimates. Measurements were performed on Novalis Tx™ linear accelerator for 6MV SRS beam with stereotactic cones of diameter 6 mm, 7.5 mm, 10 mm, 12.5 mm, and 15 mm. The advantage of plastic scintillator detector is in its energy dependence. The total scatter factor was measured in water at the depth of dose maximum. Total scatter factor with plastic scintillation detector was determined by normalizing the readings to field size of 10 cm × 10 cm. To overcome energy dependence of diode detector for the determination of scatter factor with diode detector, daisy chaining method was used. The plastic scintillator detector was calibrated against the ionization chamber, and the reproducibility in the measured doses was found to be within ± 1%. Total scatter factor measured with plastic scintillation detector was 0.728 ± 0.3, 0.783 ± 0.05, 0.866 ± 0.55, 0.885 ± 0.5, and 0.910 ± 0.06 for cone sizes of 6 mm, 7.5 mm, 10 mm, 12.5 mm, and 15 mm, respectively. Total scatter factor measured with diode detector was 0.733 ± 0.03, 0.782 ± 0.02, 0.834 ± 0.07, 0.854 ± 0.02, and 0.872 ± 0.02 for cone sizes of 6 mm, 7.5 mm, 10 mm, 12.5 mm, and 15 mm, respectively. The variation in the measurement of total scatter factor with published Monte Carlo data was found to be −1.3%, 1.9%, −0.4%, and 0.4% for cone sizes of 7.5 mm, 10 mm, 12.5 mm, and 15 mm, respectively. We conclude that total scatter factor measurements for stereotactic cones can be adequately carried out with a plastic scintillation detector. Our results show

  13. Patient specific quality control for Stereotactic Ablative Body Radiotherapy (SABR): it takes more than one phantom

    NASA Astrophysics Data System (ADS)

    Kron, T.; Ungureanu, E.; Antony, R.; Hardcastle, N.; Clements, N.; Ukath, J.; Fox, C.; Lonski, P.; Wanigaratne, D.; Haworth, A.

    2017-01-01

    Stereotactic Ablative Body Radiotherapy (SABR) is an extension of the concepts of Stereotactic Radiosurgery from intracranial procedures to extracranial targets. This brings with it new technological challenges for set-up of a SABR program and continuing quality assurance. Compared with intracranial procedures SABR requires consideration of motion and inhomogeneities and has to deal with a much larger variety of targets ranging from lung to liver, kidney and bone. To meet many of the challenges virtually all advances in modern radiotherapy, such as Intensity Modulated and Image Guided Radiation Therapy (IMRT and IGRT) are used. Considering the few fractions and high doses per fraction delivered to complex targets it is not surprising that patient specific quality control is considered essential for safe delivery. Given the variety of targets and clinical scenarios we employ different strategies for different patients to ensure that the most important aspects of the treatment are appropriately tested, be it steep dose gradients, inhomogeneities or the delivery of dose in the presence of motion. The current paper reviews the different approaches and phantoms utilised at Peter MacCallum Cancer Centre for SABR QA.

  14. A current perspective on stereotactic body radiation therapy for pancreatic cancer

    PubMed Central

    Hong, Julian C; Czito, Brian G; Willett, Christopher G; Palta, Manisha

    2016-01-01

    Pancreatic cancer is a formidable malignancy with poor outcomes. The majority of patients are unable to undergo resection, which remains the only potentially curative treatment option. The management of locally advanced (unresectable) pancreatic cancer is controversial; however, treatment with either chemotherapy or chemoradiation is associated with high rates of local tumor progression and metastases development, resulting in low survival rates. An emerging local modality is stereotactic body radiation therapy (SBRT), which uses image-guided, conformal, high-dose radiation. SBRT has demonstrated promising local control rates and resultant quality of life with acceptable rates of toxicity. Over the past decade, increasing clinical experience and data have supported SBRT as a local treatment modality. Nevertheless, additional research is required to further evaluate the role of SBRT and improve upon the persistently poor outcomes associated with pancreatic cancer. This review discusses the existing clinical experience and technical implementation of SBRT for pancreatic cancer and highlights the directions for ongoing and future studies. PMID:27826200

  15. Inglemoor High School Curriculum Guide for Outdoor Recreation & Outdoor Education.

    ERIC Educational Resources Information Center

    Kline, Jim

    Descriptions of 12-week courses in hunting and fishing and in outdoor activities for male and female students at Inglemoor High School in Bothell, Washington, are presented in this curriculum guide for outdoor education and recreation. Offering both classroom and field experience, each of the two courses meets 55 minutes daily; recommended class…

  16. The Estuary Guide. Level 3: High School. Draft.

    ERIC Educational Resources Information Center

    Alexander, Glen; And Others

    Estuaries are marine systems that serve as nurseries for animals, links in the migratory pathways, and habitat for a complex community of organisms. This curriculum guide intended for use at the high school level seeks to teach what estuaries are; provide opportunities to practice decision-making that affects estuaries; and encourage students to…

  17. Teachers Guide to Social Studies in the Senior High School.

    ERIC Educational Resources Information Center

    Cason, Constance; And Others

    This guide to the social studies was developed for use in the senior high schools of Duval County, Jacksonville, Florida. Topics covered are United States government, United States history, anthropology, bible history, comparative institutions, European history, Florida history, human relations, political science, economics, psychology, sociology,…

  18. Heads Up: Concussion in High School Sports. Guide for Coaches

    ERIC Educational Resources Information Center

    Centers for Disease Control and Prevention, 2005

    2005-01-01

    This guide provides general information to high school sports coaches about concussions. It focuses on the fact that coaches can play a key role in preventing concussions and managing them properly when they occur. The following sections are included: (1) The Facts; (2) Signs and Symptoms; (3) Prevention and Preparation; (4) When a Concussion…

  19. Law and the Family: A High School Curriculum Guide.

    ERIC Educational Resources Information Center

    Khanlian, John F., Ed.; And Others

    This curriculum guide is designed to assist high school classroom teachers in developing and implementing a program on family law. The major objective of the document is to help students understand how profoundly the law is associated with their private lives. The document is presented in four chapters. Key areas in this frequently ignored area of…

  20. Investigating Safely: A Guide for High School Teachers

    ERIC Educational Resources Information Center

    Texley, Juliana; Kwan, Terry; Summers, John

    2004-01-01

    Just as high school science is more complex than it is at lower grade levels, so are the safety issues teachers face in their classes and labs. Reduce the risks to people and place with Investigating Safely, the third and most advanced and detailed volume in NSTA's unique series of safety guidebooks for science teachers. Some of the guides 11…

  1. A Curriculum Guide for Teaching the Educable Mentally Retarded: Elementary - Junior High - High School.

    ERIC Educational Resources Information Center

    Bailey, Carol D.; And Others

    The curriculum guide suggests ideas, activities, procedures, and materials for teaching the educable mentally retarded at the elementary, junior high, and high school levels. For the elementary level, the guide covers the areas of maturational skills and concepts and social skills, reading, writing, spelling, arithmetic, social relationships (life…

  2. Cranial Stereotactic Radiosurgery: Current Status of the Initial Paradigm Shifter

    PubMed Central

    Sheehan, Jason P.; Yen, Chun-Po; Lee, Cheng-Chia; Loeffler, Jay S.

    2014-01-01

    The concept of stereotactic radiosurgery (SRS) was first described by Lars Leksell in 1951. It was proposed as a noninvasive alternative to open neurosurgical approaches to manage a variety of conditions. In the following decades, SRS emerged as a unique discipline involving a collegial partnership among neurosurgeons, radiation oncologists, and medical physicists. SRS relies on the precisely guided delivery of high-dose ionizing radiation to an intracranial target. The focused convergence of multiple beams yields a potent therapeutic effect on the target and a steep dose fall-off to surrounding structures, thereby minimizing the risk of collateral damage. SRS is typically administered in a single session but can be given in as many as five sessions or fractions. By providing an ablative effect noninvasively, SRS has altered the treatment paradigms for benign and malignant intracranial tumors, functional disorders, and vascular malformations. Literature on extensive intracranial radiosurgery has unequivocally demonstrated the favorable benefit-to-risk profile that SRS affords for appropriately selected patients. In a departure from conventional radiotherapeutic strategies, radiosurgical principles have recently been extended to extracranial indications such as lung, spine, and liver tumors. The paradigm shift resulting from radiosurgery continues to alter the landscape of related fields. PMID:25113762

  3. Stereotactic Radiosurgery and Stereotactic Body Radiotherapy (SBRT)

    MedlinePlus

    ... due to the development of highly advanced radiation technologies that permit maximum dose delivery within the target ... local control. SRS and SBRT rely on several technologies: three-dimensional imaging and localization techniques that determine ...

  4. Corrosion monitoring using high-frequency guided ultrasonic waves

    NASA Astrophysics Data System (ADS)

    Fromme, Paul

    2014-02-01

    Corrosion develops due to adverse environmental conditions during the life cycle of a range of industrial structures, e.g., offshore oil platforms, ships, and desalination plants. Both pitting corrosion and generalized corrosion leading to wall thickness loss can cause the degradation of the structural integrity. The nondestructive detection and monitoring of corrosion damage in difficult to access areas can be achieved using high frequency guided waves propagating along the structure from accessible areas. Using standard ultrasonic transducers with single sided access to the structure, guided wave modes were generated that penetrate through the complete thickness of the structure. The wave propagation and interference of the different guided wave modes depends on the thickness of the structure. Laboratory experiments were conducted and the wall thickness reduced by consecutive milling of the steel structure. Further measurements were conducted using accelerated corrosion in a salt water bath and the damage severity monitored. From the measured signal change due to the wave mode interference the wall thickness reduction was monitored. The high frequency guided waves have the potential for corrosion damage monitoring at critical and difficult to access locations from a stand-off distance.

  5. Corrosion monitoring using high-frequency guided waves

    NASA Astrophysics Data System (ADS)

    Fromme, P.

    2016-04-01

    Corrosion can develop due to adverse environmental conditions during the life cycle of a range of industrial structures, e.g., offshore oil platforms, ships, and desalination plants. Generalized corrosion leading to wall thickness loss can cause the reduction of the strength and thus degradation of the structural integrity. The monitoring of corrosion damage in difficult to access areas can be achieved using high frequency guided waves propagating along the structure from accessible areas. Using standard ultrasonic wedge transducers with single sided access to the structure, guided wave modes were selectively generated that penetrate through the complete thickness of the structure. The wave propagation and interference of the different guided wave modes depends on the thickness of the structure. Laboratory experiments were conducted for wall thickness reduction due to milling of the steel structure. From the measured signal changes due to the wave mode interference the reduced wall thickness was monitored. Good agreement with theoretical predictions was achieved. The high frequency guided waves have the potential for corrosion damage monitoring at critical and difficult to access locations from a stand-off distance.

  6. High Five: A Nutrition Program for High School Youth. Teacher Guide.

    ERIC Educational Resources Information Center

    James, Delores C. S.; Rienzo, Barbara A.

    This teacher's guide is part of a multiculturally sensitive teaching package to promote health-enhancing nutrition concepts for Florida public high school students. These nutrition promotion materials are intended to be incorporated into life skills management, home economics, physical education, or life science classes. The guide includes…

  7. Stereotactic CO2 laser therapy for hydrocephalus

    NASA Astrophysics Data System (ADS)

    Kozodoy-Pins, Rebecca L.; Harrington, James A.; Zazanis, George A.; Nosko, Michael G.; Lehman, Richard M.

    1994-05-01

    A new fiber-optic delivery system for CO2 radiation has been used to successfully treat non-communicating hydrocephalus. This system consists of a hollow sapphire waveguide employed in the lumen of a stereotactically-guided neuroendoscope. CO2 gas flows through the bore of the hollow waveguide, creating a path for the laser beam through the cerebrospinal fluid (CSF). This delivery system has the advantages of both visualization and guided CO2 laser radiation without the same 4.3 mm diameter scope. Several patients with hydrocephalus were treated with this new system. The laser was used to create a passage in the floor of the ventricle to allow the flow of CSF from the ventricles to the sub-arachnoid space. Initial postoperative results demonstrated a relief of the clinical symptoms. Long-term results will indicate if this type of therapy will be superior to the use of implanted silicone shunts. Since CO2 laser radiation at 10.6 micrometers is strongly absorbed by the water in tissue and CSF, damage to tissue surrounding the lesion with each laser pulse is limited. The accuracy and safety of this technique may prove it to be an advantageous therapy for obstructive hydrocephalus.

  8. Stereotactic radiofrequency thermocoagulation for hypothalamic hamartoma with intractable gelastic seizures.

    PubMed

    Homma, Junpei; Kameyama, Shigeki; Masuda, Hiroshi; Ueno, Takehiko; Fujimoto, Ayataka; Oishi, Makoto; Fukuda, Masafumi

    2007-08-01

    Management of hypothalamic hamartoma with intractable gelastic epilepsy remains controversial. We have used stereotactic thermocoagulation for treatment of hypothalamic hamartoma with intractable gelastic epilepsy since 1997. Herein, we review our experience in five cases to clarify the usefulness of this treatment. A total of five patients with hypothalamic hamartoma were treated by stereotactic thermocoagulation at our hospital during the period October 1997 through February 2004. In all patients, the hamartoma was less than 10mm in diameter and was located on the floor of the third ventricle with sessile attachment to the wall. To identify ictal onset, chronic intracranial electroencephalography was performed in three patients with the use of a depth electrode implanted in the hamartoma. Attempts were made to induce gelastic seizure by electrical stimulation of the hamartoma in three patients. After magnetic resonance imaging-guided targeting, radiofrequency thermocoagulation of the boundary between the hamartoma and normal hypothalamus was performed to achieve disconnection effects. Marked reductions in seizure frequency were obtained in all cases, with three patients becoming seizure-free after the procedure. No intraoperative complications occurred except in one patient who experienced acute and transient panidrosis with hot flushes during coagulation. Our results suggest that stereotactic thermocoagulation of hypothalamic hamartoma is an acceptable treatment option for patients with intractable gelastic seizures.

  9. Stereotactic radiosurgery of the foramen magnum region and upper neck lesions: technique modification.

    PubMed

    Samblas, J M; Bustos, J C; Gutiérrez-Díaz, J A; Donckaster, G; Santos, M; Ortiz de Urbina, D I

    1994-04-01

    A modification of the stereotactic radiosurgical procedure to permit treatment of lesions in the foramen magnum and upper cervical regions is described. The modification consists of placing the frontal pins of the stereotactic head ring in the zigoma bone, with no changes in the position of the occipital pins, so the final BRW head ring is oblique to the orbito-meatal plane. In this new position there is room enough in the posterior part of the guide for the support scrubs. This is unhampered by the patient's shoulders and the lesion is far enough to permit setting the axial coordinate sufficiently above the head ring plane.

  10. Decision theoretic steering and genetic algorithm optimization: application to stereotactic radiosurgery treatment planning.

    PubMed

    Yu, Y; Schell, M C; Zhang, J B

    1997-11-01

    Treatment planning for stereotactic radiosurgery and fractionated radiotherapy is currently a labor intensive, operator-dependent process. Many degrees of freedom exist to make rigorous optimization intractable except by computationally intelligent techniques. The quality of a given plan is determined by an aggregate of clinical objectives, most of which are subject to competing tradeoffs. In this work, we present an autonomous scheme that couples decision theoretic guidance with a genetic algorithm for optimization. Ordinal ranking among a population of viable treatment plans is based on a generalized distance metric, which promotes a decreasing hyperfrontier of the efficient solution set. The solution set is driven toward efficiency by the genetic algorithm, which uses the tournament selection mechanism based on the ordinal ranking. Goals and satisficing conditions can be defined to signal the ultimate and the minimum achievement levels in a given objective. A conventionally challenging case in radiosurgery was used to demonstrate the practical utility and the problem-solving power of the decision theoretic genetic algorithm. Treatment plans with one isocenter and four isocenters were derived under the autonomous scheme and compared to the actual treatment plan manually optimized by the expert planner. Quality assessment based on dose-volume histograms and normal tissue complication probabilities suggested that computational optimization could be driven to offer varying degrees of dosimetric improvement over a human-guided optimization effort. Furthermore, it was possible to achieve a high degree of isodose conformity to the target volume in computational optimization by increasing the degree of freedom in the treatment parameters. The time taken to derive an efficient planning solution was comparable and usually shorter than in the manual planning process, and can be scaled down almost linearly with the number of processors. Overall, the autonomous genetic

  11. Clip migration after vacuum-assisted stereotactic breast biopsy: a pitfall in preoperative wire localization.

    PubMed

    Bernaerts, A; De Schepper, A; Van Dam, P; Pouillon, M

    2007-01-01

    Vacuum-assisted stereotactic breast biopsy has become an irreplaceable instrument in the management of suspicious mammographic lesions. If the initial mammographic lesion becomes obscured or absent following the biopsy, a clip is commonly placed by interventional breast radiologists at the biopsy site. This enables future wire localization if atypical or malignant histology warrants excision. Currently, clip malposition or migration has become increasingly recognized in the literature as a possible complication of stereotactic breast biopsy. As in this case, recognition of migration of the clip was crucial in the planning of the patient's subsequent wire localization procedure. This article aims to increase the awareness of radiologists and surgeons of this potential pitfall to prevent false-negative biopsies and minimize positive surgical margins after wire-guided breast conservation surgery. Routine evaluation of pre- and postbiopsy mammograms and prospective identification of inaccurate clip placement before stereotactic wire localization and excision should be performed.

  12. Greatly improved neuroprotective efficiency of citicoline by stereotactic delivery in treatment of ischemic injury.

    PubMed

    Xu, Fangjingwei; Hongbin Han; Yan, Junhao; Chen, He; He, Qingyuan; Xu, Weiguo; Zhu, Ning; Zhang, Hong; Zhou, Fugen; Lee, Kejia

    2011-01-01

    Limited penetration of neuroprotective drug citicoline into the central nervous system (CNS) by systemic administration led to poor efficiency. A novel method of stereotactic drug delivery was explored to make citicoline bypass the blood brain barrier (BBB) and take effect by direct contact with ischemic neurons. A permanent middle cerebral artery occlusion (pMCAO) model of rats was prepared. To get the optimal conditions for citicoline administration by the novel stereotactic delivery pathway, magnetic resonance imaging (MRI) tracer method was used, and a dose-dependent effect was given. Examinations of MRI, behavior evaluation, infarct volume assessment and histological staining were performed to evaluate the outcome. This MRI-guided stereotactic delivery of citicoline resulted in a notable reduction (>80%) in infarct size and a delayed ischemic injury in cortex 12 hours after onset of acute ischemia when compared with the systematic delivery. The improved neuroprotective efficiency was realized by a full distribution of citicoline in most of middle cerebral artery (MCA) territory and an adequate drug reaction in the involved areas of the brain. Brain lesions of treated rats by stereotactic delivery of citicoline were well predicted in the lateral ventricle and thalamus due to a limited drug deposition by MRI tracer method. Our study realized an improved neuroprotective efficiency of citicoline by stereotactic delivery, and an optimal therapeutic effect of this administration pathway can be achieved under MRI guidance.

  13. [The "LINAC Knife": stereotactic radiotherapy with a linear accelerator].

    PubMed

    Vetterli, D; Born, E J; Curschmann, J

    1998-07-01

    Stereotactic radiosurgery stands for a high precision irradiation concept, which allows to deliver a high dose of ionizing radiation to the tumor volume. The characteristic steep dose fall-off immediately outside the target volume enables the selective destruction of small intracranial tumors while sharply minimizing the dose to the surrounding healthy tissue. This treatment modality is non-invasive and in general well tolerated with minimal side-effects. Especially for palliative concepts the short treatment time is of great importance.

  14. [Stereotactic body radiation therapy for spinal metastases].

    PubMed

    Pasquier, D; Martinage, G; Mirabel, X; Lacornerie, T; Makhloufi, S; Faivre, J-C; Thureau, S; Lartigau, É

    2016-10-01

    After the liver and lungs, bones are the third most common sites of cancer metastasis. Palliative radiotherapy for secondary bone tumours helps relieve pain, improve the quality of life and reduce the risk of fractures. Stereotactic body radiotherapy can deliver high radiation doses with very tight margins, which has significant advantages when treating tumours close to the spinal cord. Strict quality control is essential as dose gradient at the edge of the spinal cord is important. Optimal schedule is not defined. A range of dose-fractionation schedules have been used. Pain relief and local control are seen in over 80%. Toxicity rates are low, although vertebral fracture may occur. Ongoing prospective studies will help clarify its role in the management of oligometastatic patients.

  15. Stereotactic hypothalamotomy for behaviour disorders

    PubMed Central

    Schvarcz, J. R.; Driollet, R.; Rios, E.; Betti, O.

    1972-01-01

    Posterior hypothalamotomy is a relatively simple stereotactic procedure. The radiological determination of the target and its physiological corroboration by electrical stimulation are accurate. The lesions have always been made in the site of maximum sympathetic response. In this respect, the cardiovascular changes (hypertension and tachycardia), which are always elicited from a more restricted area, are of particular importance. Depth recordings, however, have been less useful. Undesirable side-effects, if present, were mild and transitory. There was no postoperative intelligence deficit, at least with the standard tests. Images PMID:5035309

  16. 1D profiling using highly dispersive guided waves

    NASA Astrophysics Data System (ADS)

    Volker, Arno; van Zon, Tim; Hsu, Mick; Boogert, Lennart

    2016-02-01

    Corrosion is one of the industries major issues regarding the integrity of assets. Currently inspections are conducted at regular intervals to ensure a sufficient integrity level of these assets. Cost reduction while maintaining a high level of reliability and safety of installations is a major challenge. There are many situations where the actual defect location is not accessible, e.g., a pipe support or a partially buried pipe. In case of bottom of the line corrosion, i.e., a single corrosion pit, a simpler approach may be followed. Guided waves are propagated around the circumference of a pipe. In case of wall loss, the phase of the signal changes which is used to estimate the local wall thickness profile. A special EMAT sensor has been developed, which works in a pit-catch configuration at the 12 o'clock position using highly dispersive guided waves. In order to improve the sensitivity, an inversion in performed on multiple orders of circumferential passes. Experimental results are presented on different pipes containing artificial and real defects.

  17. 1D profiling using highly dispersive guided waves

    SciTech Connect

    Volker, Arno; Zon, Tim van; Enthoven, Daniel; Verburg, Wesley

    2015-03-31

    Corrosion is one of the industries major issues regarding the integrity of assets. Currently inspections are conducted at regular intervals to ensure a sufficient integrity level of these assets. Cost reduction while maintaining a high level of reliability and safety of installations is a major challenge. There are many situations where the actual defect location is not accessible, e.g., a pipe support or a partially buried pipe. Guided wave tomography has been developed to reconstruct the wall thickness. In case of bottom of the line corrosion, i.e., a single corrosion pit, a simpler approach may be followed. Data is collected in a pit-catch configuration at the 12 o'clock position using highly dispersive guided waves. The phase spectrum is used to invert for a wall thickness profile in the circumferential direction, assuming a Gaussian defect profile. An EMAT sensor design has been made to measure at the 12 o'clock position of a pipe. The concept is evaluated on measured data, showing good sizing capabilities on a variety simple defect profiles.

  18. 1-D profiling using highly dispersive guided waves

    SciTech Connect

    Volker, Arno; Zon, Tim van

    2014-02-18

    Corrosion is one of the industries major issues regarding the integrity of assets. Currently, inspections are conducted at regular intervals to ensure a sufficient integrity level of these assets. Cost reduction while maintaining a high level of reliability and safety of installations is a major challenge. There are many situations where the actual defect location is not accessible, e.g., a pipe support or a partially buried pipe. Guided wave tomography has been developed to reconstruct the wall thickness of steel pipes. In case of bottom of the line corrosion, i.e., a single corrosion pit, a simpler approach may be followed. Data is collected in a pitch-catch configuration at the 12 o'clock position using highly dispersive guided waves. After dispersion correction the data collapses to a short pulse, any residual dispersion indicates wall loss. The phase spectrum is used to invert for the wall thickness profile in the circumferential direction, assuming a Gaussian defect profile. The approach is evaluated on numerically simulated and on measured data. The method is intended for rapid, semi-quantitative screening of pipes.

  19. Salvage Reirradiaton With Stereotactic Body Radiotherapy for Locally Recurrent Head-and-Neck Tumors

    SciTech Connect

    Cengiz, Mustafa; Ozyigit, Goekhan; Yazici, Goezde; Dogan, Ali; Yildiz, Ferah; Zorlu, Faruk; Guerkaynak, Murat; Gullu, Ibrahim H.; Hosal, Sefik; Akyol, Fadil

    2011-09-01

    Purpose: In this study, we present our results of reirradiation of locally recurrent head-and-neck cancer with image-guided, fractionated, frameless stereotactic body radiotherapy technique. Methods and Materials: From July 2007 to February 2009, 46 patients were treated using the CyberKnife (Accuray, Sunnyvale, CA) at the Department of Radiation Oncology, Hacettepe University, Ankara, Turkey. All patients had recurrent, unresectable, and previously irradiated head-and-neck cancer. The most prominent site was the nasopharynx (32.6%), and the most common histopathology was epidermoid carcinoma. The planning target volume was defined as the gross tumor volume identified on magnetic resonance imaging and computed tomography. There were 22 female and 24 male patients. Median age was 53 years (range, 19-87 years). The median tumor dose with stereotactic body radiotherapy was 30 Gy (range, 18-35 Gy) in a median of five (range, one to five) fractions. Results: Of 37 patients whose response to therapy was evaluated, 10 patients (27%) had complete tumor regression, 11 (29.8%) had partial response, and 10 (27%) had stable disease. Ultimate local disease control was achieved in 31 patients (83.8%). The overall survival was 11.93 months in median (ranged, 11.4 - 17.4 months), and the median progression free survival was 10.5 months. One-year progression-free survival and overall survival were 41% and 46%, respectively. Grade II or greater long-term complications were observed in 6 (13.3%) patients. On follow-up, 8 (17.3%) patients had carotid blow-out syndrome, and 7 (15.2%) patients died of bleeding from carotid arteries. We discovered that this fatal syndrome occurred only in patients with tumor surrounding carotid arteries and carotid arteries receiving all prescribed dose. Conclusions: Stereotactic body radiotherapy is an appealing treatment option for patients with recurrent head-and-neck cancer previously treated with radiation to high doses. Good local control with

  20. Dynamic Lung Tumor Tracking for Stereotactic Ablative Body Radiation Therapy

    PubMed Central

    Kunos, Charles A.; Fabien, Jeffrey M.; Shanahan, John P.; Collen, Christine; Gevaert, Thierry; Poels, Kenneth; Van den Begin, Robbe; Engels, Benedikt; De Ridder, Mark

    2015-01-01

    Physicians considering stereotactic ablative body radiation therapy (SBRT) for the treatment of extracranial cancer targets must be aware of the sizeable risks for normal tissue injury and the hazards of physical tumor miss. A first-of-its-kind SBRT platform achieves high-precision ablative radiation treatment through a combination of versatile real-time imaging solutions and sophisticated tumor tracking capabilities. It uses dual-diagnostic kV x-ray units for stereoscopic open-loop feedback of cancer target intrafraction movement occurring as a consequence of respiratory motions and heartbeat. Image-guided feedback drives a gimbaled radiation accelerator (maximum 15 x 15 cm field size) capable of real-time ±4 cm pan-and-tilt action. Robot-driven ±60° pivots of an integrated ±185° rotational gantry allow for coplanar and non-coplanar accelerator beam set-up angles, ultimately permitting unique treatment degrees of freedom. State-of-the-art software aids real-time six dimensional positioning, ensuring irradiation of cancer targets with sub-millimeter accuracy (0.4 mm at isocenter). Use of these features enables treating physicians to steer radiation dose to cancer tumor targets while simultaneously reducing radiation dose to normal tissues. By adding respiration correlated computed tomography (CT) and 2-[18F] fluoro-2-deoxy-ᴅ-glucose (18F-FDG) positron emission tomography (PET) images into the planning system for enhanced tumor target contouring, the likelihood of physical tumor miss becomes substantially less1. In this article, we describe new radiation plans for the treatment of moving lung tumors. PMID:26131774

  1. Apparatus-dependent dosimetric differences in spine stereotactic body radiotherapy.

    PubMed

    Ma, Lijun; Sahgal, Arjun; Cozzi, Luca; Chang, Eric; Shiu, Almon; Letourneau, Daniel; Yin, Fang-Fang; Fogliata, Antonella; Kaissl, Wolfgang; Hyde, Derek; Laperriere, Normand J; Shrieve, Dennis C; Larson, David A

    2010-12-01

    The purpose of this investigation was to study apparatus-dependent dose distribution differences specific to spine stereotactic body radiotherapy (SBRT) treatment planning. This multi-institutional study was performed evaluating an image-guided robotic radiosurgery system (CK), intensity modulated protons (IMP), multileaf collimator (MLC) fixed-field IMRT with 5 mm (11 field), 4 mm (9 field), and 2.5 mm (8- and 9-field) leaf widths and intensity modulated volumetric arc therapy (IMVAT) with a 2.5 mm MLC. Treatment plans were systematically developed for targets consisting of one, two and three consecutive thoracic vertebral bodies (VBs) with the esophagus and spinal cord contoured as the organs at risk. It was found that all modalities achieved acceptable treatment planning constraints. However, following normalization fixed field IMRT with a 2.5 mm MLC, IMVAT and IMP systems yielded the smallest ratio of maximum dose divided by the prescription dose (MD/PD) for one-, two- and three-VB PTVs (ranging from 1.1-1.16). The 2.5 mm MLC 9-field IMRT, IMVAT and CK plans resulted in the least dose to 0.1 cc volumes of spinal cord and esophagus. CK plans had the greatest degree of target dose inhomogeneity. As the level of complexity increased with an increasing number of vertebral bodies, distinct apparatus features such as the use of a high number of beams and a finer leaf size MLC were favored. Our study quantified apparatus-dependent dose-distribution differences specific to spine SBRT given strict, but realistic, constraints and highlights the need to benchmark physical dose distributions for multi-institutional clinical trials.

  2. Junior High Business Education. Arkansas Public School Course Content Guide.

    ERIC Educational Resources Information Center

    Arkansas State Dept. of Education, Little Rock.

    This course content guide was developed in accordance with the Standards for Accreditation of Public Schools adopted by the Arkansas State Board of Education. The guide is offered as a framework upon which a curriculum can be built. Within the subject area and at each grade level, the content guide identifies skills at three instructional levels:…

  3. The Clinical Outcome of Hypofractionated Stereotactic Radiotherapy With CyberKnife Robotic Radiosurgery for Perioptic Pituitary Adenoma.

    PubMed

    Puataweepong, Putipun; Dhanachai, Mantana; Hansasuta, Ake; Dangprasert, Somjai; Swangsilpa, Thiti; Sitathanee, Chomporn; Jiarpinitnun, Chuleeporn; Vitoonpanich, Patamintita; Yongvithisatid, Pornpan

    2016-12-01

    Stereotactic radiation technique including single fraction radiosurgery and conventional fractionated stereotactic radiotherapy is widely reported as an effective treatment of pituitary adenomas. Because of the restricted radiation tolerance dose of the optic pathway, single fraction radiosurgery has been accepted for small tumor located far away from the optic apparatus, while fractionated stereotactic radiotherapy may be suitable for larger tumor located close to the optic pathway. More recently, hypofractionated stereotactic radiotherapy has become an alternative treatment option that provides high rate of tumor control and visual preservation for the perioptic lesions within 2 to 3 mm of the optic pathway. The objective of the study was to analyze the clinical outcomes of perioptic pituitary adenomas treated with hypofractionated stereotactic radiotherapy. From 2009 to 2012, 40 patients with perioptic pituitary adenoma were treated with CyberKnife robotic radiosurgery. The median tumor volume was 3.35 cm(3) (range, 0.82-25.86 cm(3)). The median prescribed dose was 25 Gy (range, 20-28 Gy) in 5 fractions (range, 3-5). After the median follow-up time of 38.5 months (range, 14-71 months), 1 (2.5%) patient with prolactinoma had tumor enlargement, 31 (77.5%) were stable, and the remaining 8 (20%) tumors were smaller in size. No patient's vision deteriorated after hypofractionated stereotactic radiotherapy. Hormone normalization was observed in 7 (54%) of 13 patients. No newly developed hypopituitarism was detected in our study. These data confirmed that hypofractionated stereotactic radiotherapy achieved high rates of tumor control and visual preservation. Because of the shorter duration of treatment, it may be preferable to use hypofractionated stereotactic radiotherapy over fractionated stereotactic radiotherapy for selected pituitary adenomas immediately adjacent to the optic apparatus.

  4. Cushing's disease: a single centre's experience using the linear accelerator (LINAC) for stereotactic radiosurgery and fractionated stereotactic radiotherapy.

    PubMed

    Wilson, P J; Williams, J R; Smee, R I

    2014-01-01

    Cushing's disease is hypercortisolaemia secondary to an adrenocorticotrophic hormone secreting pituitary adenoma. Primary management is almost always surgical, with limited effective medical interventions available. Adjuvant therapy in the form of radiation is gaining popularity, with the bulk of the literature related to the Gamma Knife. We present the results from our own institution using the linear accelerator (LINAC) since 1990. Thirty-six patients who underwent stereotactic radiosurgery (SRS), one patient who underwent fractionated stereotactic radiotherapy (FSRT) and for the purposes of comparison, 13 patients who had undergone conventional radiotherapy prior to 1990, were included in the analysis. Serum cortisol levels improved in nine of 36 (25%) SRS patients and 24 hour urinary free cortisol levels improved in 13 of 36 patients (36.1%). Tumour volume control was excellent in the SRS group with deterioration in only one patient (3%). The patient who underwent FSRT had a highly aggressive tumour refractory to radiation.

  5. Nelson's syndrome: single centre experience using the linear accelerator (LINAC) for stereotactic radiosurgery and fractionated stereotactic radiotherapy.

    PubMed

    Wilson, Peter J; Williams, Janet R; Smee, Robert I

    2014-09-01

    Nelson's syndrome is a unique clinical phenomenon of growth of a pituitary adenoma following bilateral adrenalectomies for the control of Cushing's disease. Primary management is surgical, with limited effective medical therapies available. We report our own institution's series of this pathology managed with radiation: prior to 1990, 12 patients were managed with conventional radiotherapy, and between 1990 and 2007, five patients underwent stereotactic radiosurgery (SRS) and two patients fractionated stereotactic radiotherapy (FSRT), both using the linear accelerator (LINAC). Tumour control was equivocal, with two of the five SRS patients having a reduction in tumour volume, one patient remaining unchanged, and two patients having an increase in volume. In the FSRT group, one patient had a decrease in tumour volume whilst the other had an increase in volume. Treatment related morbidity was low. Nelson's syndrome is a challenging clinical scenario, with a highly variable response to radiation in our series.

  6. Extracranial stereotactic radiotherapy: evaluation of PTV coverage and dose conformity.

    PubMed

    Hädinger, Ulrich; Thiele, Wibke; Wulf, Jörn

    2002-01-01

    During the past few years the concept of cranial stereotactic radiotherapy has been successfully extended to extracranial tumoral targets. In our department, hypofractionated treatment of tumours in lung, liver, abdomen, and pelvis is performed in the Stereotactic Body Frame (ELEKTA Instrument AB) since 1997. We present the evaluation of 63 consecutively treated targets (22 lung, 21 liver, 20 abdomen/pelvis) in 58 patients with respect to dose coverage of the planning target volume (PTV) as well as conformity of the dose distribution. The mean PTV coverage was found to be 96.3% +/- 2.3% (lung), 95.0% +/- 4.5% (liver), and 92.1% +/- 5.2% (abdomen/pelvis). For the so-called conformation number we obtained values of 0.73 +/- 0.09 (lung), 0.77 +/- 0.10 (liver), and 0.70 +/- 0.08 (abdomen/pelvis). The results show that highly conformal treatment techniques can be applied also in extracranial stereotactic radiotherapy. This is primarily due to the relatively simple geometrical shape of most of the targets. Especially lung and liver targets turned out to be approximately spherically/cylindrically shaped, so that the dose distribution can be easily tailored by rotational fields.

  7. Review of long-term results of stereotactic psychosurgery.

    PubMed

    Kim, Moon-Chan; Lee, Tae-Kyu; Choi, Chang-Rak

    2002-09-01

    Stereotactic psychosurgery is an effective method for treating some medically intractable psychiatric illnesses. However, it is unfamiliar and the long-term clinical results have not been reported in Asia. The long-term results of psychosurgery are evaluated and the neuroanatomical basis is discussed. Twenty-one patients underwent stereotactic psychosurgery for medically intractable psychiatric illnesses since 1993. All were referred from psychiatrists for these disorders. Two patients showed aggressive behavior, 12 had obsessive-compulsive disorder (OCD), and seven had depression with anxiety disorders. Bilateral amygdalotomy and subcaudate tractotomy were performed for aggressive behavior, limbic leucotomy was performed for OCD, and subcaudate tractotomy with or without cingulotomy was performed for depression with anxiety. OCD was evaluated with the Yale-Brown Obsessive Compulsive Scale (YBOCS), the visual analogue scale, the Clinical Global Impression Scale, and the Overt Aggression Scale (OAS). The Mini-Mental State Examination and the Wechsler Adult Intelligence Scale-Revised were used for the evaluation of aggressive behavior. The 17-item Hamilton Depression Rating Scale (HAMD) was used for evaluation of depression. Ventriculography was used in the first seven patients and magnetic resonance imaging-guided stereotaxy was used in the recent 14 cases for localization of the target. The lesions were made with a radiofrequency lesion generator. OAS scores in the two patients with aggressive behavior during follow up declined from 8 to 2 with clinical improvement. All 12 patients with OCD returned to their previous life and showed the mean YBOCS scores decreased from 34 to 3. Ten patients with OCD could be followed up (mean 45 months). All patients returned to their previous social life. In seven patients with depression with anxiety, HAMD scores declined from 28.5 to 16.5. There was no operative mortality and no significant morbidity except for one case of mild

  8. Principles of Stereotactic Electroencephalography in Epilepsy Surgery.

    PubMed

    Lhatoo, Samden; Lacuey, Nuria; Ryvlin, Philippe

    2016-12-01

    Stereotactic electroencephalography is a method for the invasive study for the human epileptic brain as a prelude to epilepsy surgery. The discipline of stereotactic electroencephalography is underpinned by an anatomo-electro-clinical analysis of epileptic seizures of focal origin and goes beyond simple stereotactic placement of depth electrodes. Stringent analysis of semiological and electrophysiological features is coupled with an understanding of this information in 3D anatomical space. Stereotactic electroencephalography offers significant advantages over subdural grid implantations, allowing pinpoint accuracy access to sulcal areas and deep brain structures, such as the insula, cingulate, basal and mesial brain regions, while associated with lower complication rates. Recent times have seen an exponential growth in stereotactic electroencephalography interest, driven in part by increasing complexity of typical epilepsy surgery patients in epilepsy surgery centers. Such patients are much more likely to be magnetic resonance imaging negative, or reoperations, or to have multifocal or widespread areas of cortical abnormalities. Herein, we discuss the advantages of stereotactic electroencephalography, principles of patient selection, implantation, and interpretation.

  9. Once-Weekly, High-Dose Stereotactic Body Radiotherapy for Lung Cancer: 6-Year Analysis of 60 Early-Stage, 42 Locally Advanced, and 7 Metastatic Lung Cancers

    SciTech Connect

    Salazar, Omar M. Sandhu, Taljit S.; Lattin, Paul B.; Chang, Jung H.; Lee, Choon K.; Groshko, Gayle A.; Lattin, Cheryl J.

    2008-11-01

    Purpose: To explore once-weekly stereotactic body radiotherapy (SBRT) in nonoperable patients with localized, locally advanced, or metastatic lung cancer. Methods and Materials: A total of 102 primary (89 untreated plus 13 recurrent) and 7 metastatic tumors were studied. The median follow-up was 38 months, the average patient age was 75 years. Of the 109 tumors studied, 60 were Stage I (45 IA and 15 IB), 9 were Stage II, 30 were Stage III, 3 were Stage IV, and 7 were metastases. SBRT only was given in 73% (40 Gy in four fractions to the planning target volume to a total dose of 53 Gy to the isocenter for a biologically effective dose of 120 Gy{sub 10}). SBRT was given as a boost in 27% (22.5 Gy in three fractions once weekly for a dose of 32 Gy at the isocenter) after 45 Gy in 25 fractions to the primary plus the mediastinum. The total biologically effective dose was 120 Gy{sub 10}. Respiration gating was used in 46%. Results: The overall response rate was 75%; 33% had a complete response. The overall response rate was 89% for Stage IA patients (40% had a complete response). The local control rate was 82%; it was 100% and 93% for Stage IA and IB patients, respectively. The failure rate was 37%, with 17% within the planning target volume. No Grade 3-4 acute toxicities developed in any patient; 12% and 7% of patients developed Grade 1 and 2 toxicities, respectively. Late toxicity, all Grade 2, developed in 3% of patients. The 5-year cause-specific survival rate for Stage I was 70% and was 74% and 64% for Stage IA and IB patients, respectively. The 3-year Stage III cause-specific survival rate was 30%. The patients with metastatic lung cancer had a 57% response rate, a 27% complete response rate, an 86% local control rate, a median survival time of 19 months, and 23% 3-year survival rate. Conclusions: SBRT is noninvasive, convenient, fast, and economically attractive; it achieves results similar to surgery for early or metastatic lung cancer patients who are older

  10. Junior High Computer Literacy. Curriculum Guide=L'Informatique au Secondaire 7-8-9. Guide Pedagogique.

    ERIC Educational Resources Information Center

    Alberta Dept. of Education, Edmonton. Curriculum Branch.

    This curriculum guide provides information in both English and French for the teaching of computer literacy in junior high schools in the Canadian province of Alberta. A basic introductory course developed in response to the need to acquaint junior high school students with a general understanding of computers and their use, the program for grades…

  11. Creating Career Cluster Programs: A Guide for Oregon High Schools.

    ERIC Educational Resources Information Center

    Oregon State Dept. of Education, Salem. Career and Vocational Education Section.

    The guide was intended to provide the information needed to implement or improve an 11th and 12th grade career education cluster program. The authors suggest that the guide will be most useful in schools where a long-range plan for career education has been prepared and adopted by the local board of education, and where it has been decided to…

  12. Best Practices Guide for High-Performance Indian Office Buildings

    SciTech Connect

    Singh, Reshma; Sartor, Dale; Ghatikar, Girish

    2013-04-01

    This document provides best practice guidance and energy- efficiency recommendations for the design, construction, and operation of high-­performance office buildings in India. Through a discussion of learnings from exemplary projects and inputs from experts, it provides recommendations that can potentially help achieve (1) enhanced working environments, (2) economic construction/faster payback, (3) reduced operating costs, and (4) reduced greenhouse gas (GHG) emissions. It also provides ambitious (but achievable) energy performance benchmarks, both as adopted targets during building modeling (design phase) and during measurement and verification (operations phase). These benchmarks have been derived from a set of representative best-in-class office buildings in India. The best practices strategies presented in this guide would ideally help in delivering high-­performance in terms of a triad—of energy efficiency, cost efficiency, and occupant comfort and well-­being. These best practices strategies and metrics should be normalized—that is, corrected to account for building characteristics, diversity of operations, weather, and materials and construction methods.

  13. Plans, Patterns, and Move Categories Guiding a Highly Selective Search

    NASA Astrophysics Data System (ADS)

    Trippen, Gerhard

    In this paper we present our ideas for an Arimaa-playing program (also called a bot) that uses plans and pattern matching to guide a highly selective search. We restrict move generation to moves in certain move categories to reduce the number of moves considered by the bot significantly. Arimaa is a modern board game that can be played with a standard Chess set. However, the rules of the game are not at all like those of Chess. Furthermore, Arimaa was designed to be as simple and intuitive as possible for humans, yet challenging for computers. While all established Arimaa bots use alpha-beta search with a variety of pruning techniques and other heuristics ending in an extensive positional leaf node evaluation, our new bot, Rat, starts with a positional evaluation of the current position. Based on features found in the current position - supported by pattern matching using a directed position graph - our bot Rat decides which of a given set of plans to follow. The plan then dictates what types of moves can be chosen. This is another major difference from bots that generate "all" possible moves for a particular position. Rat is only allowed to generate moves that belong to certain categories. Leaf nodes are evaluated only by a straightforward material evaluation to help avoid moves that lose material. This highly selective search looks, on average, at only 5 moves out of 5,000 to over 40,000 possible moves in a middle game position.

  14. Science Fair. It's a Blast! A Guide for Junior High Students. Teacher's Guide.

    ERIC Educational Resources Information Center

    Riggins, Patricia C., Ed.

    Science fairs have the potential to help students develop new ways of solving problems using a scientific approach. This supplemental guide was developed for those teachers involved with science fairs as well as others who work with students in developing a project. Several reasons for holding a science fair are listed, along with some…

  15. Alaska's Living Tundra. Alaska Wildlife Week, 25-29 April 1988. Unit 6: Primary Teacher's Guide; Upper Elementary Teacher's Guide; Junior/Senior High School Teacher's Guide; Supplement.

    ERIC Educational Resources Information Center

    Quinlan, Susan E.

    Despite its cold and barren appearance, Alaska's tundra supports a surprising variety of insects, birds, and mammals. In this document, three teacher's guides (for primary, upper elementary, and junior and senior high schools) and a supplementary resource packet present a comprehensive unit of study on Alaska's living tundra. The five lessons in…

  16. Sci—Sat AM: Stereo — 08: Stereotactic Ablative Radiotherapy (SABR) for low, intermediate and high risk prostate cancer using Volumetric Modulated Arc Therapy (VMAT) with a 10x Flattening Filter Free (FFF) beam

    SciTech Connect

    Mestrovic, A; Fortin, D; Alexander, A

    2014-08-15

    Purpose: To determine the feasibility of using Volumetric Modulated Arc Therapy (VMAT) with a 10x Flattening Filter Free (FFF) beam for Stereotactic Ablative Radiotherapy (SABR) for low, intermediate and high risk prostate cancer. Methods and Materials: Ten anonymized patient CT data sets were used in this planning study. For each patient CT data set, three sets of contours were generated: 1) low risk, 2) intermediate risk, and 3) high risk scenarios. For each scenario, a single-arc and a double-arc VMAT treatment plans were created. Plans were generated with the Varian Eclipse™ treatment planning system for a Varian TrueBeam™ linac equipped with Millenium 120 MLC. Plans were created using a 10x-FFF beam with a maximum dose rate of 2400 MU/min. Dose prescription was 36.25Gy/5 fractions with the planning objective of covering 99% of the Planning Target Volume with the 95% of the prescription dose. Normal tissue constraints were based on provincial prostate SABR planning guidelines, derived from national and international prostate SABR protocols. Plans were evaluated and compared in terms of: 1) dosimetric plan quality, and 2) treatment delivery efficiency. Results: Both single-arc and double-arc VMAT plans were able to meet the planning goals for low, intermediate and high risk scenarios. No significant dosimetric differences were observed between the plans. However, the treatment time was significantly lower for a single-arc VMAT plans. Conclusions: Prostate SABR treatments are feasible with 10x-FFF VMAT technique. A single-arc VMAT offers equivalent dosimetric plan quality and a superior treatment delivery efficiency, compared to a double-arc VMAT.

  17. High School/High Tech Program Guide: An Implementation Guide for High School/High Tech Program Coordinators. Promoting Careers in Science and Technology for High School Students with Disabilities.

    ERIC Educational Resources Information Center

    Office of Disability Employment Policy (DOL), Washington, DC.

    This implementation guide is intended to assist educators in planning, establishing, building, and managing a High School/High Tech project for high school students with disabilities. The program is designed to develop career opportunities, provide activities that will spark an interest in high technology fields, and encourage students to pursue…

  18. Characteristics Data Base: Programmer's guide to the High-Level Waste Data Base

    SciTech Connect

    Jones, K.E. ); Salmon, R. )

    1990-08-01

    The High-Level Waste Data Base is a menu-driven PC data base developed as part of OCRWM's technical data base on the characteristics of potential repository wastes, which also includes spent fuel and other materials. This programmer's guide completes the documentation for the High-Level Waste Data Base, the user's guide having been published previously. 3 figs.

  19. Stereotactic radiosurgery of brain metastasis from melanoma.

    PubMed

    Marchan, Edward M; Sheehan, Jason

    2012-01-01

    Brain metastasis represents the most common intracranial neoplasm in adult patients. Melanoma is the third most frequent cancer histology and consequently comprises a significant portion of brain metastasis patients. Unlike the more frequent lung and breast cancers, melanoma represents a particularly challenging entity because of its radioresistant nature. Stereotactic radiosurgery appears to overcome the inherent radioresistance of brain metastasis from melanoma and, thereby, affords a high rate of local tumor control. Reports from leading centers indicate a favorable benefit to risk profile for radiosurgery in melanoma patients. Local tumor control after radiosurgery generally exceeds 80%, and neurological complications as a result of radiosurgery are infrequent. A higher performance status and lower intracranial tumor burden in melanoma patients at the time of radiosurgery are associated with longer survival. Radiosurgery may be used in conjunction upfront with radiotherapy, resection, and chemotherapy or as a salvage therapy in selected melanoma patients. Careful radiological and neurological follow-up is required to assess local tumor control and distant intracranial disease progression. Further clinical studies will be required to better define the role of upfront and salvage radiosurgery in selected cohorts of patients with brain metastasis from melanoma. However, it appears likely that radiosurgery will play an expanded role in the overall management of these patients.

  20. Imaging of Radiation Dose for Stereotactic Radiosurgery

    SciTech Connect

    Guan, Timothy Y.; Almond, Peter R.; Park, Hwan C.; Lindberg, Robert D.; Shields, Christopher B.

    2015-01-15

    The distributions of radiation dose for stereotactic radiosurgery, using a modified linear accelerator (Philips SL-25 and SRS-200), have been studied by using three different dosimeters: (1) ferrous-agarose-xylenol orange (FAX) gels, (2) TLD, and (3) thick-emulsion GafChromic dye film. These dosimeters were loaded into a small volume of defect in a phantom head. A regular linac stereotactic radiosurgery treatment was then given to the phantom head for each type of dosimeter. The measured radiation dose and its distributions were found to be in good agreement with those calculated by the treatment planning computer.

  1. Hospitality Education: A Guide for High School Teachers.

    ERIC Educational Resources Information Center

    Illinois State Office of Education, Springfield. Div. of Vocational and Technical Education.

    The guide presents key steps in establishing hospitality education curricula, based on recommendations of more than 300 surveyed educators and industry personnel and on information from over 60 proposed or existing curricula. The scope of the hospitality industries is described as including the categories of food service, lodging, tourism, and…

  2. Social Science Instructional Guides: High School (Grades 9-12).

    ERIC Educational Resources Information Center

    Hartman, Carl; And Others

    The guide, part of a social science learning continuum from first through twelfth grades, contains outlines for two-semester social studies courses for grades 9-12. Three components comprise each section: time allocations for units, instructional objectives, and a content outline. The Grade 9 course, Cultures of the Non-Western World, contains…

  3. Competency-Based Adult High School Completion Student Services Guide.

    ERIC Educational Resources Information Center

    Singer, Elizabeth; And Others

    Designed as part of a 310 Special Demonstration and Teacher Training Project undertaken at Brevard Community College, this student services guide contains information to assist adult education administrators, counselors, instructors, and office personnel in meeting the needs of students enrolled in adult/community education schools. Primary…

  4. Stereotactic Body Radiation Therapy Delivery in a Genetically Engineered Mouse Model of Lung Cancer

    PubMed Central

    Du, Shisuo; Lockamy, Virginia; Zhou, Lin; Xue, Christine; LeBlanc, Justin; Glenn, Shonna; Shukla, Gaurav; Yu, Yan; Dicker, Adam P.; Leeper, Dennis B.; Lu, You; Lu, Bo

    2016-01-01

    Purpose To implement clinical stereotactic body radiation therapy (SBRT) using a small animal radiation research platform (SARRP) in a genetically engineered mouse model of lung cancer. Methods and Materials A murine model of multinodular Kras-driven spontaneous lung tumors was used for this study. High-resolution cone beam computed tomography (CBCT) imaging was used to identify and target peripheral tumor nodules, whereas off-target lung nodules in the contralateral lung were used as a nonirradiated control. CBCT imaging helps localize tumors, facilitate high-precision irradiation, and monitor tumor growth. SBRT planning, prescription dose, and dose limits to normal tissue followed the guidelines set by RTOG protocols. Pathologic changes in the irradiated tumors were investigated using immunohistochemistry. Results The image guided radiation delivery using the SARRP system effectively localized and treated lung cancer with precision in a genetically engineered mouse model of lung cancer. Immunohistochemical data confirmed the precise delivery of SBRT to the targeted lung nodules. The 60 Gy delivered in 3 weekly fractions markedly reduced the proliferation index, Ki-67, and increased apoptosis per staining for cleaved caspase-3 in irradiated lung nodules. Conclusions It is feasible to use the SARRP platform to perform dosimetric planning and delivery of SBRT in mice with lung cancer. This allows for preclinical studies that provide a rationale for clinical trials involving SBRT, especially when combined with immunotherapeutics. PMID:27681749

  5. An x-ray image guidance system for small animal stereotactic irradiation

    NASA Astrophysics Data System (ADS)

    Song, K. H.; Pidikiti, R.; Stojadinovic, S.; Speiser, M.; Seliounine, S.; Saha, D.; Solberg, T. D.

    2010-12-01

    An x-ray image-guided small animal stereotactic irradiator was developed and characterized to enable tumor visualization and accurate target localization for small field, high dose irradiation. The system utilizes a custom collimation system, a motorized positioning system (x, y, θ), a digital imaging panel and operating software, and is integrated with a commercial x-ray unit. The essential characteristics of the irradiator include small radiation fields (1-10 mm), high dose rate (>10 Gy min-1) and submillimeter target localization. The software enables computer-controlled image acquisition, stage motion and target localization providing simple and precise automated target localization. The imaging panel was characterized in terms of signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and spatial resolution. Overall localization accuracy and precision were assessed. SNR, CNR and spatial resolution are 24 dB, 21 dB and 2.8 lp mm-1, respectively, and localization accuracy is approximately 65 µm with 6 µm precision. With the aid of image guidance, system performance was subsequently used to evaluate radiation response in a rat orthotopic lung tumor effectively sparing normal tissues and in a mouse normal lung. The capabilities of 3D treatment and cone-beam computed tomography are presented for 3D localization and delivery as a work in progress.

  6. Stereotactic radiotherapy for malignancies involving the trigeminal and facial nerves.

    PubMed

    Cuneo, K C; Zagar, T M; Brizel, D M; Yoo, D S; Hoang, J K; Chang, Z; Wang, Z; Yin, F F; Das, S K; Green, S; Ready, N; Bhatti, M T; Kaylie, D M; Becker, A; Sampson, J H; Kirkpatrick, J P

    2012-06-01

    Involvement of a cranial nerve caries a poor prognosis for many malignancies. Recurrent or residual disease in the trigeminal or facial nerve after primary therapy poses a challenge due to the location of the nerve in the skull base, the proximity to the brain, brainstem, cavernous sinus, and optic apparatus and the resulting complex geometry. Surgical resection caries a high risk of morbidity and is often not an option for these patients. Stereotactic radiosurgery and radiotherapy are potential treatment options for patients with cancer involving the trigeminal or facial nerve. These techniques can deliver high doses of radiation to complex volumes while sparing adjacent critical structures. In the current study, seven cases of cancer involving the trigeminal or facial nerve are presented. These patients had unresectable recurrent or residual disease after definitive local therapy. Each patient was treated with stereotactic radiation therapy using a linear accelerator based system. A multidisciplinary approach including neuroradiology and surgical oncology was used to delineate target volumes. Treatment was well tolerated with no acute grade 3 or higher toxicity. One patient who was reirradiated experienced cerebral radionecrosis with mild symptoms. Four of the seven patients treated had no evidence of disease after a median follow up of 12 months (range 2-24 months). A dosimetric analysis was performed to compare intensity modulated fractionated stereotactic radiation therapy (IM-FSRT) to a 3D conformal technique. The dose to 90% (D90) of the brainstem was lower with the IM-FSRT plan by a mean of 13.5 Gy. The D95 to the ipsilateral optic nerve was also reduced with IM-FSRT by 12.2 Gy and the D95 for the optic chiasm was lower with FSRT by 16.3 Gy. Treatment of malignancies involving a cranial nerve requires a multidisciplinary approach. Use of an IM-FSRT technique with a micro-multileaf collimator resulted in a lower dose to the brainstem, optic nerves and chiasm

  7. Environmental Education Teacher's Guide, Junior High School. A Core Experience Study of the Natural Environment.

    ERIC Educational Resources Information Center

    Bennett, Dean B.; Willink, Wesley H.

    This Environmental Education Teacher's Guide, developed for use in the junior high school, is designed to familiarize teachers with how an environmental education program can help in their teaching and in achieving the goals of the school. The suggested core activities in this guide are designed to be a motivating way of introducting junior high…

  8. Environmental Education Teacher's Guide, Junior High School. A Core Experience Study of the Human Environment.

    ERIC Educational Resources Information Center

    Bennett, Dean B.; Willink, Wesley H.

    This Environmental Education Teacher's Guide, developed for use in the junior high school, is designed to familiarize teachers with how an environmental education program can help in their teaching and in achieving the goals of the school. The suggested core activities in this guide are designed to be a motivating way of introducing junior high…

  9. Resource Guide to Mathematics Curriculum Materials for High Ability Learners, Grades K-8

    ERIC Educational Resources Information Center

    Center for Gifted Education, 2004

    2004-01-01

    Mathematics education has undergone many changes over the past few decades. Those changes are reflected in the curriculum materials that are currently available. This guide is intended to help the teachers, administrators, and parents of high ability mathematics students explore the materials on the market today. The guide gives a set of criteria…

  10. Creating and Sustaining High-Quality Charter School Governing Boards. A Guide for State Policymakers

    ERIC Educational Resources Information Center

    Butler, Elizabeth A.

    2008-01-01

    This guide for state policymakers examines the laws, policies, and programs that states are using to create and sustain high-quality charter school governing boards. In particular, the guide focuses on the two aspects of governing boards that interviews with state administrators revealed are most critical for a board's success: board composition…

  11. Guided Practice Software for Teaching DNA Replication to Senior High School Students

    ERIC Educational Resources Information Center

    Woods, Eric C.; McKinnon, Alan E.; Hickford, Jonathan G. H.; Abell, Walt A.

    2008-01-01

    The prototype of a guided practice application was developed to instruct year 13 biology students in the process of DNA replication. The application uses a high degree of interaction to engage the student in a guided exploration and problem solving exercise. An evaluation revealed that the students showed considerable enthusiasm and significant…

  12. Early manifestation of communicating hydrocephalus after fractionated stereotactic radiotherapy for aggressive giant atypical prolactinoma.

    PubMed

    Ohtakara, Kazuhiro; Ohe, Naoyuki; Iwama, Toru; Hoshi, Hiroaki

    2014-05-01

    Aggressive giant invasive pituitary adenomas refractory to standard surgical or medical treatment remain a genuine challenge. In addition, communicating hydrocephalus (CH) attributed to malabsorption of cerebrospinal fluid (CSF) developing after radiotherapy for pituitary adenomas has not been previously reported. Herein, we describe the case of a 48-year-old male presenting with a giant atypical prolactinoma refractory to previous therapies, including pharmacotherapy and repetitive surgery. He underwent image-guided fractionated stereotactic radiotherapy in 28 fractions, resulting in early manifestation of CH associated with undisputed, both radiological and hormonal response. He recovered well after a shunt placement, with otherwise favorable consequences such as sustained tumor regression, decreasing prolactin level, and retained visual function for a 22-month follow-up. Fractionated stereotactic radiotherapy would provide a viable treatment alternative for these refractory cases, while caution should be exercised regarding the possibility of iatrogenic CH.

  13. Energy Sources (Energy/Power). Industrial Arts, Senior High--Level II. North Dakota Senior High Industrial Arts Curriculum Guides.

    ERIC Educational Resources Information Center

    Lawrence, Allen; And Others

    This course guide for an energy sources course is one of four developed for the energy/power area in the North Dakota senior high industrial arts education program. (Eight other guides are available for two other areas of Industrial Arts--graphic communications and production.) Part 1 provides such introductory information as a definition and…

  14. Plastic Technology (Production). Industrial Arts, Senior High--Level II. North Dakota Senior High Industrial Arts Curriculum Guides.

    ERIC Educational Resources Information Center

    Claus, Robert; And Others

    This course guide for a plastic technology course is one of four developed for the production area in the North Dakota senior high industrial arts education program. (Eight other guides are available for two other areas of Industrial Arts--energy/power and graphic communications.) Part 1 provides such introductory information as a definition and…

  15. Transportation (Energy/Power). Industrial Arts, Senior High--Level II. North Dakota Senior High Industrial Arts Curriculum Guides.

    ERIC Educational Resources Information Center

    Lawrence, Allen; And Others

    This course guide for a transportation course is one of four developed for the energy/power area in the North Dakota senior high industrial arts education program. (Eight other guides are available for two other areas of Industrial Arts--graphic communications and production.) Part 1 provides such introductory information as a definition and…

  16. Power Technology (Energy/Power). Industrial Arts, Senior High--Level II. North Dakota Senior High Industrial Arts Curriculum Guides.

    ERIC Educational Resources Information Center

    Lawrence, Allen; And Others

    This course guide for a power technology course is one of four developed for the energy/power area in the North Dakota senior high industrial arts education program. (Eight other guides are available for two other areas of Industrial Arts--graphic communications and production.) Part 1 provides such introductory information as a definition and…

  17. Intraoperative MR-guided DBS implantation for treating PD and ET

    NASA Astrophysics Data System (ADS)

    Liu, Haiying; Maxwell, Robert E.; Truwit, Charles L.

    2001-05-01

    Deep brain stimulator (DBS) implantation is a promising treatment alternative for suppressing the motor tremor symptoms in Parkinson disease (PD) patient. The main objective is to develop a minimally invasive approach using high spatial resolution and soft-tissue contrast MR imaging techniques to guide the surgical placement of DBS. In the MR-guided procedure, the high spatial resolution MR images were obtained intra-operatively and used to target stereotactically a specific deep brain location. The neurosurgery for craniotomy was performed in the front of the magnet outside of the 10 Gauss line. Aided with positional registration assembly for the stereotactic head frame, the target location (VIM or GPi or STN) in deep brain areas was identified and measured from the MR images in reference to the markers in the calibration assembly of the head frame before the burrhole prep. In 20 patients, MR- guided DBS implantations have been performed according to the new methodology. MR-guided DBS implantation at high magnetic field strength has been shown to be feasible and desirable. In addition to the improved outcome, this offers a new surgical approach in which intra-operative visualization is possible during intervention, and any complications such as bleeding can be assessed in situ immediately prior to dural closure.

  18. Magnetic resonance image-guided versus ultrasound-guided high-intensity focused ultrasound in the treatment of breast cancer

    PubMed Central

    Li, Sheng; Wu, Pei-Hong

    2013-01-01

    Image-guided high-intensity focused ultrasound (HIFU) has been used for more than ten years, primarily in the treatment of liver and prostate cancers. HIFU has the advantages of precise cancer ablation and excellent protection of healthy tissue. Breast cancer is a common cancer in women. HIFU therapy, in combination with other therapies, has the potential to improve both oncologic and cosmetic outcomes for breast cancer patients by providing a curative therapy that conserves mammary shape. Currently, HIFU therapy is not commonly used in breast cancer treatment, and efforts to promote the application of HIFU is expected. In this article, we compare different image-guided models for HIFU and reviewed the status, drawbacks, and potential of HIFU therapy for breast cancer. PMID:23237221

  19. Guiding Principles for Federal Leadership in High Performance and Sustainable Buildings

    EPA Pesticide Factsheets

    This page provides and overview of the memorandum of understanding (MOU) which was voluntarily committed the Agency to follow the Guiding Principles for Federal Leadership in High Performance and Sustainable Buildings.

  20. Practical patterns for stereotactic body radiotherapy to hepatocellular carcinoma in Korea: a survey of the Korean Stereotactic Radiosurgery Group

    PubMed Central

    Bae, Sun Hyun; Kim, Mi-Sook; Jang, Won Il; Kay, Chul-Seung; Kim, Woochul; Kim, Eun Seog; Kim, Jin Ho; Kim, Jin Hee; Yang, Kwang Mo; Lee, Kyu Chan; Chang, A Ram; Jo, Sunmi

    2016-01-01

    Objective To investigate practical patterns for stereotactic body radiotherapy to hepatocellular carcinoma in Korea. Methods In June 2013, the Korean Stereotactic Radiosurgery Group of the Korean Society for Radiation Oncology conducted a national patterns-of-care survey about stereotactic body radiotherapy to the liver lesion in hepatocellular carcinoma, consisting of 19 questions and 2 clinical scenarios. Results All 208 radiation oncologists (100%), who are regular members of Korean Society for Radiation Oncology, responded to this survey. Among these, 95 radiation oncologists were specialists for hepatology; 64 physicians did not use stereotactic body radiotherapy for hepatocellular carcinoma, and 31 physicians used stereotactic body radiotherapy. Most physicians (52%) performed stereotactic body radiotherapy to hepatocellular carcinoma in ≤5 cases per year. Physicians applied stereotactic body radiotherapy according to tumour size and baseline Child–Pugh class. All physicians agreed the use of stereotactic body radiotherapy to 2.8-cm hepatocellular carcinoma with Child–Pugh class of A, while 23 physicians (74%) selected stereotactic body radiotherapy for Child–Pugh class of B. Nineteen physicians (61%) selected stereotactic body radiotherapy to 5-cm hepatocellular carcinoma with Child–Pugh class of A, and only 14 physicians (45%) selected stereotactic body radiotherapy for Child–Pugh class of B. On the other hand, the preferred dose scheme was same as 60 Gy in three fractions. Conclusions Among radiation oncologists in Korea, there was diversity in the practice for stereotactic body radiotherapy to the liver lesion in hepatocellular carcinoma. Additional prospective studies are necessary to standardize the practice and establish Korea-specific practice guidelines for hepatocellular carcinoma stereotactic body radiotherapy. PMID:26826720

  1. Scattering of high order guided wave modes around a through-thickness circular hole

    NASA Astrophysics Data System (ADS)

    Travaglini, Christophe; Bescond, Christophe; França, Demartonne Ramos; Kruger, Silvio E.; Viens, Martin; Bélanger, Pierre

    2016-02-01

    Ultrasonic guided waves have the ability to propagate long distances with minimal attenuation, which makes them particularly interesting in structural health monitoring (SHM) applications. Using the baseline subtraction approach, the signal from a defect-free structure is compared with the actual monitoring signal to detect and locate defects. There are many scientific publications on low-frequency guided waves for SHM purposes, and the interaction between guided wave fundamental modes and defects is also well documented. There is however a very limited number of studies on high order modes. High-frequency guided waves may enable the detection of smaller cracks related to conventional low-frequency guided wave SHM. The main difficulty at high frequency is the existence of several modes with different velocities. This study investigates the scattering of high order guided wave modes around a through-thickness hole with a view to developing a highly sensitive SHM method. A 3D finite element model of a 305 mm × 305 mm × 1.6 mm aluminium plate was used to determine the scattering of cracks on the circumference of a through-thickness hole in the middle of the plate. Crack properties such as orientation, length and depth were studied. A subset of the finite element simulations were validated against experimental results. The experimental setup comprised a film type PZT actuator bonded on the side of the plate and a laser interferometer detector. An input signal centered at 4 MHz was used in all simulations and experiments.

  2. A Survey of Stereotactic Body Radiotherapy in Korea

    PubMed Central

    Bae, Sun Hyun; Kim, Mi-Sook; Jang, Won Il; Kay, Chul-Seung; Kim, Woochul; Kim, Eun Seog; Kim, Jin Ho; Kim, Jin Hee; Yang, Kwang Mo; Lee, Kyu Chan; Chang, A Ram; Jo, Sunmi

    2015-01-01

    Purpose The purpose of this study is to investigate the current status of stereotactic body radiotherapy (SBRT) in Korea. A nationwide survey was conducted by the Korean Stereotactic Radiosurgery Group of the Korean Society for Radiation Oncology (KROG 13-13). Materials and Methods SBRT was defined as radiotherapy with delivery of a high dose of radiation to an extracranial lesion in ≤ 4 fractions. A 16-questionnaire survey was sent by e-mail to the chief of radiation oncology at 85 institutions in June 2013. Results All institutions (100%) responded to this survey. Of these, 38 institutions (45%) have used SBRT and 47 institutions (55%) have not used SBRT. Regarding the treatment site, the lung (92%) and liver (76%) were the two most common sites. The most common schedules were 60 Gy/4 fractions for non-small cell lung cancer, 48 Gy/4 fractions for lung metastases, 60 Gy/3 fractions for hepatocellular carcinoma, and 45 Gy/3 fractions or 40 Gy/4 fractions for liver metastases. Four-dimensional computed tomography (CT) was the most common method for planning CT (74%). During planning CT, the most common method of immobilization was the use of an alpha cradle/vacuum-lock (42%). Conclusion Based on this survey, conduct of further prospective studies will be needed in order to determine the appropriate prescribed doses and to standardize the practice of SBRT. PMID:25578057

  3. Robot Assisted Stereotactic Laser Ablation for a Radiosurgery Resistant Hypothalamic Hamartoma

    PubMed Central

    Acharya, Vinita; Sather, Michael

    2016-01-01

    Hypothalamic hamartomas (HH) are benign tumors that can cause significant morbidity in adults as a cause of epilepsy, particularly gelastic seizures. Open and endoscopic resections of HH offer good seizure control but have high rates of morbidity and are technically challenging. Stereotactic radiosurgery has been an alternative treatment; however, it results in comparably poor seizure control. Recently, in children, stereotactic laser ablation has shown promise as a surgical technique that can combine the best features of both of these approaches for the treatment of HH. Here we present the first reported use of a frameless robot-assisted stereotactic system to treat an HH. The patient had failed two previous Gamma Knife radiosurgery treatments. Post-procedure he had a stable, but unintentional weight loss of 20 kg and a transient episode of hemiparesis the night of the operation. At six months postoperatively the patient remained seizure free. Stereotactic laser ablation may represent a new standard in the treatment of HH in adults, especially in those who have failed radiosurgery. Further study is warranted in this population to determine efficacy and safety profiles. PMID:27217984

  4. Six-Dimensional Correction of Intra-Fractional Prostate Motion with CyberKnife Stereotactic Body Radiation Therapy.

    PubMed

    Lei, Siyuan; Piel, Nathaniel; Oermann, Eric K; Chen, Viola; Ju, Andrew W; Dahal, Kedar N; Hanscom, Heather N; Kim, Joy S; Yu, Xia; Zhang, Guowei; Collins, Brian T; Jha, Reena; Dritschilo, Anatoly; Suy, Simeng; Collins, Sean P

    2011-01-01

    Large fraction radiation therapy offers a shorter course of treatment and radiobiological advantages for prostate cancer treatment. The CyberKnife is an attractive technology for delivering large fraction doses based on the ability to deliver highly conformal radiation therapy to moving targets. In addition to intra-fractional translational motion (left-right, superior-inferior, and anterior-posterior), prostate rotation (pitch, roll, and yaw) can increase geographical miss risk. We describe our experience with six-dimensional (6D) intra-fraction prostate motion correction using CyberKnife stereotactic body radiation therapy (SBRT). Eighty-eight patients were treated by SBRT alone or with supplemental external radiation therapy. Trans-perineal placement of four gold fiducials within the prostate accommodated X-ray guided prostate localization and beam adjustment. Fiducial separation and non-overlapping positioning permitted the orthogonal imaging required for 6D tracking. Fiducial placement accuracy was assessed using the CyberKnife fiducial extraction algorithm. Acute toxicities were assessed using Common Toxicity Criteria v3. There were no Grade 3, or higher, complications and acute morbidity was minimal. Ninety-eight percent of patients completed treatment employing 6D prostate motion tracking with intra-fractional beam correction. Suboptimal fiducial placement limited treatment to 3D tracking in two patients. Our experience may guide others in performing 6D correction of prostate motion with CyberKnife SBRT.

  5. Neutron Spectral Brightness of Cold Guide 4 at the High Flux Isotope Reactor

    NASA Astrophysics Data System (ADS)

    Winn, B. L.; Robertson, J. L.; Iverson, E. B.; Selby, D. L.

    2010-11-01

    The High Flux Isotope Reactor resumed operation in June of 2007 with a supercritical hydrogen cold source in horizontal beam tube 4. Cold guide 4 is a guide system designed to deliver neutrons from this source with a reasonable flux at wavelengths greater than 4 Å to several instruments, and includes a 15-m, 96-section, 4-channel bender. A time-of-flight spectrum with calibrated detector was recorded at port C of cold guide 4, and compared to McStas simulations, to generate a brightness spectrum.

  6. A Phase 1/2 Trial of Brief Androgen Suppression and Stereotactic Radiation Therapy (FASTR) for High-Risk Prostate Cancer

    SciTech Connect

    Bauman, Glenn; Ferguson, Michelle; Lock, Michael; Chen, Jeff; Ahmad, Belal; Venkatesan, V.M.; Sexton, Tracy; D'Souza, David; Loblaw, Andrew; Warner, Andrew; Rodrigues, George

    2015-07-15

    Purpose: To initiate a phase 1/2 trial to examine the tolerability of a condensed combined-modality protocol for high-risk prostate cancer. Methods and Materials: Men scoring ≥3 on the Vulnerable Elderly Scale (VES) or refusing conventionally fractionated treatment for high-risk prostate cancer were eligible to participate. Androgen suppression was delivered for 12 months, and radiation therapy was delivered using 25 Gy to pelvic nodes delivered synchronously with 40 Gy to the prostate given as 1 fraction per week over 5 weeks. The phase 1 component included predetermined stopping rules based on 6-month treatment-related toxicity, with trial suspension specified if there were ≥6 of 15 patients (40%) or ≥3 of 15 (20%) who experienced grade ≥2 or ≥3 gastrointestinal (GI) or genitourinary (GU) toxicity, respectively. Results: Sixteen men were enrolled, with 7 men meeting the criteria of VES ≥3 and 9 men having a VES <3 but choosing the condensed treatment. One man was not treated owing to discovery of a synchronous primary rectal cancer. Four patients (26%) experienced grade ≥2 toxicity at 6 weeks after treatment. There were 9 of 15 (60%) who experienced grade ≥2 GI or GU toxicity and 4 of 15 (26%) grade ≥3 GI or GU toxicity at 6 months, and 5 of 15 (30%) grade ≥2 GI and GU toxicity at 6 months. A review of the 15 cases did not identify any remedial changes, thus the phase 1 criteria were not met. Conclusion: This novel condensed treatment had higher than anticipated late toxicities and was terminated before phase 2 accrual. Treatment factors, such as inclusion of pelvic lymph node radiation therapy, planning constraints, and treatment margins, or patient factors related to the specific frail elderly population may be contributing.

  7. 1D profiling using highly dispersive guided waves

    NASA Astrophysics Data System (ADS)

    Volker, Arno; Brandenburg, Martijn

    2017-02-01

    Corrosion is one of the industries major issues regarding the integrity of assets. Currently inspections are conducted at regular intervals to ensure a sufficient integrity level of these assets. There are many situations where the actual defect location is not accessible, e.g., a pipe support or a partially buried pipe. Last year an approach was presented using a phase inversion of guided waves that propagated around the circumference of a pipe. This approach works well for larger corrosion spots, but shows significant under-sizing of small spots due to lack of sufficient phase rotation. In this paper the use of arrival time and amplitude loss of higher order circumferential passes is evaluated. Using higher order passes increases sensitivity for sizing smaller defects. Different defect profiles are assumed and the change in arrival time and amplitude loss are calculated using a wave equation based approach for different defect widths and depths. This produces a differential travel time and amplitude change map as function of defect depth and defect width. The actually measured travel time change and amplitude change produces two contours in these maps. Calculating the intersection point gives the defect dimensions. The contours for amplitude loss and travel time change are quite orthogonal, this yields a good discrimination between deep and shallow defects. The approach is evaluated using experimental data from different pipes contain artificial and real defects.

  8. Stereotactic radiosurgery for trigeminal neuralgia utilizing the BrainLAB Novalis system.

    PubMed

    Zahra, Hadi; Teh, Bin S; Paulino, Arnold C; Yoshor, Daniel; Trask, Todd; Baskin, David; Butler, E Brian

    2009-12-01

    Stereotactic radiosurgery (SRS) is one of the least invasive treatments for trigeminal neuralgia (TN). To date, most reports have been about Cobalt-based treatments (i.e., Gamma Knife) with limited data on image-guided stereotactic linear accelerator treatments. We describe our initial experience of using BrainLAB Novalis stereotactic system for the radiosurgical treatment of TN. A total of 20 patients were treated between July 2004 and February 2007. Each SRS procedure was performed using the BrainLAB Novalis System. Thin cuts MRI images of 1.5 mm thickness were acquired and fused with the simulation CT of each patient. Majority of the patients received a maximum dose of 90 Gy. The median brainstem dose to 1.0 cc and 0.1 cc was 2.3 Gy and 13.5 Gy, respectively. In addition, specially acquired three-dimensional fast imaging sequence employing steady-state acquisition (FIESTA) MRI was utilized to improve target delineation of the trigeminal proximal nerve root entry zone. Barrow Neurological Index (BNI) pain scale for TN was used for assessing treatment outcome. At a median follow-up time of 14.2 months, 19 patients (95%) reported at least some improvement in pain. Eight (40%) patients were completely pain-free and stopped all medications (BNI Grade I) while another 2 (10%) patients also stopped medications but reported occasional pain (BNI Grade II). Another 2 (10%) patients reported no pain and 7 (35%) patients only occasional pain while continuing medications, BNI Grade IIIA and IIIB, respectively. Median time to pain control was 8.5 days (range: 1-70 days). No patient reported severe pain, worsening pain or any pain not controlled on their previously taken medication. Intermittent or persistent facial numbness following treatments occurred in 35% of patients. No other complications were reported. Stereotactic radiosurgery using the BrainLAB Novalis system is a safe and effective treatment for TN. This information is important as more centers are obtaining image-guided

  9. Convection-enhanced delivery improves MRI visualization of basal ganglia for stereotactic surgery.

    PubMed

    Bond, Aaron E; Dallapiazza, Robert F; Lopes, M Beatriz; Elias, W Jeffrey

    2016-11-01

    OBJECTIVE Stereotactic deep brain stimulation surgery is most commonly performed while patients are awake. This allows for intraoperative clinical assessment and electrophysiological target verification, thereby promoting favorable outcomes with few side effects. Intraoperative CT and MRI have challenged this concept of clinical treatment validation. Image-guided surgery is capable of delivering electrodes precisely to a planned, stereotactic target; however, these methods can be limited by low anatomical resolution even with sophisticated MRI modalities. The authors are developing a novel method using convection-enhanced delivery to safely manipulate the extracellular space surrounding common anatomical targets for surgery. By altering the extracellular content of deep subcortical structures and their associated white matter tracts, the MRI visualization of the basal ganglia can be improved to better define the anatomy. This technique could greatly improve the accuracy and success of stereotactic surgery, potentially eliminating the reliance on awake surgery. METHODS Observations were made in the clinical setting where vasogenic and cytotoxic edema improved the MRI visualization of the basal ganglia. These findings were replicated in the experimental setting using an FDA-approved intracerebral catheter that was stereotactically inserted into the thalamus or basal ganglia of 7 swine. Five swine were infused with normal saline, and 2 were infused with autologous CSF. Flow rates varied between 1 μl/min to 6 μl/min to achieve convective distributions. Concurrent MRI was performed at 15-minute intervals to monitor the volume of infusion and observe the imaging changes of the deep subcortical structures. The animals were then clinically observed, and necropsy was performed within 48 hours, 1 week, or 1 month for histological analysis. RESULTS In all animals, the white matter tracts became hyperintense on T2-weighted imaging as compared with basal ganglia nuclei

  10. Stereotactic radiosurgery for multiple brain metastases

    NASA Astrophysics Data System (ADS)

    Lee, Anna; (Josh Yamada, Yoshiya

    2017-01-01

    Whole brain radiation therapy has been the traditional treatment of choice for patients with multiple brain metastases. Although stereotactic radiosurgery is widely accepted for the management to up to 4 brain metastases, its use is still controversial in cases of 5 or more brain metastases. Randomized trials have suggested that stereotactic radiosurgery alone is appropriate in up to 4 metastases without concomitant whole brain radiation. Level 1 evidence also suggests that withholding whole brain radiation may also reduce the impact of radiation on neurocognitive function and also may even offer a survival advantage. A recent analysis of a large multicentre prospective database has suggested that there are no differences in outcomes such as the likelihood of new metastasis or leptomeningeal disease in cases of 2-10 brain metastases, nor in overall survival. Hence in the era of prolonged survival with stage IV cancer, stereotactic radiosurgery is a reasonable alternative to whole brain radiation in order to minimize the impact of treatment upon quality of life without sacrificing overall survival.

  11. Futures, 1999: Your Guide to Life after High School.

    ERIC Educational Resources Information Center

    Kentucky Council on Postsecondary Education, Frankfort.

    Futures is an annual resource document designed to help high school students prepare for post-high school activities and decisions. Materials are provided for a variety of audiences, including counselors and teachers, students, and parents. The resource document covers high school curriculum choice, employment and work profiles for a variety of…

  12. Brain mapping in stereotactic surgery: a brief overview from the probabilistic targeting to the patient-based anatomic mapping.

    PubMed

    Lemaire, Jean-Jacques; Coste, Jérôme; Ouchchane, Lemlih; Caire, François; Nuti, Christophe; Derost, Philippe; Cristini, Vittorio; Gabrillargues, Jean; Hemm, Simone; Durif, Franck; Chazal, Jean

    2007-01-01

    In this article, we briefly review the concept of brain mapping in stereotactic surgery taking into account recent advances in stereotactic imaging. The gold standard continues to rely on probabilistic and indirect targeting, relative to a stereotactic reference, i.e., mostly the anterior (AC) and the posterior (PC) commissures. The theoretical position of a target defined on an atlas is transposed into the stereotactic space of a patient's brain; final positioning depends on electrophysiological analysis. The method is also used to analyze final electrode or lesion position for a patient or group of patients, by projection on an atlas. Limitations are precision of definition of the AC-PC line, probabilistic location and reliability of the electrophysiological guidance. Advances in MR imaging, as from 1.5-T machines, make stereotactic references no longer mandatory and allow an anatomic mapping based on an individual patient's brain. Direct targeting is enabled by high-quality images, an advanced anatomic knowledge and dedicated surgical software. Labeling associated with manual segmentation can help for the position analysis along non-conventional, interpolated planes. Analysis of final electrode or lesion position, for a patient or group of patients, could benefit from the concept of membership, the attribution of a weighted membership degree to a contact or a structure according to its level of involvement. In the future, more powerful MRI machines, diffusion tensor imaging, tractography and computational modeling will further the understanding of anatomy and deep brain stimulation effects.

  13. Stereotactic Laser Ablation for Medically Intractable Epilepsy: The Next Generation of Minimally Invasive Epilepsy Surgery

    PubMed Central

    LaRiviere, Michael J.; Gross, Robert E.

    2016-01-01

    Epilepsy is a common, disabling illness that is refractory to medical treatment in approximately one-third of patients, particularly among those with mesial temporal lobe epilepsy. While standard open mesial temporal resection is effective, achieving seizure freedom in most patients, efforts to develop safer, minimally invasive techniques have been underway for over half a century. Stereotactic ablative techniques, in particular, radiofrequency (RF) ablation, were first developed in the 1960s, with refinements in the 1990s with the advent of modern computed tomography and magnetic resonance-based imaging. In the past 5 years, the most recent techniques have used MRI-guided laser interstitial thermotherapy (LITT), the development of which began in the 1980s, saw refinements in MRI thermal imaging through the 1990s, and was initially used primarily for the treatment of intracranial and extracranial tumors. The present review describes the original stereotactic ablation trials, followed by modern imaging-guided RF ablation series for mesial temporal lobe epilepsy. The developments of LITT and MRI thermometry are then discussed. Finally, the two currently available MRI-guided LITT systems are reviewed for their role in the treatment of mesial temporal lobe and other medically refractory epilepsies. PMID:27995127

  14. Extracranial stereotactic body radiotherapy. Review of main SBRT features and indications in primary tumors

    PubMed Central

    Rubio, Carmen; Morera, Rosa; Hernando, Ovidio; Leroy, Thomas.; Lartigau, S. Eric

    2013-01-01

    Aim Review of main SBRT features and indications in primary tumors. Background Stereotactic body radiotherapy has been developed in the last few years. SBRT allows the hypofractionated treatment of extra cranial tumors, using either a single or limited number of dose fractions, and resulting in the delivery of a high biological effective dose with low toxicity. Material and methods SBRT requires a high level of accuracy for all phases of the treatment process: effective patient immobilization, precise target localization, highly conformed dosimetry and image guided systems for treatment verification. The implementation of SBRT in routine requires a careful considering of organ motion. Gating and tracking are effective ways to do so, and less invasive technologies “fiducials free” have been developed. Due to the hypofractionated scheme, the physician must pay attention to new dosimetric constraints in organ at risk and new radiobiological models are needed to assess the optimal fractionation and dose schemes. Results Currently, SBRT is safe and effective to treat primary tumors, which are otherwise untreatable with conventional radiotherapy or surgery. SBRT has quickly developed because of its excellent results in terms of tolerance and its high locoregional control rates. SBRT indications in primary tumors, such as lung primary tumors, have become a standard of care for inoperable patients. SBRT seems to be effective in many others indications in curative or palliative intent such as liver primary tumors, and novel indications and strategies are currently emerging in prostate cancer, head and neck tumor recurrences or pelvis reirradiations. Conclusion Currently, SBRT is mainly used when there is no other therapeutic alternative for the patient. This is due to the lack of randomized trials in these settings. However, the results shown in retrospective studies let us hope to impose SBRT as a new standard of care for many patients in the next few years. PMID

  15. Initial Experience with a Cone-beam Breast Computed Tomography-guided Biopsy System

    PubMed Central

    Seifert, Posy J; Morgan, Renee C; Conover, David L; Arieno, Andrea L

    2017-01-01

    Objective: To evaluate our initial experience with a cone-beam breast computed tomography (BCT)-guided breast biopsy system for lesion retrieval in phantom studies for use with a cone-beam BCT imaging system. Materials and Methods: Under the Institutional Review Board approval, a phantom biopsy study was performed using a dedicated BCT-guided biopsy system. Fifteen biopsies were performed on each of the small, medium, and large anthropomorphic breast phantoms with both BCT and stereotactic guidance for comparison. Each set of the 45 phantoms contained masses and calcification clusters of varying sizes. Data included mass/calcium retrieval rate and dose and length of procedure time for phantom studies. Results: Phantom mass and calcium retrieval rate were 100% for BCT and stereotactic biopsy. BCT dose for small and medium breast phantoms was found to be equivalent to or less than the corresponding stereotactic approach. Stereotactic-guided biopsy dose was 34.2 and 62.5 mGy for small and medium breast phantoms, respectively. BCT-guided biopsy dose was 15.4 and 30.0 mGy for small and medium breast phantoms, respectively. Both computed tomography biopsy and stereotactic biopsy study time ranged from 10 to 20 min. Conclusion: Initial experience with a BCT-guided biopsy system has shown to be comparable to stereotactic biopsy in phantom studies with equivalent or decreased dose. PMID:28217404

  16. A simple guide screw method for intracranial xenograft studies in mice.

    PubMed

    Donoghue, Jacqueline F; Bogler, Oliver; Johns, Terrance G

    2011-09-26

    The grafting of human tumor cells into the brain of immunosuppressed mice is an established method for the study of brain cancers including glioblastoma (glioma) and medulloblastoma. The widely used stereotactic approach only allows for the injection of a single animal at a time, is labor intensive and requires highly specialized equipment. The guide screw method, initially developed by Lal et al.,(1) was developed to eliminate cumbersome stereotactic procedures. We now describe a modified guide screw approach that is rapid and exceptionally safe; both of which are critical ethical considerations. Notably, our procedure now incorporates an infusion pump that allows up to 10 animals to be simultaneously injected with tumor cells. To demonstrate the utility of this procedure, we established human U87MG glioma cells as intracranial xenografts in mice, which were then treated with AMG102; a fully human antibody directed to HGF/scatter factor currently undergoing clinical evaluation(2-5). Systemic injection of AMG102 significantly prolonged the survival of all mice with intracranial U87MG xenografts and resulted in a number of complete cures. This study demonstrates that the guide screw method is an inexpensive, highly reproducible approach for establishing intracranial xenografts. Furthermore, it provides a relevant physiological model for validating novel therapeutic strategies for the treatment of brain cancers.

  17. A Resource Guide for Career Development in the Junior High School.

    ERIC Educational Resources Information Center

    Benson, Arland

    This resource guide for a developmental junior high career education program contains general and specific behavioral objectives, a program description, and a wide range of resource materials, including student and teacher worksheets and evaluation forms. Developed by a junior high counselor and funded by the Elementary Secondary Education Act,…

  18. Stereotactic radiotherapy of meningiomas compressing optical pathways

    SciTech Connect

    Hamm, Klaus-Detlef . E-mail: khamm@erfurt.helios-kliniken.de; Henzel, Martin; Gross, Markus W.; Surber, Gunnar; Kleinert, Gabriele; Engenhart-Cabillic, Rita

    2006-11-15

    Purpose: Microsurgical resection is usually the treatment of choice for meningiomas, especially for those that compress the optical pathways. However, in many cases of skull-base meningiomas a high risk of neurological deficits and recurrences exist in cases where the complete tumor removal was not possible. In such cases (fractionated) stereotactic radiotherapy (SRT) can offer an alternative treatment option. We evaluated the local control rate, symptomatology, and toxicity. Patients and Methods: Between 1997 and 2003, 183 patients with skull-base meningiomas were treated with SRT, among them were 65 patients with meningiomas that compressed optical pathways (64 benign, 1 atypical). Of these 65 cases, 20 were treated with SRT only, 27 were subtotally resected before SRT, and 18 underwent multiple tumor resections before SRT. We investigated the results until 2005, with a median follow-up of 45 months (range, 22-83 months). The tumor volume (TV = gross tumor volume) ranged from 0.61 to 90.20 cc (mean, 18.9 cc). Because of the risk of new visual disturbances, the dose per fraction was either 2 or 1.8 Gy for all patients, to a total dose of 50 to 60 Gy. Results: The overall survival and the progression-free survival rates for 5 years were assessed to 100% in this patient group. To date, no progression for these meningiomas have been observed. Quantitatively, tumor shrinkage of more than 20%, or more than 2 mm in diameter, was proved in 35 of the 65 cases after SRT. In 29 of the 65 patients, at least 1 of the symptoms improved. On application of the Common Toxicity Criteria (CTC), acute toxicity (Grade 3) was seen in 1 case (worsening of conjunctivitis). Another 2 patients developed late toxicity by LENT-SOMA score, 1 x Grade 1 and 1 x Grade 3 (field of vision loss). Conclusion: As a low-risk and effective treatment option for tumor control, SRT with 1.8 to 2.0 Gy per fraction can also be recommended in case of meningiomas that compress optical pathways. An

  19. Dosimetric verification of stereotactic radiosurgery/stereotactic radiotherapy dose distributions using Gafchromic EBT3

    SciTech Connect

    Cusumano, Davide; Fumagalli, Maria L.; Marchetti, Marcello; Fariselli, Laura; De Martin, Elena

    2015-10-01

    Aim of this study is to examine the feasibility of using the new Gafchromic EBT3 film in a high-dose stereotactic radiosurgery and radiotherapy quality assurance procedure. Owing to the reduced dimensions of the involved lesions, the feasibility of scanning plan verification films on the scanner plate area with the best uniformity rather than using a correction mask was evaluated. For this purpose, signal values dispersion and reproducibility of film scans were investigated. Uniformity was then quantified in the selected area and was found to be within 1.5% for doses up to 8 Gy. A high-dose threshold level for analyses using this procedure was established evaluating the sensitivity of the irradiated films. Sensitivity was found to be of the order of centiGray for doses up to 6.2 Gy and decreasing for higher doses. The obtained results were used to implement a procedure comparing dose distributions delivered with a CyberKnife system to planned ones. The procedure was validated through single beam irradiation on a Gafchromic film. The agreement between dose distributions was then evaluated for 13 patients (brain lesions, 5 Gy/die prescription isodose ~80%) using gamma analysis. Results obtained using Gamma test criteria of 5%/1 mm show a pass rate of 94.3%. Gamma frequency parameters calculation for EBT3 films showed to strongly depend on subtraction of unexposed film pixel values from irradiated ones. In the framework of the described dosimetric procedure, EBT3 films proved to be effective in the verification of high doses delivered to lesions with complex shapes and adjacent to organs at risk.

  20. Robust frameless stereotactic localization in extra-cranial radiotherapy

    SciTech Connect

    Riboldi, Marco; Baroni, Guido; Spadea, Maria Francesca; Bassanini, Fabio; Tagaste, Barbara; Garibaldi, Cristina; Orecchia, Roberto; Pedotti, Antonio

    2006-04-15

    In the field of extra-cranial radiotherapy, several inaccuracies can make the application of frameless stereotactic localization techniques error-prone. When optical tracking systems based on surface fiducials are used, inter- and intra-fractional uncertainties in marker three-dimensional (3D) detection may lead to inexact tumor position estimation, resulting in erroneous patient setup. This is due to the fact that external fiducials misdetection results in deformation effects that are poorly handled in a rigid-body approach. In this work, the performance of two frameless stereotactic localization algorithms for 3D tumor position reconstruction in extra-cranial radiotherapy has been specifically tested. Two strategies, unweighted versus weighted, for stereotactic tumor localization were examined by exploiting data coming from 46 patients treated for extra-cranial lesions. Measured isocenter displacements and rotations were combined to define isocentric procedures, featuring 6 degrees of freedom, for correcting patient alignment (isocentric positioning correction). The sensitivity of the algorithms to uncertainties in the 3D localization of fiducials was investigated by means of 184 numerical simulations. The performance of the implemented isocentric positioning correction was compared to conventional point-based registration. The isocentric positioning correction algorithm was tested on a clinical dataset of inter-fractional and intra-fractional setup errors, which was collected by means of an optical tracker on the same group of patients. The weighted strategy exhibited a lower sensitivity to fiducial localization errors in simulated misalignments than those of the unweighted strategy. Isocenter 3D displacements provided by the weighted strategy were consistently smaller than those featured by the unweighted strategy. The peak decrease in median and quartile values of isocenter 3D displacements were 1.4 and 2.7 mm, respectively. Concerning clinical data, the

  1. Theory of high-frequency waves in a coaxial plasma wave guide

    NASA Astrophysics Data System (ADS)

    Maraghechi, B.; Farrokhi, B.; Willett, J. E.

    1999-10-01

    An analysis of the high-frequency eigenmodes of a coaxial wave guide containing a magnetized annular plasma column is presented. A transcendental equation is derived from the boundary conditions in the form of an eighth-order determinant equated to zero. Simultaneous solution of this determinantal equation and a polynomial equation derived from the wave equation yields the dispersion relations for the eigenmodes. By reduction of the order of the determinant the appropriate transcendental equation is easily obtained for some special cases, e.g., partially filled coaxial wave guide. The electrostatic treatment of a coaxial cylindrical wave guide is also presented. The corresponding transcendental equation is reduced to some special cases, e.g., conventional wave guide containing an annular plasma column under electrostatic approximation. Numerical solutions are obtained for some azimuthally symmetric EH (perturbed TM) and HE (perturbed TE) wave guide modes, cyclotron modes, and space-charge modes. A strong dependence of the frequencies of these electromagnetic-electrostatic waves on the radii of the coaxial wave guide and the plasma column is revealed.

  2. Curriculum in Food Handling and Distribution; a Guide for Experimentation in High School and Post High School Vocational Training.

    ERIC Educational Resources Information Center

    Stiles, Philip G.; And Others

    The project developed an experimental curriculum guide for training persons at the high school and post-high school levels in food handling and distribution. Data were gathered through interviews with over 200 food industries in Connecticut. Courses and curriculums were obtained from six secondary schools and seven post-secondary schools. Some of…

  3. Noncontact monitoring of fatigue crack growth using high frequency guided waves

    NASA Astrophysics Data System (ADS)

    Masserey, B.; Fromme, P.

    2014-03-01

    The development of fatigue cracks at fastener holes due to stress concentration is a common problem in aircraft maintenance. This contribution investigates the use of high frequency guided waves for the non-contact monitoring of fatigue crack growth in tensile, aluminium specimens. High frequency guided ultrasonic waves have a good sensitivity for defect detection and can propagate along the structure, thus having the potential for the inspection of difficult to access parts by means of non-contact measurements. Experimentally the required guided wave modes are excited using standard wedge transducers and measured using a laser interferometer. The growth of fatigue cracks during cyclic loading was monitored optically and the resulting changes in the signal caused by crack growth are quantified. Full three-dimensional simulation of the scattering of the high frequency guided ultrasonic waves at the fastener hole and crack has been implemented using the Finite Difference (FD) method. The comparison of the results shows a good agreement of the measured and predicted scattered field of the guided wave at quarter-elliptical and through-thickness fatigue cracks. The measurements show a good sensitivity for the early detection of fatigue damage and for the monitoring of fatigue crack growth at a fastener hole. The sensitivity and repeatability are ascertained, and the robustness of the methodology for practical in-situ ultrasonic monitoring of fatigue crack growth is discussed.

  4. Which Type of Inquiry Project Do High School Biology Students Prefer: Open or Guided?

    NASA Astrophysics Data System (ADS)

    Sadeh, Irit; Zion, Michal

    2012-10-01

    In teaching inquiry to high school students, educators differ on which method of teaching inquiry is more effective: Guided or open inquiry? This paper examines the influence of these two different inquiry learning approaches on the attitudes of Israeli high school biology students toward their inquiry project. The results showed significant differences between the two groups: Open inquiry students were more satisfied and felt they gained benefits from implementing the project to a greater extent than guided inquiry students. On the other hand, regarding documentation throughout the project, guided inquiry students believed that they conducted more documentation, as compared to their open inquiry peers. No significant differences were found regarding `the investment of time', but significant differences were found in the time invested and difficulties which arose concerning the different stages of the inquiry process: Open inquiry students believed they spent more time in the first stages of the project, while guided inquiry students believed they spent more time in writing the final paper. In addition, other differences were found: Open inquiry students felt more involved in their project, and felt a greater sense of cooperation with others, in comparison to guided inquiry students. These findings may help teachers who hesitate to teach open inquiry to implement this method of inquiry; or at least provide their students with the opportunity to be more involved in inquiry projects, and ultimately provide their students with more autonomy, high-order thinking, and a deeper understanding in performing science.

  5. High precision ultrasonic guided wave technique for inspection of power transmission line

    NASA Astrophysics Data System (ADS)

    Cheng, Jun; Qiu, Jinhao; Ji, Hongli; Wang, Enrong; Takagi, Toshiyuki; Uchimoto, Tetsuya

    2017-01-01

    Due to the merits of high inspection speed and long detecting distance, Ultrasonic Guided Wave(UGW) method has been commonly applied to the on-line maintenance of power transmission line. However, the guided wave propagation in this structure is very complicated, leading to the unfavorable defect localization accuracy. Aiming at this situation, a high precision UGW technique for inspection of local surface defect in power transmission line is proposed. The technique is realized by adopting a novel segmental piezoelectric ring transducer and transducer mounting scheme, combining with the comprehensive characterization of wave propagation and circumferential defect positioning with multiple piezoelectric elements. Firstly, the propagation path of guided waves in the multi-wires of transmission line under the proposed technique condition is investigated experimentally. Next, the wave velocities are calculated by dispersion curves and experiment test respectively, and from comparing of the two results, the guided wave mode propagated in transmission line is confirmed to be F(1,1) mode. Finally, the axial and circumferential positioning of local defective wires in transmission line are both achieved, by using multiple piezoelectric elements to surround the stands and send elastic waves into every single wire. The proposed research can play a role of guiding the development of highly effective UGW method and detecting system for multi-wire transmission line.

  6. Curriculum Guide for Art Education in the Senior High School.

    ERIC Educational Resources Information Center

    Byar, Corinne L.; Dougherty, Marguerite D.

    This course outline for art education at the senior high school level aims to promote the development of each child so that he is not only proficient in measurable skills and knowledge but is also a resourceful and creative individual. The suggested teaching activities include classroom demonstrations and slide shows followed by student…

  7. Guide to School Design: Healthy + High Performance Schools

    ERIC Educational Resources Information Center

    Healthy Schools Network, Inc., 2007

    2007-01-01

    A "healthy and high performance school" uses a holistic design process to promote the health and comfort of children and school employees, as well as conserve resources. Children may spend over eight hours a day at school with little, if any, legal protection from environmental hazards. Schools are generally not well-maintained; asthma is a…

  8. [Brain radiation necrosis after stereotactic radiotherapy of the resection cavity for intracranial metastases: analysis of the literature from four cases].

    PubMed

    Doré, M; Lefebvre, L; Delpon, G; Thillays, F

    2015-04-01

    Stereotactic hypofractionated radiotherapy after resection of brain metastasis is an alternative to whole brain radiotherapy. A high dose per fraction is associated with a risk of radiation necrosis. We present four cases of confirmed histological radiation necrosis. Differentiating recurrent tumour from radiation necrosis in this scenario is challenging. An enhancing area in magnetic resonance imaging (MRI) with a "cut bell pepper" appearance may suggest radiation necrosis. Advanced imaging modalities such as perfusion MR imaging and positron emission tomography can be useful. Dosimetric predictors of the occurrence of radiation necrosis after stereotactic hypofractionated radiotherapy are poorly understood and require prospective studies on larger cohorts.

  9. Inception of a national multidisciplinary registry for stereotactic radiosurgery.

    PubMed

    Sheehan, Jason P; Kavanagh, Brian D; Asher, Anthony; Harbaugh, Robert E

    2016-01-01

    Stereotactic radiosurgery (SRS) represents a multidisciplinary approach to the delivery of ionizing high-dose radiation to treat a wide variety of disorders. Much of the radiosurgical literature is based upon retrospective single-center studies along with a few randomized controlled clinical trials. More timely and effective evidence is needed to enhance the consistency and quality of and clinical outcomes achieved with SRS. The authors summarize the creation and implementation of a national SRS registry. The American Association of Neurological Surgeons (AANS) through NeuroPoint Alliance, Inc., started a successful registry effort with its lumbar spine initiative. Following a similar approach, the AANS and NeuroPoint Alliance collaborated with corporate partners and the American Society for Radiation Oncology to devise a data dictionary for an SRS registry. Through administrative and financial support from professional societies and corporate partners, a framework for implementation of the registry was created. Initial plans were devised for a 3-year effort encompassing 30 high-volume SRS centers across the country. Device-specific web-based data-extraction platforms were built by the corporate partners. Data uploaders were then used to port the data to a common repository managed by Quintiles, a national and international health care trials company. Audits of the data for completeness and veracity will be undertaken by Quintiles to ensure data fidelity. Data governance and analysis are overseen by an SRS board comprising equal numbers of representatives from the AANS and NeuroPoint Alliance. Over time, quality outcome assessments and post hoc research can be performed to advance the field of SRS. Stereotactic radiosurgery offers a high-technology approach to treating complex intracranial disorders. Improvements in the consistency and quality of care delivered to patients who undergo SRS should be afforded by the national registry effort that is underway.

  10. New developments in intracranial stereotactic radiotherapy for metastases.

    PubMed

    Pinkham, M B; Whitfield, G A; Brada, M

    2015-05-01

    Brain metastases are common and the prognosis for patients with multiple brain metastases treated with whole brain radiotherapy is limited. As systemic disease control continues to improve, the expectations of radiotherapy for brain metastases are growing. Stereotactic radiosurgery (SRS) as a high precision localised irradiation given in a single fraction prolongs survival in patients with a single brain metastasis and functional independence in those with up to three brain metastases. SRS technology has become commonplace and is available in many radiation oncology and neurosurgery departments. With increasing use there is a need for appropriate patient selection, refinement of dose-fractionation and safe integration of SRS with other treatment modalities. We review the evidence for current practice and new developments in the field, with a specific focus on patient-relevant outcomes.

  11. Stereotactic body radiotherapy: a critical review for nonradiation oncologists.

    PubMed

    Kirkpatrick, John P; Kelsey, Christopher R; Palta, Manisha; Cabrera, Alvin R; Salama, Joseph K; Patel, Pretesh; Perez, Bradford A; Lee, Jason; Yin, Fang-Fang

    2014-04-01

    Stereotactic body radiotherapy (SBRT) involves the treatment of extracranial primary tumors or metastases with a few, high doses of ionizing radiation. In SBRT, tumor kill is maximized and dose to surrounding tissue is minimized, by precise and accurate delivery of multiple radiation beams to the target. This is particularly challenging, because extracranial lesions often move with respiration and are irregular in shape, requiring careful treatment planning and continual management of this motion and patient position during irradiation. This review presents the rationale, process workflow, and technology for the safe and effective administration of SBRT, as well as the indications, outcome, and limitations for this technique in the treatment of lung cancer, liver cancer, and metastatic disease.

  12. Normal tissue toxicity after small field hypofractionated stereotactic body radiation

    PubMed Central

    Milano, Michael T; Constine, Louis S; Okunieff, Paul

    2008-01-01

    Stereotactic body radiation (SBRT) is an emerging tool in radiation oncology in which the targeting accuracy is improved via the detection and processing of a three-dimensional coordinate system that is aligned to the target. With improved targeting accuracy, SBRT allows for the minimization of normal tissue volume exposed to high radiation dose as well as the escalation of fractional dose delivery. The goal of SBRT is to minimize toxicity while maximizing tumor control. This review will discuss the basic principles of SBRT, the radiobiology of hypofractionated radiation and the outcome from published clinical trials of SBRT, with a focus on late toxicity after SBRT. While clinical data has shown SBRT to be safe in most circumstances, more data is needed to refine the ideal dose-volume metrics. PMID:18976463

  13. Plasma guiding and deflection of high speed projectiles

    NASA Astrophysics Data System (ADS)

    Starikovskiy, Andrey; Miles, Richard; PU Team

    2016-09-01

    The deposition of energy in the air in front of a high-speed projectile can lead to both the reduction of drag and the production of steering moments. Modeling has shown that the major contributor to the drag reduction and the steering moment is the high temperature, low density region that is produced by the energy addition. If the energy addition is off axis, it leads to a non symmetric pressure distribution on the projectile as it passes through this region, producing steering control authority that increases nonlinearly with Mach number. Experiments with a tethered projectile and subsequently with a rotating projectile using pulsed laser energy addition were reported. More recent experiments with a 30-mm diameter projectile in M =3.5 flow have been undertaken using a nozzle driven by a pulsed shock tunnel 9.5 m in length and 100 mm internal diameter. Energy was deposited by Nd-YAG laser with pulse energy of about 3 Joules at 1064nm. The laser pulse duration was 5-6 ns. Preliminary results indicate that the laser spark - flow interaction changes the angular momentum of the model for with a laser pulse energy of 2.85 J, the angle between laser spark axis and the flow 30-0 and a flow speed 1100 m/s.

  14. A Virtual Frame System for Stereotactic Radiosurgery Planning

    SciTech Connect

    Ford, Eric Purger, David; Tryggestad, Erik; McNutt, Todd; Christodouleas, John; Rigamonti, Daniele; Shokek, Ori; Won Sang; Zhou, Jessica; Lim, Michael; Wong, John; Kleinberg, Larry

    2008-11-15

    Purpose: We describe a computerized (or virtual) model of a stereotactic head frame to enable planning prior to the day of radiosurgery. The location of the virtual frame acts as a guide to frame placement on the day of the procedure. Methods and Materials: The software consists of a triangular mesh representation of the essential frame hardware that can be overlaid with any MR scan of the patient and manipulated in three dimensions. The software calculates regions of the head that will actually be accessible for treatment, subject to the geometric constraints of the Leksell Gamma Knife hardware. DICOM-compliant MR images with virtual fiducial markers overlaid onto the image can then be generated for recognition by the treatment planning system. Results: Retrospective evaluation of the software on 24 previously treated patients shows a mean deviation of the position of the virtual frame from the actual frame position of 1.6 {+-} 1.3 mm. Initial clinical use on five patients indicates an average discrepancy of the virtual frame location and the actual frame location of <1 mm. MR images with virtual fiducial markers can be imported into radiosurgical treatment planning software and used to generate an initial treatment plan. Conclusions: The virtual frame provides a tool for prospective determination of lesion accessibility, optimization of the frame placement, and treatment planning before the day of the procedure. This promises to shorten overall treatment times, improve patient comfort, and reduce the need for repeat treatments due to suboptimally placed frames.

  15. Stereotactic guidance for navigated percutaneous sacroiliac joint fusion

    PubMed Central

    Lee, Darrin J.; Kim, Sung-Bum; Rosenthal, Philip; Panchal, Ripul R.; Kim, Kee D.

    2016-01-01

    Abstract Arthrodesis of the sacroiliac joint (SIJ) for surgical treatment of SIJ dysfunction has regained interest among spine specialists. Current techniques described in the literature most often utilize intraoperative fluoroscopy to aid in implant placement; however, image guidance for SIJ fusion may allow for minimally invasive percutaneous instrumentation with more precise implant placement. In the following cases, we performed percutaneous stereotactic navigated sacroiliac instrumentation using O-arm® multidimensional surgical imaging with StealthStation® navigation (Medtronic, Inc. Minneapolis, MN). Patients were positioned prone and an image-guidance reference frame was placed contralateral to the surgical site. O-arm® integrated with StealthStation® allowed immediate auto-registration. The skin incision was planned with an image-guidance probe. An image-guided awl, drill and tap were utilized to choose a starting point and trajectory. Threaded titanium cage(s) packed with autograft and/or allograft were then placed. O-arm® image-guidance allowed for implant placement in the SIJ with a small skin incision. However, we could not track the cage depth position with our current system, and in one patient, the SIJ cage had to be revised secondary to the anterior breach of sacrum. PMID:28270652

  16. Guided-Mode-Leaky-Mode-Guided-Mode Fiber Interferometer and Its High Sensitivity Refractive Index Sensing Technology.

    PubMed

    Wang, Qi; Li, Chunyue; Zhao, Chengwu; Li, Weizheng

    2016-06-01

    A cascaded symmetrical dual-taper Mach-Zehnder interferometer structure based on guided-mode and leaky-mode interference is proposed in this paper. Firstly, the interference spectrum characteristics of interferometer has been analyzed by the Finite Difference-Beam Propagation Method (FD-BPM). When the diameter of taper waist is 20 μm-30 μm, dual-taper length is 1 mm and taper distance is 4 cm-6 cm, the spectral contrast is higher, which is suitable for sensing. Secondly, experimental research on refractive index sensitivity is carried out. A refractive index sensitivity of 62.78 nm/RIU (refractive index unit) can achieved in the RI range of 1.3333-1.3792 (0%~25% NaCl solution), when the sensor structure parameters meet the following conditions: diameter of taper waist is 24 μm, dual-taper length is 837 μm and taper distance is 5.5 cm. The spectrum contrast is 0.8 and measurement resolution is 1.6 × 10(-5) RIU. The simulation analysis is highly consistent with experimental results. Research shows that the sensor has promising application in low RI fields where high-precision measurement is required due to its high sensitivity and stability.

  17. Guided-Mode-Leaky-Mode-Guided-Mode Fiber Interferometer and Its High Sensitivity Refractive Index Sensing Technology

    PubMed Central

    Wang, Qi; Li, Chunyue; Zhao, Chengwu; Li, Weizheng

    2016-01-01

    A cascaded symmetrical dual-taper Mach-Zehnder interferometer structure based on guided-mode and leaky-mode interference is proposed in this paper. Firstly, the interference spectrum characteristics of interferometer has been analyzed by the Finite Difference-Beam Propagation Method (FD-BPM). When the diameter of taper waist is 20 μm–30 μm, dual-taper length is 1 mm and taper distance is 4 cm–6 cm, the spectral contrast is higher, which is suitable for sensing. Secondly, experimental research on refractive index sensitivity is carried out. A refractive index sensitivity of 62.78 nm/RIU (refractive index unit) can achieved in the RI range of 1.3333–1.3792 (0%~25% NaCl solution), when the sensor structure parameters meet the following conditions: diameter of taper waist is 24 μm, dual-taper length is 837 μm and taper distance is 5.5 cm. The spectrum contrast is 0.8 and measurement resolution is 1.6 × 10−5 RIU. The simulation analysis is highly consistent with experimental results. Research shows that the sensor has promising application in low RI fields where high-precision measurement is required due to its high sensitivity and stability. PMID:27258281

  18. Stereotactic radiation therapy for hepatic malignancies.

    PubMed

    Meyer, Jeffrey

    2016-12-01

    Management of primary and secondary tumors of the liver is a complex undertaking involving multi‑disciplinary input. Radiation therapy has played a relatively marginal role in the treatment of liver tumors, but with technological innovations and the growth of the field of stereotactic body radiation therapy (SBRT), this role is evolving. In this review, I discuss the issues of radiation‑induced hepatic toxicity, the planning of liver SBRT treatments, clinical results with SBRT, its place amongst other non‑surgical ablative treatments, and potential future avenues of investigation.

  19. High Voltage Power Supply Design Guide for Space

    NASA Technical Reports Server (NTRS)

    Bever, Renate S.; Ruitberg, Arthur P.; Kellenbenz, Carl W.; Irish, Sandra M.

    2006-01-01

    This book is written for newcomers to the topic of high voltage (HV) in space and is intended to replace an earlier (1970s) out-of-print document. It discusses the designs, problems, and their solutions for HV, mostly direct current, electric power, or bias supplies that are needed for space scientific instruments and devices, including stepping supplies. Output voltages up to 30kV are considered, but only very low output currents, on the order of microamperes. The book gives a brief review of the basic physics of electrical insulation and breakdown problems, especially in gases. It recites details about embedment and coating of the supplies with polymeric resins. Suggestions on HV circuit parts follow. Corona or partial discharge testing on the HV parts and assemblies is discussed both under AC and DC impressed test voltages. Electric field analysis by computer on an HV device is included in considerable detail. Finally, there are many examples given of HV power supplies, complete with some of the circuit diagrams and color photographs of the layouts.

  20. Nutrition Education: Choose Well, Be Well. A Curriculum Guide for High School.

    ERIC Educational Resources Information Center

    California State Dept. of Education, Sacramento.

    This curriculum guide for high school students contains 20 information acquisition lessons, 6 values awareness lessons, and 5 open-ended discussion lessons. Some lessons contain activities that extend over several days; other lessons contain one specific activity. The nutrition education goals are directed toward the attainment of nutrition…

  1. Nutrition Education: Choose Well, Be Well. A Curriculum Guide for Junior High School.

    ERIC Educational Resources Information Center

    California State Dept. of Education, Sacramento.

    This curriculum guide for junior high school students contains 17 information acquisition lessons, 5 values awareness lessons, and 6 open-ended discussion lessons. Some lessons contain activities that extend over several days; other lessons contain one specific activity. The nutrition education goals are directed toward the attainment of nutrition…

  2. Common Core Standards for High School English Language Arts: A Quick-Start Guide

    ERIC Educational Resources Information Center

    Kendall, John; Frazee, Dana; Ryan, Susan

    2012-01-01

    High school teachers and leaders with responsibility for English language arts (ELA) need this handy guide to successfully implement the Common Core in their respective grade levels. Getting a copy for every staff member ensures they know: (1) How grades 11-12 ELA content differs from and builds upon 9-10 standards; (2) How the four strands…

  3. Coastal Awareness: A Resource Guide for Teachers in Junior High Science.

    ERIC Educational Resources Information Center

    Rasmussen, Frederick A.

    Background information, activity suggestions, and recommended resource materials comprise this guide for designing a week-long ecology unit for junior high school students on Coastal Awareness. Discussed is how various physical processes such as waves, currents, and tides affect rocky shores, marshes, sandy beaches, and estuaries. To encourage…

  4. Occupational Preparation in the Natural Resources: A Suggested High School Curriculum Guide.

    ERIC Educational Resources Information Center

    Mortensen, James H.

    This curriculum guide was developed to provide a model plan to help public high schools and area vocational-technical schools to initiate, or evaluate and improve, natural resource occupational preparation programs. It offers a curriculum plan which can be modified to meet particular needs and objectives which are career education oriented. This…

  5. Development of a Career Student Guide for the Tech Prep Program for Henry County High School.

    ERIC Educational Resources Information Center

    Winchester, Ruth Ann

    This practicum report describes the research conducted in preparation for developing a career student guide to acquaint students attending Henry County High School (HCHS) in McDonough, Georgia, with the school's new tech prep program. Chapters 1 and 2 contain background information about HCHS' tech prep program and a review of literature regarding…

  6. Post High School Transition: A Planning Guide for Educational and Job Placement.

    ERIC Educational Resources Information Center

    Research for Better Schools, Inc., Philadelphia, PA.

    This guide for teachers, counselors, and administrators presents a comprehensive system for educational and job placement aimed at facilitating post high school transition. It emphasizes activities and services for educational placement and job placement and development of student skills leading to self-placement. Chapter 1 describes features of…

  7. GUIDE FOR SOCIAL STUDIES AND SCIENCE-HEALTH, FIRST YEAR. JUNIOR HIGH SCHOOL SPECIAL CURRICULUM.

    ERIC Educational Resources Information Center

    STINCHCOMB, KOMA D.; AND OTHERS

    THIS CURRICULUM GUIDE FOR JUNIOR HIGH EDUCABLE MENTALLY HANDICAPPED STUDENTS PROVIDES INFORMATION ON TEACHING PROCEDURES, SUGGESTIONS FOR PLANNING SUPPLEMENTAL UNITS, TYPES OF LESSONS, AND EVALUATION. INDIVIDUAL UNITS INCLUDE THE INFORMATION CONTENT, SUGGESTIONS FOR BACKGROUND STUDY, SPECIFIC TEACHING PLANS, DISCUSSION QUESTIONS, ASSIGNMENTS,…

  8. The 2009 High School Transcript Study User's Guide. NCES 2011-465

    ERIC Educational Resources Information Center

    Nord, C.; Hicks, L.; Hoover, K.; Jones, M.; Lin, A.; Lyons, M.; Perkins, R.; Roey, S.; Rust, K.; Sickles, D.

    2011-01-01

    This user's guide documents the procedures used to collect, process, and summarize data from the 2009 High School Transcript Study (HSTS 2009). Chapters detail the sampling of schools and graduates (chapters 2 and 3), data collection procedures (chapter 4), data processing procedures (chapter 5), and weighting procedures (chapter 6). Chapter 7…

  9. The Negro in United States History. A Resource Guide (Tentative) for Senior High School.

    ERIC Educational Resources Information Center

    Boston Public Schools, MA.

    GRADES OR AGES: Senior high school (Grades 10-12). SUBJECT MATTER: The Negro in United States history. ORGANIZATION AND PHYSICAL APPEARANCE: The guide has 12 units: 1) African Background; 2) Exploration; 3) The Revolution; 4) The Constitution; 5) Westward Expansion; 6) Slavery; 7) Lincoln and Slavery; 8) The Civil War; 9) Reconstruction; 10)…

  10. Curriculum Assessment Guide. Developing Science Curriculum for High Ability Learners K-8. Draft.

    ERIC Educational Resources Information Center

    Boyce, Linda Neal; And Others

    This guide is intended to assist in the evaluation of elementary science curriculum materials for use with high ability learners, in the light of calls for a "new science" which stresses depth of conceptual understanding. It presents a curriculum review process and two evaluation instruments. The process is intended to balance sound practices of…

  11. Teachers' Guide to Music Appreciation III A and III B in the Senior High School.

    ERIC Educational Resources Information Center

    Scott, J. Mark; Dawkins, Barbara R.

    This guide to music appreciation courses was developed for use in senior high schools in Duval County, Jacksonville, Florida. Music Appreciation III A examines the development of music, from the Gothic period through the Classical period. Music Appreciation III B examines the development of music from the Romantic period through the 1970s.…

  12. Model Rocketry in the Middle School/Junior High School. Grades 6-9. Course Guide.

    ERIC Educational Resources Information Center

    Downs, Gary E.

    Stressing the use of hands-on activities, this guide contains ideas and suggestions for teaching model rocketry to junior high school students. It is intended to be used as a supplemental unit to the existing science curriculum. The unit includes a listing of goals and objectives that are designed to be used by the teacher to correlate this unit…

  13. Natural Resources Technologies: A Suggested Post High School Program Development Guide.

    ERIC Educational Resources Information Center

    Soles, Robert L.

    This post high school program development guide considers the following natural resources technological areas: air pollution control, forest, rangeland, minerals and mineral fuels, geological, outdoor recreation, soil, urban-regional planning, landscape, water, wastewater, oceanography, wildlife, fish, and marine life. Within each area, the…

  14. "Failure Is Not an Option": Struggling High School Uses Standards to Guide Reform

    ERIC Educational Resources Information Center

    Lambertson, Sherry

    2014-01-01

    This article describes the use of standards to guide the reform of a struggling high school in Grant Michigan. The author describes the challenges and obstacles that the school was facing, and admits that school reform was difficult. Turnaround seemed impossible, but it held the promise of something larger than life: successful students who become…

  15. Prospective Mathematics Teachers' Ways of Guiding High School Students in GeoGebra-Supported Inquiry Tasks

    ERIC Educational Resources Information Center

    Hahkioniemi, Markus; Leppaaho, Henry

    2012-01-01

    In this paper, we study how prospective teachers guide students' reasoning in GeoGebra-supported inquiry tasks. Twenty prospective mathematics teachers wrote about how they would react as a teacher in hypothetical situations where high school students present their GeoGebra-supported solutions to the teacher. Before writing their reactions, the…

  16. The 1998 High School Transcript Study User's Guide and Technical Report.

    ERIC Educational Resources Information Center

    Roey, Stephen; Caldwell, Nancy; Rust, Keith; Blumstein, Eyal; Krenzke, Tom; Legum, Stan; Kuhn, Judy; Waksberg, Mark; Haynes, Jacqueline

    The 1998 High School Transcript Study provides the U.S. Department of Education and other educational policymakers with information regarding current course offerings and students' course-taking patterns in U.S. secondary schools. Similar studies were conducted in 1982, 1987, 1990, and 1994. This guide documents the procedures used to collect and…

  17. Consumer Education: A Conceptual Structure and Planning Guide for Senior High Schools in Wisconsin.

    ERIC Educational Resources Information Center

    Appleton Public Schools, WI.

    Prepared by junior and senior high teachers, the curriculum guide is an interdisciplinary approach by the business education, home economics, and social studies departments to a consumer education course. The initial development of materials was field tested and revised; a second-year field testing of the revised curriculum and a final analysis…

  18. BO-CEC Business and Office Careers Course Guide; Junior High and Middle Schools.

    ERIC Educational Resources Information Center

    Colorado State Univ., Ft. Collins. Dept. of Vocational Education.

    The curriculum guide for middle and junior high school grades presents 15 resource units, designed to simulate business career situations, organized into five sections: clerical (receptionist, general office worker, cashier, typist, and accounting clerk), secretarial/stenographic (secretary, court reporter, executive secretary), accounting and…

  19. Social Studies: A Resource Guide for Hearing-Impaired High School Students.

    ERIC Educational Resources Information Center

    Jaggers, Robert A.; Jaggers, Barbara A.

    The guide was written to give secondary level hearing impaired students exposure to real life problems from a social studies perspective. Units are outlined for the three levels of the high school years and provide an overview, information on vocabulary, target competencies, suggested activities, sources, and a list of objectives. The units are…

  20. Makiko's New World: Activities for the High School Classroom. [Videotape with] Teacher's Guide.

    ERIC Educational Resources Information Center

    Stanford Univ., CA. Stanford Program on International and Cross Cultural Education.

    The film "Makiko's New World" offers U.S. high school students a unique glimpse into the latter part of the Meiji Period (1868-1912) in Japanese history. Students have the opportunity to experience the life of one Japanese woman, Makiko, during the Meiji Period through the "lens" of her diary. The teacher's guide was developed…

  1. TU-AB-201-06: Evaluation of Electromagnetically Guided High- Dose Rate Brachytherapy for Ablative Treatment of Lung Metastases

    SciTech Connect

    Pinkham, D.W.; Shultz, D.; Loo, B.W.; Sung, A.; Diehn, M.; Fahimian, B.P.

    2015-06-15

    Purpose: The advent of electromagnetic navigation bronchoscopy has enabled minimally invasive access to peripheral lung tumors previously inaccessible by optical bronchoscopes. As an adjunct to Stereotactic Ablative Radiosurgery (SABR), implantation of HDR catheters can provide focal treatments for multiple metastases and sites of retreatments. The authors evaluate a procedure to deliver ablative doses via Electromagnetically-Guided HDR (EMG-HDR) to lung metastases, quantify the resulting dosimetry, and assess its role in the comprehensive treatment of lung cancer. Methods: A retrospective study was conducted on ten patients, who, from 2009 to 2011, received a hypo-fractionated SABR regimen with 6MV VMAT to lesions in various lobes ranging from 1.5 to 20 cc in volume. A CT visible pathway was delineated for EM guided placement of an HDR applicator (catheter) and dwell times were optimized to ensure at least 98% prescription dose coverage of the GTV. Normal tissue doses were calculated using inhomogeneity corrections via a grid-based Boltzmann solver (Acuros-BV-1.5.0). Results: With EMG-HDR, an average of 83% (+/−9% standard deviation) of each patient’s GTV received over 200% of the prescription dose, as compared to SABR where the patients received an average maximum dose of 125% (+/−5%). EMG-HDR enabled a 59% (+/−12%) decrease in the aorta maximum dose, a 63% (+/−26%) decrease in the spinal cord max dose, and 57% (+/−23%) and 70% (+/−17%) decreases in the volume of the body receiving over 50% and 25% of the prescription dose, respectively. Conclusion: EMG-HDR enables delivery of higher ablative doses to the GTV, while concurrently reducing surrounding normal tissue doses. The single catheter approach shown here is limited to targets smaller than 20 cc. As such, the technique enables ablation of small lesions and a potentially safe and effective retreatment option in situations where external beam utility is limited by normal tissue constraints.

  2. High-Intensity Focused Ultrasound: Current Status for Image-Guided Therapy

    PubMed Central

    Copelan, Alexander; Hartman, Jason; Chehab, Monzer; Venkatesan, Aradhana M.

    2015-01-01

    Image-guided high-intensity focused ultrasound (HIFU) is an innovative therapeutic technology, permitting extracorporeal or endocavitary delivery of targeted thermal ablation while minimizing injury to the surrounding structures. While ultrasound-guided HIFU was the original image-guided system, MR-guided HIFU has many inherent advantages, including superior depiction of anatomic detail and superb real-time thermometry during thermoablation sessions, and it has recently demonstrated promising results in the treatment of both benign and malignant tumors. HIFU has been employed in the management of prostate cancer, hepatocellular carcinoma, uterine leiomyomas, and breast tumors, and has been associated with success in limited studies for palliative pain management in pancreatic cancer and bone tumors. Nonthermal HIFU bioeffects, including immune system modulation and targeted drug/gene therapy, are currently being explored in the preclinical realm, with an emphasis on leveraging these therapeutic effects in the care of the oncology patient. Although still in its early stages, the wide spectrum of therapeutic capabilities of HIFU offers great potential in the field of image-guided oncologic therapy. PMID:26622104

  3. Relativistic electron motion in cylindrical waveguide with strong guiding magnetic field and high power microwave

    SciTech Connect

    Wu, Ping; Sun, Jun; Cao, Yibing

    2015-06-15

    In O-type high power microwave (HPM) devices, the annular relativistic electron beam is constrained by a strong guiding magnetic field and propagates through an interaction region to generate HPM. Some papers believe that the E × B drift of electrons may lead to beam breakup. This paper simplifies the interaction region with a smooth cylindrical waveguide to research the radial motion of electrons under conditions of strong guiding magnetic field and TM{sub 01} mode HPM. The single-particle trajectory shows that the radial electron motion presents the characteristic of radial guiding-center drift carrying cyclotron motion. The radial guiding-center drift is spatially periodic and is dominated by the polarization drift, not the E × B drift. Furthermore, the self fields of the beam space charge can provide a radial force which may pull electrons outward to some extent but will not affect the radial polarization drift. Despite the radial drift, the strong guiding magnetic field limits the drift amplitude to a small value and prevents beam breakup from happening due to this cause.

  4. Is Your Local High School Making the Grade? Ten Elements of Successful High Schools: A Guide for Rural Communities

    ERIC Educational Resources Information Center

    Alliance for Excellent Education, 2009

    2009-01-01

    The Alliance for Excellent Education understands that the first step in improving any rural high school is to encourage and support the active engagement of students, parents, teachers, the community, and business leaders. This guide is designed to give parents and community members some suggested ways to begin thinking about whether their local…

  5. Clinical accuracy of ExacTrac intracranial frameless stereotactic system

    SciTech Connect

    Ackerly, T.; Lancaster, C. M.; Geso, M.; Roxby, K. J.

    2011-09-15

    Purpose: In this paper, the authors assess the accuracy of the Brainlab ExacTrac system for frameless intracranial stereotactic treatments in clinical practice. Methods: They recorded couch angle and image fusion results (comprising lateral, longitudinal, and vertical shifts, and rotation corrections about these axes) for 109 stereotactic radiosurgery and 166 stereotactic radiotherapy patient treatments. Frameless stereotactic treatments involve iterative 6D image fusion corrections applied until the results conform to customizable pass criteria, theirs being 0.7 mm and 0.5 deg. for each axis. The planning CT slice thickness was 1.25 mm. It has been reported in the literature that the CT slices' thickness impacts the accuracy of localization to bony anatomy. The principle of invariance with respect to patient orientation was used to determine spatial accuracy. Results: The data for radiosurgery comprised 927 image pairs, of which 532 passed (pass ratio of 57.4%). The data for radiotherapy comprised 15983 image pairs, of which 10 050 passed (pass ratio of 62.9%). For stereotactic radiotherapy, the combined uncertainty of ExacTrac calibration, image fusion, and intrafraction motion was (95% confidence interval) 0.290-0.302 and 0.306-0.319 mm in the longitudinal and lateral axes, respectively. The combined uncertainty of image fusion and intrafraction motion in the anterior-posterior coordinates was 0.174-0.182 mm. For stereotactic radiosurgery, the equivalent ranges are 0.323-0.393, 0.337-0.409, and 0.231-0.281 mm. The overall spatial accuracy was 1.24 mm for stereotactic radiotherapy (SRT) and 1.35 mm for stereotactic radiosurgery (SRS). Conclusions: The ExacTrac intracranial frameless stereotactic system spatial accuracy is adequate for clinical practice, and with the same pass criteria, SRT is more accurate than SRS. They now use frameless stereotaxy exclusively at their center.

  6. A Rabbit Irradiation Platform for Outcome Assessment of Lung Stereotactic Radiosurgery

    SciTech Connect

    Cai Jing; Mata, Jaime F.; Orton, Matthew D.; Hagspiel, Klaus D.; Mugler, John P.; Larner, James M.; Sheng Ke; Read, Paul W.

    2009-04-01

    Purpose: To evaluate a helical tomotherapy-based rodent radiosurgery platform that reproduces human image-guided radiosurgery treatment to study radiobiologic effects of stereotactic radiosurgery on lung tissues using functional magnetic resonance imaging (MRI). Methods and Materials: Hypofractionated radisourgery (20 Gy x 3) was delivered to the right lung of three New Zealand rabbits using Helical TomoTherapy with MVCT image guidance. Contrast-enhanced MR perfusion, hyperpolarized helium-3 MR ventilation, and CT were obtained before radiation and monthly for 4 months after radiation. All MRI was performed on a 1.5-T whole-body scanner with broad-band capabilities. Results: Precise dose delivery to 1.6 cc of the lower right lung was achieved without additional immobilization. No deficits were detected at baseline with respect to perfusion and ventilation. Lung perfusion deficits in the irradiated lung regions began at 2 months after radiation and worsened with time. No ventilation deficits were observed after radiation. Decrease in lung CT density in irradiated regions was observed after radiation, but the changes were less significant than those in perfusion MRI. Conclusions: We demonstrated that highly conformal radiation can be reproducibly delivered to a small volume of rodent lung on a widely available clinical unit. The radiation-induced lung injury can be detected as early as 2 months after radiation with perfusion MRI. The primary pattern of injury agrees with previously reported endothelial damage to radiosurgical radiation doses. This experimental design provides a cost-effective methodology for producing radiosurgical injuries in rodents that reproduces current human treatments for studying radiation injury and agents that might affect it.

  7. Frameless Angiogram-Based Stereotactic Radiosurgery for Treatment of Arteriovenous Malformations

    SciTech Connect

    Lu Xingqi; Mahadevan, Anand; Mathiowitz, George; Lin, Pei-Jan P.; Thomas, Ajith; Kasper, Ekkehard M.; Floyd, Scott R.; Holupka, Edward; La Rosa, Salvatore; Wang, Frank; Stevenson, Mary Ann

    2012-09-01

    Purpose: Stereotactic radiosurgery (SRS) is an effective alternative to microsurgical resection or embolization for definitive treatment of arteriovenous malformations (AVMs). Digital subtraction angiography (DSA) is the gold standard for pretreatment diagnosis and characterization of vascular anatomy, but requires rigid frame (skull) immobilization when used in combination with SRS. With the advent of advanced proton and image-guided photon delivery systems, SRS treatment is increasingly migrating to frameless platforms, which are incompatible with frame-based DSA. Without DSA as the primary image, target definition may be less than optimal, in some cases precluding the ability to treat with a frameless system. This article reports a novel solution. Methods and Materials: Fiducial markers are implanted into the patient's skull before angiography. Angiography is performed according to the standard clinical protocol, but, in contrast to the previous practice, without the rigid frame. Separate images of a specially designed localizer box are subsequently obtained. A target volume projected on DSA can be transferred to the localizer system in three dimensions, and in turn be transferred to multiple CT slices using the implanted fiducials. Combined with other imaging modalities, this 'virtual frame' approach yields a highly precise treatment plan that can be delivered by frameless SRS technologies. Results: Phantom measurements for point and volume targets have been performed. The overall uncertainty of placing a point target to CT is 0.4 mm. For volume targets, deviation of the transformed contour from the target CT image is within 0.6 mm. The algorithm and software are robust. The method has been applied clinically, with reliable results. Conclusions: A novel and reproducible method for frameless SRS of AVMs has been developed that enables the use of DSA without the requirement for rigid immobilization. Multiple pairs of DSA can be used for better conformality

  8. The first formulation of image-based stereotactic principles: the forgotten work of Gaston Contremoulins.

    PubMed

    Giller, Cole A; Mornet, Patrick; Moreau, Jean-François

    2017-02-17

    Although image-based human stereotaxis began with Spiegel and Wycis in 1947, the major principles of radiographic stereotaxis were formulated 50 years earlier by the French scientific photographer Gaston Contremoulins. In 1897, frustrated by the high morbidity of bullet extraction from the brain, the Parisian surgeon Charles Rémy asked Contremoulins to devise a method for bullet localization using the then new technology of x-rays. In doing so, Contremoulins conceived of many of the modern principles of stereotaxis, including the use of a reference frame, radiopaque fiducials for registration, images to locate the target in relation to the frame, phantom devices to locate the target in relation to the fiducial marks, and the use of an adjustable pointer to guide the surgical approach. Contremoulins' ideas did not emerge from science or medicine, but instead were inspired by his training in the fine arts. Had he been a physician instead of an artist, he might have never discovered his extraordinary methods. Contremoulins' "compass" and its variants enjoyed great success during World War I, but were abandoned by 1920 for simpler methods. Although Contremoulins was one of the most eminent radiographers in France, he was not a physician, and his personality was uncompromising. By 1940, both he and his methods were forgotten. It was not until 1988 that he was rediscovered by Moreau while reviewing the history of French radiology, and chronicled by Mornet in his extensive biography. The authors examine Contremoulins' stereotactic methods in historical context, describe the details of his devices, relate his discoveries to his training in the fine arts, and discuss how his prescient formulation of stereotaxis was forgotten for more than half a century.

  9. Stereotactic Body Radiotherapy for Localized Prostate Cancer: Interim Results of a Prospective Phase II Clinical Trial

    SciTech Connect

    King, Christopher R. Brooks, James D.; Gill, Harcharan; Pawlicki, Todd; Cotrutz, Cristian; Presti, Joseph C.

    2009-03-15

    Purpose: The radiobiology of prostate cancer favors a hypofractionated dose regimen. We report results of a prospective Phase II clinical trial of stereotactic body radiotherapy (SBRT) for localized prostate cancer. Methods and Materials: Forty-one low-risk prostate cancer patients with 6 months' minimum follow-up received 36.25 Gy in five fractions of 7.25 Gy with image-guided SBRT alone using the CyberKnife. The early (<3 months) and late (>6 months) urinary and rectal toxicities were assessed using validated quality of life questionnaires (International Prostate Symptom Score, Expanded Prostate Cancer Index Composite) and the Radiation Therapy Oncology Group (RTOG) toxicity criteria. Patterns of prostate-specific antigen (PSA) response are analyzed. Results: The median follow-up was 33 months. There were no RTOG Grade 4 acute or late rectal/urinary complications. There were 2 patients with RTOG Grade 3 late urinary toxicity and none with RTOG Grade 3 rectal complications. A reduced rate of severe rectal toxicities was observed with every-other-day vs. 5 consecutive days treatment regimen (0% vs. 38%, p = 0.0035). A benign PSA bounce (median, 0.4 ng/mL) was observed in 12 patients (29%) occurring at 18 months (median) after treatment. At last follow-up, no patient has had a PSA failure regardless of biochemical failure definition. Of 32 patients with 12 months minimum follow-up, 25 patients (78%) achieved a PSA nadir {<=}0.4 ng/mL. A PSA decline to progressively lower nadirs up to 3 years after treatment was observed. Conclusions: The early and late toxicity profile and PSA response for prostate SBRT are highly encouraging. Continued accrual and follow-up will be necessary to confirm durable biochemical control rates and low toxicity profiles.

  10. Results of patient specific quality assurance for patients undergoing stereotactic ablative radiotherapy for lung lesions.

    PubMed

    Hardcastle, Nicholas; Clements, Natalie; Chesson, Brent; Aarons, Yolanda; Cramb, Jim; Siva, Shankar; Wanigaratne, Derrick M; Ball, David; Kron, Tomas

    2014-03-01

    Hypofractionated image guided radiotherapy of extracranial targets has become increasingly popular as a treatment modality for inoperable patients with one or more small lesions, often referred to as stereotactic ablative body radiotherapy (SABR). This report details the results of the physical quality assurance (QA) program used for the first 33 lung cancer SABR radiotherapy 3D conformal treatment plans in our centre. SABR involves one or few fractions of high radiation dose delivered in many small fields or arcs with tight margins to mobile targets often delivered through heterogeneous media with non-coplanar beams. We have conducted patient-specific QA similar to the more common intensity modulated radiotherapy QA with particular reference to motion management. Individual patient QA was performed in a Perspex phantom using point dose verification with an ionisation chamber and radiochromic film for verification of the dose distribution both with static and moving detectors to verify motion management strategies. While individual beams could vary by up to 7%, the total dose in the target was found to be within ±2% of the prescribed dose for all 33 plans. Film measurements showed qualitative and quantitative agreement between planned and measured isodose line shapes and dimensions. The QA process highlighted the need to account for couch transmission and demonstrated that the ITV construction was appropriate for the treatment technique used. QA is essential for complex radiotherapy deliveries such as SABR. We found individual patient QA helpful in setting up the technique and understanding potential weaknesses in SABR workflow, thus providing confidence in SABR delivery.

  11. Damage detection using high order longitudinal guided waves (HOLGW) in the anchorage zone of stayed cable

    NASA Astrophysics Data System (ADS)

    Pan, Yong-dong; Jin, Jian; Yang, Feng; Chen, Wei-zhen

    2017-02-01

    High order longitudinal guided waves (HOLGW) are studied for the damage detection in the anchorage zone of stayed cable through the theoretical analysis, numerical simulation and experimental validation. First, based on the theory of elastic wave propagation in cylinder, the dispersion curves of longitudinal modes were obtained and calculated analytically and the high-frequency such as 5MHz corresponding to the higher order longitudinal guided wave modes are identified for the damage detection. Then, the ultrasonic guided waves propagating in a steel wire with or without defects were simulated by using the finite element method and the effects of defect depth and length on the reflection coefficient are studied. Finally, the free wires and a tested cable were studied experimentally. The results show that the finite element method is able to model the high-order guided wave propagation in the steel wire. The agreement between the experiment and theory has demonstrated that the HOLGW is a potential candidate for the damage detection in anchorage zones of stayed-cables.

  12. Application of polymer-gel dosimetry in stereotactic radiosurgery

    NASA Astrophysics Data System (ADS)

    Novotny, J., Jr.; Spevacek, V.; Dvorak, P.; Hrbacek, J.; Novotny, J.; Tlachacova, D.; Schmitt, M.; Vymazal, J.; Tintera, J.; Cechak, T.

    2004-01-01

    Stereotactic irradiation with the Leksell gamma knife (Elekta Instrument AB, Stockholm, Sweden) is one of the primary methods used for the stereotactic radiosurgery treatment of intracranial lesions. To assure the quality of the whole treatment procedure a proper dosimetric system is required. The polymer-gel dosimeter evaluated by nuclear magnetic resonance (NMR) is a promising tool to satisfy this requirement. The purpose of this study was to investigate the use of polymer-gel dosimeter as a dosimetric tool for the quality control of stereotactic radiosurgery procedures performed by the Leksell gamma knife.

  13. A quality assurance program in stereotactic radiosurgery using the Gamma Knife unit.

    PubMed

    Stuecklschweiger, G F; Feichtinger, K

    1998-10-01

    Because of the large single-fraction dose in stereotactic radiosurgery it is important to guarantee a high geometric and dosimetric accuracy. The paper represent the quality assurance program for the Gamma Knife unit at the University Clinic of Neurosurgery in Graz. The program includes the following procedures: timer control, mechanical radiation isocenter coincidence, trunnion centricity, helmet microswitches test, radiation output and relative helmet factors, dose profile verification, safety interlocks checks and software quality assurance. In summary, the mechanical accuracy and reproducibility of the Gamma Knife unit are < 1 mm. The geometric failure in stereotactic Gamma Knife treatment is limited by the human error in setting the clinical target volume and the spatial accuracy of dose delivery to the patient is limited by the accuracy of modern target localization procedures.

  14. Quality Assurance of Immobilization and Target Localization Systems for Frameless Stereotactic Cranial and Extracranial Hypofractionated Radiotherapy

    SciTech Connect

    Solberg, Timothy D. Medin, Paul M.; Mullins, John; Li Sicong

    2008-05-01

    The success of stereotactic radiosurgery has stimulated significant interest in the application of such an approach for the treatment of extracranial tumors. The potential benefits of reduced healthcare costs and improved patient outcomes that could be realized in a high-precision, hypofractionated treatment paradigm are numerous. Image-guidance technologies are eliminating the historic requirement for rigid head fixation and will also accelerate the clinical implementation of the approach in extracranial sites. An essential prerequisite of 'frameless' stereotactic systems is that they provide localization accuracy consistent with the safe delivery of a therapeutic radiation dose given in one or few fractions. In this report, we reviewed the technologies for frameless localization of cranial and extracranial targets with emphasis on the quality assurance aspects.

  15. Dose profile measurements during respiratory-gated lung stereotactic radiotherapy: A phantom study

    NASA Astrophysics Data System (ADS)

    Jong, W. L.; Wong, J. H. D.; Ng, K. H.; Ung, N. M.

    2016-03-01

    During stereotactic body radiotherapy, high radiation dose (∼60 Gy) is delivered to the tumour in small fractionation regime. In this study, the dosimetric characteristics were studied using radiochromic film during respiratory-gated and non-gated lung stereotactic body radiotherapy (SBRT). Specifically, the effect of respiratory cycle and amplitude, as well as gating window on the dosimetry were studied. In this study, the dose profiles along the irradiated area were measured. The dose profiles for respiratory-gated radiation delivery with different respiratory or tumour motion amplitudes, gating windows and respiratory time per cycle were in agreement with static radiation delivery. The respiratory gating system was able to deliver the radiation dose accurately (±1.05 mm) in the longitudinal direction. Although the treatment time for respiratory-gated SBRT was prolonged, this approach can potentially reduce the margin for internal tumour volume without compromising the tumour coverage. In addition, the normal tissue sparing effect can be improved.

  16. Dual mode stereotactic localization method and application

    DOEpatents

    Keppel, Cynthia E.; Barbosa, Fernando Jorge; Majewski, Stanislaw

    2002-01-01

    The invention described herein combines the structural digital X-ray image provided by conventional stereotactic core biopsy instruments with the additional functional metabolic gamma imaging obtained with a dedicated compact gamma imaging mini-camera. Before the procedure, the patient is injected with an appropriate radiopharmaceutical. The radiopharmaceutical uptake distribution within the breast under compression in a conventional examination table expressed by the intensity of gamma emissions is obtained for comparison (co-registration) with the digital mammography (X-ray) image. This dual modality mode of operation greatly increases the functionality of existing stereotactic biopsy devices by yielding a much smaller number of false positives than would be produced using X-ray images alone. The ability to obtain both the X-ray mammographic image and the nuclear-based medicine gamma image using a single device is made possible largely through the use of a novel, small and movable gamma imaging camera that permits its incorporation into the same table or system as that currently utilized to obtain X-ray based mammographic images for localization of lesions.

  17. Survival after stereotactic biopsy of malignant gliomas

    SciTech Connect

    Coffey, R.J.; Lunsford, L.D.; Taylor, F.H.

    1988-03-01

    For many patients with malignant gliomas in inaccessible or functionally important locations, stereotactic biopsy followed by radiation therapy (RT) may be a more appropriate initial treatment than craniotomy and tumor resection. We studied the long term survival in 91 consecutive patients with malignant gliomas diagnosed by stereotactic biopsy: 64 had glioblastoma multiforme (GBM) and 27 had anaplastic astrocytoma (AA). Sixty-four per cent of the GBMs and 33% of the AAs involved deep or midline cerebral structures. The treatment prescribed after biopsy, the tumor location, the histological findings, and the patient's age at presentation (for AAs) were statistically important factors determining patient survival. If adequate RT (tumor dose of 5000 to 6000 cGy) was not prescribed, the median survival was less than or equal to 11 weeks regardless of tumor histology or location. The median survival for patients with deep or midline tumors who completed RT was similar in AA (19.4 weeks) and GBM (27 weeks) cases. Histology was an important predictor of survival only for patients with adequately treated lobar tumors. The median survival in lobar GBM patients who completed RT was 46.9 weeks, and that in lobar AA patients who completed RT was 129 weeks. Cytoreductive surgery had no statistically significant effect on survival. Among the clinical factors examined, age of less than 40 years at presentation was associated with prolonged survival only in AA patients. Constellations of clinical features, tumor location, histological diagnosis, and treatment prescribed were related to survival time.

  18. High-frequency guided ultrasonic waves to monitor corrosion thickness loss

    NASA Astrophysics Data System (ADS)

    Fromme, Paul; Bernhard, Fabian; Masserey, Bernard

    2017-02-01

    Corrosion due to adverse environmental conditions can occur for a range of industrial structures, e.g., ships and offshore oil platforms. Pitting corrosion and generalized corrosion can lead to the reduction of the strength and thus degradation of the structural integrity. The nondestructive detection and monitoring of corrosion damage in difficult to access areas can be achieved using high frequency guided ultrasonic waves propagating along the structure. Using standard ultrasonic transducers with single sided access to the structure, the two fundamental Lamb wave modes were selectively generated simultaneously, penetrating through the complete thickness of the structure. The wave propagation and interference of the guided wave modes depends on the thickness of the structure. Numerical simulations were performed using a 2D Finite Difference Method (FDM) algorithm in order to visualize the guided wave propagation and energy transfer across the plate thickness. Laboratory experiments were conducted and the wall thickness reduced initially uniformly by milling of the steel structure. Further measurements were conducted using accelerated corrosion in salt water. From the measured signal change due to the wave mode interference, the wall thickness reduction was monitored and good agreement with theoretical predictions was achieved. Corrosion can lead to non-uniform thickness reduction and the influence of this on the propagation of the high frequency guided ultrasonic waves was investigated. The wave propagation in a steel specimen with varying thickness was measured experimentally and the influence on the wave propagation characteristics quantified.

  19. Life Experience Unit Guide Developed for Junior High and High School Resource Room Programs.

    ERIC Educational Resources Information Center

    Dorhman, Mary H.; Riker, Jerry

    The life experience unit guide, which is intended to be used with emotionally unstable adolescents and which offers selected activities for an integrated language arts, science, and social studies curriculum, is described. Provided for the language arts strand are forms such as sentence completion forms, a feeling checklist, a self evaluation…

  20. Image guided surgery in the management of craniocerebral gunshot injuries

    PubMed Central

    Elserry, Tarek; Anwer, Hesham; Esene, Ignatius Ngene

    2013-01-01

    Background: A craniocerebral trauma caused by firearms is a complex injury with high morbidity and mortality. One of the most intriguing and controversial part in their management in salvageable patients is the decision to remove the bullet/pellet. A bullet is foreign to the brain and, in principle, should be removed. Surgical options for bullet extraction span from conventional craniotomy, through C-arm-guided surgery to minimally invasive frame or frameless stereotaxy. But what is the best surgical option? Methods: We prospectively followed up a cohort of 28 patients with cranio-cerebral gunshot injury (CCHSI) managed from January to December 2012 in our department of neurosurgery. The missiles were extracted via stereotaxy (frame or frameless), C-arm-guided, or free-hand-based surgery. Cases managed conservatively were excluded. The Glasgow Outcome Score was used to assess the functional outcome on discharge. Results: Five of the eight “stereotactic cases” had an excellent outcome after missile extraction while the initially planned stereotaxy missed locating the missile in three cases and were thus subjected to free hand craniotomy. Excellent outcome was obtained in five of the nine “neuronavigation cases, five of the eight cases for free hand surgery based on the bony landmarks, and five of the six C-arm-based surgery. Conclusion: Conventional craniotomy isn’t indicated in the extraction of isolated, retained, intracranial firearm missiles in civilian injury but could be useful when the missile is incorporated within a surgical lesion. Stereotactic surgery could be useful for bullet extraction, though with limited precision in identifying small pellets because of their small sizes, thus exposing patients to same risk of brain insult when retrieving a missile by conventional surgery. Because of its availability, C-arm-guided surgery continues to be of much benefit, especially in emergency situations. We recommend an extensive long-term study of these

  1. High-density polytetrafluoroethylene membranes in guided bone and tissue regeneration procedures: a literature review.

    PubMed

    Carbonell, J M; Martín, I Sanz; Santos, A; Pujol, A; Sanz-Moliner, J D; Nart, J

    2014-01-01

    Expanded polytetrafluoroethylene (e-PTFE) has been used successfully as a membrane barrier for regeneration procedures. However, when exposed to the oral cavity, its high porosity increases the risk of early infection, which can affect surgical outcomes. An alternative to e-PTFE is non-expanded and dense polytetrafluoroethylene (n-PFTE), which results in lower levels of early infection following surgical procedures. The aim of this literature review was to analyze and describe the available literature on n-PFTE, report the indications for use, advantages, disadvantages, surgical protocols, and complications. The medical databases Medline-PubMed and Cochrane Library were searched and supplemented with a hand search for reports published between 1980 and May 2012 on n-PTFE membranes. The search strategy was limited to animal, human, and in vitro studies in dental journals published in English. Twenty-four articles that analyzed the use of n-PTFE as a barrier membrane for guided tissue regeneration and guided bone regeneration around teeth and implants were identified: two in vitro studies, seven experimental studies, and 15 clinical studies. There is limited clinical and histological evidence for the use of n-PTFE membranes at present, with some indications in guided tissue regeneration and guided bone regeneration in immediate implants and fresh extraction sockets.

  2. 3D Surgical Printing Cutting Guides for Open-Wedge High Tibial Osteotomy: Do It Yourself.

    PubMed

    Pérez-Mañanes, Rubén; Burró, Juan Arnal; Manaute, Jose Rojo; Rodriguez, Francisco Chana; Martín, Javier Vaquero

    2016-11-01

    Opening wedge osteotomy has recently gained popularity, thanks to the recent implementation of locking plates, which have shown equivalent stability with greater reproducibility, accuracy, and longevity than the closing wedge techniques and a lower prosthetic conversion rate. We present a new "do-it-yourself" cutting guides system for tibial opening osteotomy. Using a conventional computed tomography digital image, a positioning guide and wedge spacers were printed in three dimensions (3D) for implementing the osteotomy and obtaining the planned correction. The surgeon makes the whole process in a do-it-yourself style. This new technique was used in eight cases. Previous opening osteotomies with the standard technique were used as control (20 cases). Surgical time, fluoroscopic time, and accuracy of the axial correction were measured. The use of a custom positioning guide reduced the surgical (31 minutes less) and fluoroscopic times (6.9 times less) while achieving a high-axis correction accuracy compared with the standard technique. Digitally planned and executed osteotomies under 3D printed osteotomy positioning guides help the surgeon to minimize human error while reducing surgical time. The reproducibility of this technique is very robust, allowing a transfer of the steps planned in a virtual environment to the operating table.

  3. Clinical Assessment Of Stereotactic IGRT: Spinal Radiosurgery

    SciTech Connect

    Gerszten, Peter C. Burton, Steven A.

    2008-07-01

    The role of stereotactic radiosurgery for the treatment of intracranial lesions is well established. Its use for the treatment of spinal lesions has been limited because of the availability of effective target immobilization devices. Recent advances in stereotactic IGRT have allowed for spinal applications. Large clinical experience with spinal radiosurgery to properly assess clinical outcomes has previously been limited. At our institution, we have developed a successful multidisciplinary spinal radiosurgery program in which 542 spinal lesions (486 malignant and 56 benign lesions) were treated with a single-fraction radiosurgery technique. Patient ages ranged from 18 to 85 years (mean 56 years). Lesion location included 92 cervical, 234 thoracic, 130 lumbar, and 86 sacral. The most common metastatic tumors were renal cell (89 cases), breast (74 cases), and lung (71 cases). The most common benign tumors were neurofibroma (24 cases), schwannoma (13 cases), and meningioma (7 cases). Eighty-nine cervical lesions were treated using skull tracking. Thoracic, lumbar, and sacral tumors were tracked relative to either gold or stainless steel fiducial markers. The maximum intratumoral dose ranged from 12.5 to 30 Gy (mean 20 Gy). Tumor volume ranged from 0.16 to 298 mL (mean 47 mL). Three hundred thirty-seven lesions had received prior external beam irradiation with spinal cord doses precluding further conventional irradiation. The primary indication for radiosurgery was pain in 326 cases, as a primary treatment modality in 70 cases, for tumor radiographic tumor progression in 65 cases, for post-surgical treatment in 38 cases, for progressive neurological deficit in 35 cases, and as a radiation boost in 8 cases. Follow-up period was at least 3 to 49 months. Axial and/or radicular pain improved in 300 of 326 cases (92%). Long-term tumor control was demonstrated in 90% of lesions treated with radiosurgery as a primary treatment modality and in 88% of lesions treated for

  4. High-frequency guided ultrasonic waves for hidden defect detection in multi-layer aircraft structures

    NASA Astrophysics Data System (ADS)

    Masserey, B.; Raemy, C.; Fromme, P.

    2012-05-01

    Aerospace structures contain multi-layer components subjected to cyclic loading conditions; fatigue cracks and disbonds can develop, often at fastener holes. High-frequency guided waves have the potential for non-destructive damage detection at critical and difficult to access locations from a stand-off distance. Using commercially available ultrasonic transducers, high frequency guided waves were generated that penetrate through the complete thickness of a model structure, consisting of two adhesively bonded aluminum plates. The wave propagation along the specimen was measured and quantified using a laser interferometer. The wave propagation and scattering at internal defects was simulated using Finite Element (FE) models and good agreement with the measurement results found. The detection sensitivity using standard pulse-echo measurements was verified and the influence of the stand-off distance predicted from the FE simulation results.

  5. High frequency guided waves for hidden fatigue crack growth monitoring in multi-layer aerospace structures

    NASA Astrophysics Data System (ADS)

    Chan, Henry; Fromme, Paul

    2015-03-01

    Varying loading conditions of aircraft structures result in stress concentration at fastener holes, where multi-layered components are connected, possibly leading to the development of fatigue cracks. High frequency guided waves propagating along the structure allow for the non-destructive testing of such components, e.g., aircraft wings. However, the sensitivity for the detection of small, potentially hidden, fatigue cracks has to be ascertained. The type of multi-layered model structure investigated consists of two adhesively bonded aluminium plate-strips. Fatigue experiments were carried out. The sensitivity of the high frequency guided wave modes to monitor fatigue crack growth at a fastener hole during cyclic loading was investigated, using both standard pulse-echo equipment and laser interferometry. The sensitivity and repeatability of the measurements were ascertained, having the potential for fatigue crack growth monitoring at critical and difficult to access fastener locations from a stand-off distance.

  6. Defect Detection in Multi-Layered Structures Using High Frequency Guided Waves

    NASA Astrophysics Data System (ADS)

    Masserey, B.; Kostson, E.; Fromme, P.

    2011-06-01

    Aircraft structures contain multi-layered components connected by fasteners, where fatigue cracks and disbonds can develop due to cyclic loading conditions and stress concentration. High frequency guided waves propagating along the structure allow for the efficient non-destructive testing of components, such as aircraft wings. However, the sensitivity for the detection of small defects has to be ascertained. The type of multi-layered model structure investigated consists of two adhesively bonded aluminium plate-strips. High frequency ultrasonic wave propagation along the structure and the sensitivity to disbonds and small defects in the metallic layers was investigated and verified experimentally. Preliminary fatigue experiments were carried out and the sensitivity of the guided waves to monitor fatigue crack growth at a fastener hole during cyclic loading was investigated. The measurement setup has the potential for fatigue crack growth monitoring at critical and difficult to access fastener locations from a stand-off distance.

  7. Monitoring of hidden damage in multi-layered aerospace structures using high-frequency guided waves

    NASA Astrophysics Data System (ADS)

    Semoroz, A.; Masserey, B.; Fromme, P.

    2011-04-01

    Aerospace structures contain multi-layered components connected by fasteners, where fatigue cracks and disbonds or localized lack of sealant can develop due to cyclic loading conditions and stress concentration. High frequency guided waves propagating along such a structure allow for the efficient non-destructive testing of large components, such as aircraft wings. The type of multi-layered model structure investigated in this contribution consists of two aluminium plates adhesively bonded with an epoxy based sealant layer. Using commercially available transducer equipment, specific high frequency guided ultrasonic wave modes that penetrate through the complete thickness of the structure were excited. The wave propagation along the structure was measured experimentally using a laser interferometer. Two types of hidden damage were considered: a localized lack of sealant and small surface defects in the metallic layer facing the sealant. The detection sensitivity using standard pulse-echo measurement equipment has been quantified and the detection of small hidden defects from significant stand-off distances has been shown. Fatigue experiments were carried out and the potential of high frequency guided waves for the monitoring of fatigue crack growth at a fastener hole during cyclic loading was discussed.

  8. Dimeric CRISPR RNA-guided FokI nucleases for highly specific genome editing.

    PubMed

    Tsai, Shengdar Q; Wyvekens, Nicolas; Khayter, Cyd; Foden, Jennifer A; Thapar, Vishal; Reyon, Deepak; Goodwin, Mathew J; Aryee, Martin J; Joung, J Keith

    2014-06-01

    Monomeric CRISPR-Cas9 nucleases are widely used for targeted genome editing but can induce unwanted off-target mutations with high frequencies. Here we describe dimeric RNA-guided FokI nucleases (RFNs) that can recognize extended sequences and edit endogenous genes with high efficiencies in human cells. RFN cleavage activity depends strictly on the binding of two guide RNAs (gRNAs) to DNA with a defined spacing and orientation substantially reducing the likelihood that a suitable target site will occur more than once in the genome and therefore improving specificities relative to wild-type Cas9 monomers. RFNs guided by a single gRNA generally induce lower levels of unwanted mutations than matched monomeric Cas9 nickases. In addition, we describe a simple method for expressing multiple gRNAs bearing any 5' end nucleotide, which gives dimeric RFNs a broad targeting range. RFNs combine the ease of RNA-based targeting with the specificity enhancement inherent to dimerization and are likely to be useful in applications that require highly precise genome editing.

  9. Monitoring of corrosion damage using high-frequency guided ultrasonic waves

    NASA Astrophysics Data System (ADS)

    Chew, D.; Fromme, P.

    2014-03-01

    Due to adverse environmental conditions corrosion can develop during the life cycle of industrial structures, e.g., offshore oil platforms, ships, and desalination plants. Both pitting corrosion and generalized corrosion leading to wall thickness loss can cause the degradation of the integrity and load bearing capacity of the structure. Structural health monitoring of corrosion damage in difficult to access areas can in principle be achieved using high frequency guided waves propagating along the structure from accessible areas. Using standard ultrasonic transducers with single sided access to the structure, high frequency guided wave modes were generated that penetrate through the complete thickness of the structure. Wall thickness reduction was induced using accelerated corrosion in a salt water bath. The corrosion damage was monitored based on the effect on the wave propagation and interference of the different modes. The change in the wave interference was quantified based on an analysis in the frequency domain (Fourier transform) and was found to match well with theoretical predictions for the wall thickness loss. High frequency guided waves have the potential for corrosion damage monitoring at critical and difficult to access locations from a stand-off distance.

  10. Monitoring of corrosion damage using high-frequency guided ultrasonic waves

    NASA Astrophysics Data System (ADS)

    Chew, D.; Fromme, P.

    2015-03-01

    Due to adverse environmental conditions corrosion can develop during the life cycle of industrial structures, e.g., offshore oil platforms, ships, and desalination plants. Both pitting corrosion and generalized corrosion leading to wall thickness loss can cause the degradation of the integrity and load bearing capacity of the structure. Structural health monitoring of corrosion damage in difficult to access areas can in principle be achieved using high frequency guided waves propagating along the structure from accessible areas. Using standard ultrasonic transducers with single sided access to the structure, high frequency guided wave modes were generated that penetrate through the complete thickness of the structure. Wall thickness reduction was induced using accelerated corrosion in a salt water bath. The corrosion damage was monitored based on the effect on the wave propagation and interference of the different modes. The change in the wave interference was quantified based on an analysis in the frequency domain (Fourier transform) and was found to match well with theoretical predictions for the wall thickness loss. High frequency guided waves have the potential for corrosion damage monitoring at critical and difficult to access locations from a stand-off distance.

  11. Stereotactic Body Radiation Therapy for Pancreatic Cancer.

    PubMed

    Goodman, Karyn A

    2016-01-01

    The role of radiation therapy in the management of pancreatic cancer represents an area of some controversy. However, local disease progression remains a significant cause of morbidity and even mortality for patients with this disease. Stereotactic body radiotherapy (SBRT) is an emerging treatment option for pancreatic cancer, primarily for locally advanced (unresectable) disease as it can provide a therapeutic benefit with significant advantages for patients' quality of life over standard conventional chemoradiation. There may also be a role for SBRT as neoadjuvant therapy for patients with borderline resectable disease to allow conversion to resectability. The objective of this review is to present the data supporting SBRT in pancreatic cancer as well as the potential limitations and caveats of current studies.

  12. 48 CFR 570.117-2 - Guiding principles for federal leadership in high performance and sustainable buildings.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Guiding principles for federal leadership in high performance and sustainable buildings. 570.117-2 Section 570.117-2 Federal... LEASEHOLD INTERESTS IN REAL PROPERTY General 570.117-2 Guiding principles for federal leadership in...

  13. A preclinical rodent model of acute radiation-induced lung injury after ablative focal irradiation reflecting clinical stereotactic body radiotherapy.

    PubMed

    Hong, Zhen-Yu; Lee, Hae-June; Choi, Won Hoon; Lee, Yoon-Jin; Eun, Sung Ho; Lee, Jung Il; Park, Kwangwoo; Lee, Ji Min; Cho, Jaeho

    2014-07-01

    In a previous study, we established an image-guided small-animal micro-irradiation system mimicking clinical stereotactic body radiotherapy (SBRT). The goal of this study was to develop a rodent model of acute phase lung injury after ablative irradiation. A radiation dose of 90 Gy was focally delivered to the left lung of C57BL/6 mice using a small animal stereotactic irradiator. At days 1, 3, 5, 7, 9, 11 and 14 after irradiation, the lungs were perfused with formalin for fixation and paraffin sections were stained with hematoxylin and eosin (H&E) and Masson's trichrome. At days 7 and 14 after irradiation, micro-computed tomography (CT) images of the lung were taken and lung functional measurements were performed with a flexiVent™ system. Gross morphological injury was evident 9 days after irradiation of normal lung tissues and dynamic sequential events occurring during the acute phase were validated by histopathological analysis. CT images of the mouse lungs indicated partial obstruction located in the peripheral area of the left lung. Significant alteration in inspiratory capacity and tissue damping were detected on day 14 after irradiation. An animal model of radiation-induced lung injury (RILI) in the acute phase reflecting clinical stereotactic body radiotherapy was established and validated with histopathological and functional analysis. This model enhances our understanding of the dynamic sequential events occurring in the acute phase of radiation-induced lung injury induced by ablative dose focal volume irradiation.

  14. Commissioning and initial stereotactic ablative radiotherapy experience with Vero.

    PubMed

    Solberg, Timothy D; Medin, Paul M; Ramirez, Ezequiel; Ding, Chuxiong; Foster, Ryan D; Yordy, John

    2014-03-06

    The purpose of this study is to describe the comprehensive commissioning process and initial clinical performance of the Vero linear accelerator, a new radiotherapy device recently installed at UT Southwestern Medical Center specifically developed for delivery of image-guided stereotactic ablative radiotherapy (SABR). The Vero system utilizes a ring gantry to integrate a beam delivery platform with image guidance systems. The ring is capable of rotating ± 60° about the vertical axis to facilitate noncoplanar beam arrangements ideal for SABR delivery. The beam delivery platform consists of a 6 MV C-band linac with a 60 leaf MLC projecting a maximum field size of 15 × 15 cm² at isocenter. The Vero planning and delivery systems support a range of treatment techniques, including fixed beam conformal, dynamic conformal arcs, fixed gantry IMRT in either SMLC (step-and-shoot) or DMLC (dynamic) delivery, and hybrid arcs, which combines dynamic conformal arcs and fixed beam IMRT delivery. The accelerator and treatment head are mounted on a gimbal mechanism that allows the linac and MLC to pivot in two dimensions for tumor tracking. Two orthogonal kV imaging subsystems built into the ring facilitate both stereoscopic and volumetric (CBCT) image guidance. The system is also equipped with an always-active electronic portal imaging device (EPID). We present our commissioning process and initial clinical experience focusing on SABR applications with the Vero, including: (1) beam data acquisition; (2) dosimetric commissioning of the treatment planning system, including evaluation of a Monte Carlo algorithm in a specially-designed anthropomorphic thorax phantom; (3) validation using the Radiological Physics Center thorax, head and neck (IMRT), and spine credentialing phantoms; (4) end-to-end evaluation of IGRT localization accuracy; (5) ongoing system performance, including isocenter stability; and (6) clinical SABR applications.

  15. Effects of combined sunitinib and extracranial stereotactic radiotherapy on bone marrow hematopoiesis

    PubMed Central

    Kao, Johnny; Timmins, Jonathan; Ozao-Choy, Junko; Packer, Stuart

    2016-01-01

    There is considerable interest in deploying stereotactic body radiotherapy in combination with immune therapy for patients with extracranial oligometastases. In addition to angiogenesis inhibition, sunitinib appears to mediate antitumor immunity through effects on circulating monocytic cells. The current study investigated the effects of combined sunitinib and stereotactic radiotherapy on hematopoiesis. As part of a phase I/II clinical trial utilizing concurrent sunitinib (25–50 mg on days 1–28) and image-guided radiation therapy (40–50 Gy in 10 fractions starting on days 8–19) for patients with metastatic cancer, the complete blood count, platelet count and automatic differential were performed pretreatment and on days 8 and 19. On average, sunitinib monotherapy for 7 days resulted in a 33% decrease in monocytes and an 18% decrease in neutrophils (P<0.01 for all). Compared to sunitinib alone, combined sunitinib and radiation resulted in a further decrease in neutrophils, lymphocytes and platelets (P<0.05). Following sunitinib and radiation treatment, a greater than average decrease in monocytes (≥200/µl) was associated with a significant increase in progression-free and overall survival times. This exploratory study provides further evidence that monocytes represent a potential biomarker in patients with solid tumors treated with sunitinib. PMID:27602153

  16. Resonantly guided modes in microstructured optical fibers with a circular array of high-index rods.

    PubMed

    Ohtera, Yasuo; Hirose, Haruka; Yamada, Hirohito

    2013-08-01

    A microstructured optical fiber with a new type of waveguiding mechanism is proposed. The fiber consists of a circular rod array of high index material (n=3.48) embedded in a low index background (n=1.44). The rod array exhibits guided-mode resonance (GMR) for cylindrical waves arriving from inside the array, and thus functions as a highly reflective circular wall. Through finite-difference time-domain (FDTD) simulations, we confirmed light confinement and guidance near the GMR wavelength. Basic optical characteristics such as dispersion relations, loss spectra, and mode field profiles were calculated.

  17. INTER- AND INTRAFRACTION MOTION FOR STEREOTACTIC RADIOSURGERY IN DOGS AND CATS USING A MODIFIED BRAINLAB FRAMELESS STEREOTACTIC MASK SYSTEM.

    PubMed

    Dieterich, Sonja; Zwingenberger, Allison; Hansen, Katherine; Pfeiffer, Isabella; Théon, Alain; Kent, Michael S

    2015-01-01

    Precise and accurate patient positioning is necessary when doing stereotactic radiosurgery (SRS) to ensure adequate dosing to the tumor and sparing of normal tissues. This prospective cross-sectional study aimed to assess feasibility of a commercially available modified frameless SRS positioning system for use in veterinary radiotherapy patients with brain tumors. Fifty-one dogs and 12 cats were enrolled. Baseline and verification CT images were acquired. The verification CT images from 32 dogs and five cats had sufficient images for fusion to baseline CT images. A rigid box-based fusion was performed to determine interfraction motion. Forty-eight dogs and 11 cats were assessed for intrafraction motion by cine CT. Seventy percent of dogs and 60% of cats had interfraction 3D vector translational shifts >1 mm, with mean values of 1.9 mm in dogs, and 1.8 mm in cats. In dogs muscle wasting was weakly correlated with translational shifts. The maximum angular interfraction motion observed was 6.3° (roll), 3.5° (pitch), and 3.3° (yaw). There was no correlation between angular interfraction motion and weight, brachycephaly, or muscle wasting. Fifty-seven percent of dogs and 50% of cats had respiration-related intrafraction motion. Of these, 4.5% of dogs and 10% of cats had intrafraction motion >1 mm. This study demonstrates the modified Brainlab system is feasible for SRS in dogs and cats. The smaller cranial size and difference in anatomy increases setup uncertainty in some animals beyond limits usually accepted in SRS. Image-guided positioning is recommended to achieve clinically acceptable setup accuracy (<1 mm) for SRS.

  18. Fractionated Stereotactic Radiotherapy in the Treatment of Vestibular Schwannoma (Acoustic Neuroma): Predicting the Risk of Hydrocephalus;Vestibular schwannoma; Hydrocephalus; Fractionated; Stereotactic radiotherapy

    SciTech Connect

    Powell, Ceri; Micallef, Caroline; Gonsalves, Adam; Wharram, Bev; Ashley, Sue; Brada, Michael

    2011-07-15

    Purpose: To determine the incidence and predictive factors for the development of hydrocephalus in patients with acoustic neuromas (AN) treated with fractionated stereotactic radiotherapy. Patients and Methods: Seventy-two patients with AN were treated with fractionated stereotactic radiotherapy between 1998 and 2007 (45-50 Gy in 25-30 fractions over 5 to 6 weeks). The pretreatment MRI scan was assessed for tumor characteristics and anatomic distortion independently of subsequent outcome and correlated with the risk of hydrocephalus. Results: At a median follow-up of 49 months (range, 1-120 months), 5-year event-free survival was 95%. Eight patients (11%) developed hydrocephalus within 19 months of radiotherapy, which was successfully treated. On univariate analysis, pretreatment factors predictive of hydrocephalus were maximum diameter (p = 0.005), proximity to midline (p = 0.009), displacement of the fourth ventricle (p = 0.02), partial effacement of the fourth ventricle (p < 0.001), contact with the medulla (p = 0.005), and more brainstem structures (p = 0.004). On multivariate analysis, after adjusting for fourth ventricular effacement, no other variables remained independently associated with hydrocephalus formation. Conclusions: Fractionated stereotactic radiotherapy results in excellent tumor control of AN, albeit with a risk of developing hydrocephalus. Patients at high risk, identified as those with larger tumors with partial effacement of the fourth ventricle before treatment, should be monitored more closely during follow-up. It would also be preferable to offer treatment to patients with progressive AN while the risk of hydrocephalus is low, before the development of marked distortion of fourth ventricle before tumor diameter significantly exceeds 2 cm.

  19. Disabling amnestic syndrome following stereotactic laser ablation of a hypothalamic hamartoma in a patient with a prior temporal lobectomy☆

    PubMed Central

    Zubkov, Sarah; Del Bene, Victor A.; MacAllister, William S.; Shepherd, Timothy M.; Devinsky, Orrin

    2015-01-01

    A 19-year-old man with cortical dysplasia and intractable focal seizures underwent a right temporal lobectomy. A hypothalamic hamartoma was subsequently recognized, and he then underwent MRI-guided stereotactic laser ablation. Unfortunately, he sustained damage to the bilateral medial mammillary bodies and suffered significant memory loss. We review laser ablation therapy for hypothalamic hamartomas and the anatomy of the memory network. We postulate that his persistent memory disorder resulted from a combination of the right temporal lobectomy and injury to the bilateral medial mammillary bodies. PMID:26288758

  20. Using problem based learning and guided inquiry in a high school acid-base chemistry unit

    NASA Astrophysics Data System (ADS)

    McKinley, Katie

    The purpose of this investigation was to determine if incorporating problem based learning and guided inquiry would improve student achievement in an acid base unit for high school chemistry. The activities and labs in the unit were modified to be centered around the problem of a fish kill that students investigated. Students also participated in guided inquiry labs to increase the amount of critical thinking and problem solving being done in the classroom. The hypothesis was that the implementation of problem based learning and guided inquiry would foster student learning. Students took a pre-test and post-test on questions covering the objectives of the acid base unit. These assessments were compared to determine the effectiveness of the unit. The results indicate that the unit was effective in increasing student performance on the unit test. This study also analyzed the process of problem based learning. Problem based learning can be an effective method of engaging students in inquiry. However, designing an effective problem based learning unit requires careful design of the problem and enough structure to assure students learn the intended content.

  1. 10 CFR 35.2645 - Records of periodic spot-checks for gamma stereotactic radiosurgery units.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 1 2012-01-01 2012-01-01 false Records of periodic spot-checks for gamma stereotactic... MATERIAL Records § 35.2645 Records of periodic spot-checks for gamma stereotactic radiosurgery units. (a) A... and intercom systems, timer termination, treatment table retraction mechanism, and stereotactic...

  2. 10 CFR 35.2645 - Records of periodic spot-checks for gamma stereotactic radiosurgery units.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 1 2014-01-01 2014-01-01 false Records of periodic spot-checks for gamma stereotactic... MATERIAL Records § 35.2645 Records of periodic spot-checks for gamma stereotactic radiosurgery units. (a) A... and intercom systems, timer termination, treatment table retraction mechanism, and stereotactic...

  3. Electrical/Electronic Technology (Energy/Power). Industrial Arts, Senior High--Level II. North Dakota Senior High Industrial Arts Curriculum Guides.

    ERIC Educational Resources Information Center

    Lawrence, Allen; And Others

    This course guide for an electrical/electronic technology course is one of four developed for the energy/power area in the North Dakota senior high industrial arts education program. (Eight other guides are available for two other areas of Industrial Arts--graphic communications and production.) Part 1 provides such introductory information as a…

  4. Stereotactic Irradiation of GH-Secreting Pituitary Adenomas

    PubMed Central

    Minniti, G.; Scaringi, C.; Amelio, D.; Maurizi Enrici, R.

    2012-01-01

    Radiotherapy (RT) is often employed in patients with acromegaly refractory to medical and/or surgical interventions in order to prevent tumour regrowth and normalize elevated GH and IGF-I levels. It achieves tumour control and hormone normalization up to 90% and 70% of patients at 10–15 years. Despite the excellent tumour control, conventional RT is associated with a potential risk of developing late toxicity, especially hypopituitarism, and its role in the management of patients with GH-secreting pituitary adenomas remains a matter of debate. Stereotactic techniques have been developed with the aim to deliver more localized irradiation and minimize the long-term consequences of treatment, while improving its efficacy. Stereotactic irradiation can be given in a single dose as stereotactic radiosurgery (SRS) or in multiple doses as fractionated stereotactic radiotherapy (FSRT). We have reviewed the recent published literature on stereotactic techniques for GH-secreting pituitary tumors with the aim to define the efficacy and potential adverse effects of each of these techniques. PMID:22518123

  5. Image-guided high-dose-rate brachytherapy in inoperable endometrial cancer

    PubMed Central

    Petsuksiri, J; Chansilpa, Y; Hoskin, P J

    2014-01-01

    Inoperable endometrial cancer may be treated with curative aim using radical radiotherapy alone. The radiation techniques are external beam radiotherapy (EBRT) alone, EBRT plus brachytherapy and brachytherapy alone. Recently, high-dose-rate brachytherapy has been used instead of low-dose-rate brachytherapy. Image-guided brachytherapy enables sufficient coverage of tumour and reduction of dose to the organs at risk, thus increasing the therapeutic ratio of treatment. Local control rates with three-dimensional brachytherapy appear better than with conventional techniques (about 90–100% and 70–90%, respectively). PMID:24807067

  6. Stereotactic ablative radiotherapy for oligometastatic disease in liver.

    PubMed

    Kim, Myungsoo; Son, Seok Hyun; Won, Yong Kyun; Kay, Chul Seung

    2014-01-01

    Liver metastasis in solid tumors, including colorectal cancer, is the most frequent and lethal complication. The development of systemic therapy has led to prolonged survival. However, in selected patients with a finite number of discrete lesions in liver, defined as oligometastatic state, additional local therapies such as surgical resection, radiofrequency ablation, cryotherapy, and radiotherapy can lead to permanent local disease control and improve survival. Among these, an advance in radiation therapy made it possible to deliver high dose radiation to the tumor more accurately, without impairing the liver function. In recent years, the introduction of stereotactic ablative radiotherapy (SABR) has offered even more intensive tumor dose escalation in a few fractions with reduced dose to the adjacent normal liver. Many studies have shown that SABR for oligometastases is effective and safe, with local control rates widely ranging from 50% to 100% at one or two years. And actuarial survival at one and two years has been reported ranging from 72% to 94% and from 30% to 62%, respectively, without severe toxicities. In this paper, we described the definition and technical aspects of SABR, clinical outcomes including efficacy and toxicity, and related parameters after SABR in liver oligometastases from colorectal cancer.

  7. Effect of spine hardware on small spinal stereotactic radiosurgery dosimetry

    NASA Astrophysics Data System (ADS)

    Wang, Xin; Yang, James N.; Li, Xiaoqiang; Tailor, Ramesh; Vassilliev, Oleg; Brown, Paul; Rhines, Laurence; Chang, Eric

    2013-10-01

    Monte Carlo (MC) modeling of a 6 MV photon beam was used to study the dose perturbation from a titanium rod 5 mm in diameter in various small fields range from 2 × 2 to 5 × 5 cm2. The results showed that the rod increased the dose to water by ˜6% at the water-rod interface because of electron backscattering and decreased the dose by ˜7% in the shadow of the rod because of photon attenuation. The Pinnacle3 treatment planning system calculations matched the MC results at the depths more than 1 cm past the rod when the correct titanium density of 4.5 g cm-3 was used, but significantly underestimated the backscattering dose at the water-rod interface. A CT-density table with a top density of 1.82 g cm-3 (cortical bone) is a practical way to reduce the dosimetric error from the artifacts by preventing high density assignment to them, but can underestimates the attenuation by the titanium rod by 6%. However, when multi-beam with intensity modulation is used in actual patient spinal stereotactic radiosurgery treatment, the dosimetric effect of assigning 4.5 instead of 1.82 g cm-3 to titanium implants is complicated. It ranged from minimal effect to 2% dose difference affecting 15% target volume in the study. When hardware is in the beam path, density override to the titanium hardware is recommended.

  8. A new system for neuronavigation and stereotactic biopsy pantograph stereotactic localization and guidance system.

    PubMed

    Abrishamkar, Saeid; Moin, Houshang; Safavi, Mohammadreza; Honarmand, Azim; Hajibabaie, Mahmood; Haghighi, Elham K; Abbasifard, Salman

    2011-07-01

    Everyday, neurosurgeons face the problem of orientation within the brain but the advent of stereotactic surgery and neuronavigation have solved this problem. Frame-based stereotactic systems (FBSS) and neuronavigation systems have their own strengths and priority and pitfalls, which were the main driving force for us to design a new system. This hybrid system comprises three main parts: main frame, monitoring system, and pantograph, which are connected to each other and to the operating table by particular attachments. For using this system, after performing CT SCAN or Magnetic Resonance Imaging (MRI) the axial view will be transferred to Liquid Cristal Display (LCD). In the operating room, the head of the patient fixes to the operating table and registration is completed by two arms of pantograph. We made a simulation operation with our system on an occipital cavernous angioma and a frontal oligodendroglioma. The software, which have been used for simulation were as follows; Poser (version-7), Catia (version 5- R18), and 3 Dimension Max (version 2008). The accuracy of this system is approximately two millimeter. The advantages of this system are: easy to use, much less expensive, and compatible with different devices, which may be needed during neurosurgical operation. For countries that do not have the opportunity to have sophisticated technology and neuronavigation system, we believe that our system is a one-stop solution.

  9. Fractionated Stereotactic Radiotherapy for Facial Nerve Schwannomas

    PubMed Central

    Shi, Wenyin; Jain, Varsha; Kim, Hyun; Champ, Colin; Jain, Gaurav; Farrell, Christopher; Andrews, David W.; Judy, Kevin; Liu, Haisong; Artz, Gregory; Werner-Wasik, Maria; Evans, James J.

    2015-01-01

    Purpose Data on the clinical course of irradiated facial nerve schwannomas (FNS) are lacking. We evaluated fractionated stereotactic radiotherapy (FSRT) for FNS. Methods Eight consecutive patients with FNS treated at our institution between 1998 and 2011 were included. Patients were treated with FSRT to a median dose of 50.4 Gy (range: 46.8–54 Gy) in 1.8 or 2.0 Gy fractions. We report the radiographic response, symptom control, and toxicity associated with FSRT for FNS. Results The median follow-up time was 43 months (range: 10–75 months). All patients presented with symptoms including pain, tinnitus, facial asymmetry, diplopia, and hearing loss. The median tumor volume was 1.57 cc. On the most recent follow-up imaging, five patients were noted to have stable tumor size; three patients had a net reduction in tumor volume. Additionally, six patients had improvement in clinical symptoms, one patient had stable clinical findings, and one patient had worsened House-Brackmann grade due to cystic degeneration. Conclusion FSRT treatment of FNS results in excellent control of growth and symptoms with a small rate of radiation toxicity. Given the importance of maintaining facial nerve function, FSRT could be considered as a primary management modality for enlarging or symptomatic FNS. PMID:26949592

  10. Stereotactic Body Radiotherapy for Oligometastatic Lung Tumors

    SciTech Connect

    Norihisa, Yoshiki; Nagata, Yasushi Takayama, Kenji; Matsuo, Yukinori; Sakamoto, Takashi; Sakamoto, Masato; Mizowaki, Takashi; Yano, Shinsuke; Hiraoka, Masahiro

    2008-10-01

    Purpose: Since 1998, we have treated primary and oligometastatic lung tumors with stereotactic body radiotherapy (SBRT). The term 'oligometastasis' is used to indicate a small number of metastases limited to an organ. We evaluated our clinical experience of SBRT for oligometastatic lung tumors. Methods and Materials: A total of 34 patients with oligometastatic lung tumors were included in this study. The primary involved organs were the lung (n = 15), colorectum (n = 9), head and neck (n = 5), kidney (n = 3), breast (n = 1), and bone (n = 1). Five to seven, noncoplanar, static 6-MV photon beams were used to deliver 48 Gy (n = 18) or 60 Gy (n = 16) at the isocenter, with 12 Gy/fraction within 4-18 days (median, 12 days). Results: The overall survival rate, local relapse-free rate, and progression-free rate at 2 years was 84.3%, 90.0%, and 34.8%, respectively. No local progression was observed in tumors irradiated with 60 Gy. SBRT-related pulmonary toxicities were observed in 4 (12%) Grade 2 cases and 1 (3%) Grade 3 case. Patients with a longer disease-free interval had a greater overall survival rate. Conclusion: The clinical result of SBRT for oligometastatic lung tumors in our institute was comparable to that after surgical metastasectomy; thus, SBRT could be an effective treatment of pulmonary oligometastases.

  11. Repeat Stereotactic Radiosurgery for Acoustic Neuromas

    SciTech Connect

    Kano, Hideyuki; Kondziolka, Douglas; Niranjan, Ajay M.Ch.; Flannery, Thomas J.; Flickinger, John C.; Lunsford, L. Dade

    2010-02-01

    Purpose: To evaluate the outcome of repeat stereotactic radiosurgery (SRS) for acoustic neuromas, we assessed tumor control, clinical outcomes, and the risk of adverse radiation effects in patients whose tumors progressed after initial management. Methods and Materials: During a 21-year experience at our center, 1,352 patients underwent SRS as management for their acoustic neuromas. We retrospectively identified 6 patients who underwent SRS twice for the same tumor. The median patient age was 47 years (range, 35-71 years). All patients had imaging evidence of tumor progression despite initial SRS. One patient also had incomplete surgical resection after initial SRS. All patients were deaf at the time of the second SRS. The median radiosurgery target volume at the time of the initial SRS was 0.5 cc and was 2.1 cc at the time of the second SRS. The median margin dose at the time of the initial SRS was 13 Gy and was 11 Gy at the time of the second SRS. The median interval between initial SRS and repeat SRS was 63 months (range, 25-169 months). Results: At a median follow-up of 29 months after the second SRS (range, 13-71 months), tumor control or regression was achieved in all 6 patients. No patient developed symptomatic adverse radiation effects or new neurological symptoms after the second SRS. Conclusions: With this limited experience, we found that repeat SRS for a persistently enlarging acoustic neuroma can be performed safely and effectively.

  12. High Temperature Shear Horizontal Electromagnetic Acoustic Transducer for Guided Wave Inspection

    PubMed Central

    Kogia, Maria; Gan, Tat-Hean; Balachandran, Wamadeva; Livadas, Makis; Kappatos, Vassilios; Szabo, Istvan; Mohimi, Abbas; Round, Andrew

    2016-01-01

    Guided Wave Testing (GWT) using novel Electromagnetic Acoustic Transducers (EMATs) is proposed for the inspection of large structures operating at high temperatures. To date, high temperature EMATs have been developed only for thickness measurements and they are not suitable for GWT. A pair of water-cooled EMATs capable of exciting and receiving Shear Horizontal (SH0) waves for GWT with optimal high temperature properties (up to 500 °C) has been developed. Thermal and Computational Fluid Dynamic (CFD) simulations of the EMAT design have been performed and experimentally validated. The optimal thermal EMAT design, material selection and operating conditions were calculated. The EMAT was successfully tested regarding its thermal and GWT performance from ambient temperature to 500 °C. PMID:27110792

  13. Guided mode resonance with extremely high Q-factors in terahertz metamaterials

    NASA Astrophysics Data System (ADS)

    Chen, Hang; Liu, Jianjun; Hong, Zhi

    2017-01-01

    We proposed and demonstrated that guided mode resonance (GMR) response with extremely high quality factor can be achieved in a planar terahertz metamaterial (MM) by rotating split ring resonators (SRRs) or moving the gaps of SRRs in a two-SRR composed MM. Furthermore, a novel extremely sharp asymmetric Fano resonance or electromagnetically induced transparency (EIT) like spectral response can be easily realized by manipulating the coherent interaction between this high Q GMR and the dipole resonance of MM. The new method can be extended to other ranges of the electromagnetic spectrum, and open new horizons for the design of ultra-high Q metamaterials for multifunctional applications, such as ultra-sensitive sensors, narrowband filters, or slow light based devices.

  14. TU-D-BRD-01: Image Guided SBRT II: Challenges ' Pitfalls

    SciTech Connect

    Chang, Z; Yin, F; Cho, J

    2014-06-15

    Stereotactic body radiation therapy (SBRT) has been effective treatment for the management of various diseases, which often delivers high radiation dose in a single or a few fractions. SBRT therefore demands precise treatment delivery to the tumor while sparing adjacent healthy tissue. Recent developments in image guidance enable target localization with increased accuracy. With such improvements in localization, image-guided SBRT has been widely adopted into clinical practice. In SBRT, high radiation dose is generally delivered with small fields. Therefore, it is crucial to accurately measure dosimetric data for the small fields during commissioning. In addition, image-guided SBRT demands accurate image localization to ensure safety and quality of patient care. Lately, the reports of AAPM TG 142 and TG 104 have been published and added recommendations for imaging devices that are integrated with the linear accelerator for SBRT. Furthermore, various challenges and potential pitfalls lie in the clinical implementation of image-guided SBRT. In this lecture, these challenges and pitfalls of image-guided SBRT will be illustrated and discussed from dosimetric, technical and clinical perspectives.Being a promising technique, image-guided SBRT has shown great potentials, and will lead to more accurate and safer SBRT treatments. Learning Objectives: To understand dosimetric challenges and pitfalls for IGRT application in SBRT. To understand major clinical challenges and pitfalls for IGRT application in SBRT. To understand major technical challenges and pitfalls for IGRT application in SBRT.

  15. Stereotactic radiosurgery for a cardiac sarcoma: a case report.

    PubMed

    Soltys, Scott G; Kalani, M Yashar S; Cheshier, Samuel H; Szabo, Katalin A; Lo, Anthony; Chang, Steven D

    2008-10-01

    Pulmonary artery intimal sarcoma is an uncommon tumor with a poor prognosis. We report a case of a 75-year-old man with a pulmonary artery sarcoma, recurrent following surgical resection. To palliate symptoms of this recurrence, he underwent CyberKnife stereotactic radiosurgery with a clinical and radiographic response of his treated disease. No acute or sub-acute toxicity was seen until the patient's death due to metastatic disease 10 weeks following treatment. The feasibility and short-term safety of this technique are reviewed, with emphasis on the stereotactic planning considerations, such as mediastinal organ movement and radiation tolerance.

  16. Radioisotope guided surgery with imaging probe, a hand-held high-resolution gamma camera

    NASA Astrophysics Data System (ADS)

    Soluri, A.; Trotta, C.; Scopinaro, F.; Tofani, A.; D'Alessandria, C.; Pasta, V.; Stella, S.; Massari, R.

    2007-12-01

    Since 1997, our group of Physics together with Nuclear Physicians studies imaging probes (IP), hand-held, high-resolution gamma cameras for radio-guided surgery (RGS). Present work is aimed to verify the usefulness of two updated IP in different surgical operations. Forty patients scheduled for breast cancer sentinel node (SN) biopsy, five patients with nodal recurrence of thyroid cancer, seven patients with parathyroid adenomas, five patients with neuroendocrine tumours (NET), were operated under the guide of IP. We used two different IP with field of view of 1 and 4 in. 2, respectively and intrinsic spatial resolution of about 2 mm. Radioisotopes were 99mTc, 123I and 111In. The 1 in. 2 IP detected SN in all the 40 patients and more than one node in 24, whereas anger camera (AC) failed locating SN in four patients and detected true positive second nodes in only nine patients. The 4 in. 2 IP was used for RGS of thyroid, parathyroid and NETs. It detected eight latero-cervical nodes. In the same patients, AC detected five invaded nodes. Parathyroid adenomas detected by IP were 10 in 7 patients, NET five in five patients. One and 4 in. 2 IPs showed usefulness in all operations. Initial studies on SN biopsy were carried out on small series of patients to validate IP and to demonstrate the effectiveness and usefulness of IP alone or against conventional probes. We propose the use of the IP as control method for legal documentation and surgeon strategy guide before and after lesion(s) removal.

  17. Medical applications of fast 3D cameras in real-time image-guided radiotherapy (IGRT) of cancer

    NASA Astrophysics Data System (ADS)

    Li, Shidong; Li, Tuotuo; Geng, Jason

    2013-03-01

    Dynamic volumetric medical imaging (4DMI) has reduced motion artifacts, increased early diagnosis of small mobile tumors, and improved target definition for treatment planning. High speed cameras for video, X-ray, or other forms of sequential imaging allow a live tracking of external or internal movement useful for real-time image-guided radiation therapy (IGRT). However, none of 4DMI can track real-time organ motion and no camera has correlated with 4DMI to show volumetric changes. With a brief review of various IGRT techniques, we propose a fast 3D camera for live-video stereovision, an automatic surface-motion identifier to classify body or respiratory motion, a mechanical model for synchronizing the external surface movement with the internal target displacement by combination use of the real-time stereovision and pre-treatment 4DMI, and dynamic multi-leaf collimation for adaptive aiming the moving target. Our preliminary results demonstrate that the technique is feasible and efficient in IGRT of mobile targets. A clinical trial has been initiated for validation of its spatial and temporal accuracies and dosimetric impact for intensity-modulated RT (IMRT), volumetric-modulated arc therapy (VMAT), and stereotactic body radiotherapy (SBRT) of any mobile tumors. The technique can be extended for surface-guided stereotactic needle insertion in biopsy of small lung nodules.

  18. Career Preparation in Agricultural Resources: A Curriculum Guide for High School Vocational Agriculture. Test Edition.

    ERIC Educational Resources Information Center

    Householder, Larry

    This curriculum guide in agricultural resources is one of 10 guides developed as part of a vocational project stressing agribusiness, natural resources, and environmental protection. The scope of this guide includes eight occupational subgroups: fish, forestry, mining area restoration, outdoor recreation, soil, range, water, and wildlife. It is…

  19. Career Preparation in Forestry: A Curriculum Guide for High School Vocational Agriculture. Test Edition.

    ERIC Educational Resources Information Center

    Householder, Larry; Moore, Eddie A.

    This curriculum guide in forestry is one of 10 guides developed as part of a vocational project stressing agribusiness, natural resources, and environmental protection. The scope of this guide includes six occupational subgroups: forest establishment, forest protection, logging (harvesting and transporting), wood utilization Christmas tree…

  20. Predictors of Rectal Tolerance Observed in a Dose-Escalated Phase 1-2 Trial of Stereotactic Body Radiation Therapy for Prostate Cancer

    SciTech Connect

    Kim, D.W. Nathan; Cho, L. Chinsoo; Straka, Christopher; Christie, Alana; Lotan, Yair; Pistenmaa, David; Kavanagh, Brian D.; Nanda, Akash; Kueplian, Patrick; Brindle, Jeffrey; Cooley, Susan; Perkins, Alida; Raben, David; Xie, Xian-Jin; Timmerman, Robert D.

    2014-07-01

    Purpose: To convey the occurrence of isolated cases of severe rectal toxicity at the highest dose level tested in 5-fraction stereotactic body radiation therapy (SBRT) for localized prostate cancer; and to rationally test potential causal mechanisms to guide future studies and experiments to aid in mitigating or altogether avoiding such severe bowel injury. Methods and Materials: Clinical and treatment planning data were analyzed from 91 patients enrolled from 2006 to 2011 on a dose-escalation (45, 47.5, and 50 Gy in 5 fractions) phase 1/2 clinical study of SBRT for localized prostate cancer. Results: At the highest dose level, 6.6% of patients treated (6 of 91) developed high-grade rectal toxicity, 5 of whom required colostomy. Grade 3+ delayed rectal toxicity was strongly correlated with volume of rectal wall receiving 50 Gy >3 cm{sup 3} (P<.0001), and treatment of >35% circumference of rectal wall to 39 Gy (P=.003). Grade 2+ acute rectal toxicity was significantly correlated with treatment of >50% circumference of rectal wall to 24 Gy (P=.010). Conclusion: Caution is advised when considering high-dose SBRT for treatment of tumors near bowel structures, including prostate cancer. Threshold dose constraints developed from physiologic principles are defined, and if respected can minimize risk of severe rectal toxicity.

  1. High Temperature Ceramic Guide Vane Temperature and Pressure Distribution Calculation for Flow with Cooling Jets

    NASA Technical Reports Server (NTRS)

    Srivastava, Rakesh

    2004-01-01

    A ceramic guide vane has been designed and tested for operation under high temperature. Previous efforts have suggested that some cooling flow may be required to alleviate the high temperatures observed near the trailing edge region. The present report describes briefly a three-dimensional viscous analysis carried out to calculate the temperature and pressure distribution on the blade surface and in the flow path with a jet of cooling air exiting from the suction surface near the trailing edge region. The data for analysis was obtained from Dr. Craig Robinson. The surface temperature and pressure distribution along with a flowfield distribution is shown in the results. The surface distribution is also given in a tabular form at the end of the document.

  2. High power double-scale pulses from a gain-guided double-clad fiber laser

    NASA Astrophysics Data System (ADS)

    Zhang, Haitao; Gao, Gan; Li, Qinghua; Gong, Mali

    2017-03-01

    Generation of high power double-scale pulses from a gain-guided double-clad fiber laser is experimentally demonstrated. By employing the Yb-doped 10/130 double-clad fiber as the gain medium, the laser realizes an output power of 5.1 W and pulse energy of 0.175 µJ at repetition rate of 29.14 MHz. To the best of our knowledge, this average output power is the highest among the reported double-scale pulse oscillators. The autocorrelation trace of pulses contains the short (98 fs) and long (29.5 ps) components, and the spectral bandwidth of the pulse is 27.3 nm. Such double-scale pulses are well suited for seeding the high power MOPA (master oscillator power amplifier) systems, nonlinear frequency conversion and optical coherence tomography.

  3. Electromagnetic dispersion characteristics of a high energy electron beam guided with an ion channel

    NASA Astrophysics Data System (ADS)

    Jixiong, Xiao; Zhong, Zeng; Zhijiang, Wang; Donghui, Xia; Changhai, Liu

    2017-02-01

    Taking self-fields into consideration, dispersion properties of two types of electromagnetic modes for a high energy electron beam guided with an ion channel are investigated by using the linear perturbation theory. The dependences of the dispersion frequencies of electromagnetic waves on the electron beam radius, betatron frequency and boundary current are revealed. It is found that the electron beam radius and betatron frequency have different influences on the electromagnetic waves dispersion behavior by compared with the previous works. As the boundary current is taken into account, the TM modes will have two branches and a low-frequency branch emerged as the new branch in strong ion channel case. This new branch has similar dispersion behavior to the betatron modes. For TE modes, there are two branches and they have different dispersion behaviors in strong ion channel case. However, in weak ion channel case, the dispersion behaviors for both of the low frequency and high frequency branches are similar.

  4. Designing an elliptical supermirror guide for the high-pressure material science beamline of J-PARC

    NASA Astrophysics Data System (ADS)

    Arima, Hiroshi; Komatsu, Kazuki; Ikeda, Kazuaki; Hirota, Katsuya; Kagi, Hiroyuki

    2009-02-01

    The design of an elliptical neutron guide for the time-of-flight (TOF) powder diffractometer of the high-pressure material science beamline at J-PARC was optimized using the McStas Monte Carlo simulation program to increase neutron flux for a small sample size. We investigated the analytical design in accordance with some requirements such as the gain factor at the small sample size and sufficient resolution at shorter wavelength of incident neutrons. The intensity and divergence with respect to energy dependence for elliptical guide designs were compared with those for the linearly tapered and straight guides. Optimizing the design of the elliptical guide results in the largest gain below 0.70 Å wavelength and gives constant instrumental resolution greater than 1 Å. The guide can support a flux gain of about 2.2 (high-intensity mode, Δ d/ d of ca. 0.6%) and 1.2 (high-resolution mode; Δ d/ d of ca. 0.5%) greater than 1 Å compared to the beamline of the natural flight path with resolution similar to that provided by the optimized elliptical guide.

  5. An integrated ultrasound-guided high intensity focused ultrasound system for in-vivo experiment

    NASA Astrophysics Data System (ADS)

    Liu, Dalong; Ebbini, Emad S.

    2017-03-01

    We present the system architecture of an integrated Ultrasound-guided High Intensity Focused Ultrasound (USgHIFU) system for image-guided surgery and temperature tracking in vivo. The system is capable of operating with multiple frontends. Current implementation has a SonixRP for imaging and a custom designed dual mode ultrasound array (DMUA) system (32Tx/32Rx) for imaging/therapy. The highlights of the system include a fully-programmable, multiple data stream capable data processing engine, and an arbitrarily programmable high power array driver that is able to synthesize complex beam patterns in space and time. The data processing engine features a pipeline-style design that can be programmed on-the-fly by re-arranging the pre-verified GPU-accelerated high performance pipeline blocks, which cover an extensive range from basic functions such as filtering to specialized processing like speckle tracking. Furthermore, the pipeline design also has the option of bringing in MATLAB (Mathworks, Natick, MA, US) as part of the processing chain, thus vastly increase the capability of the system. By properly balancing the processing load between GPU-enabled routine and MATLAB script. This allows one to achieve a high degree of flexibility while meeting real-time constraints. Results are presented from in vivo rat experiment. Where low dose of therapeutic ultrasound was delivered into the hind limb of the Copenhagen rats using DMUA and temperature was tracked using a linear probe (HST, Ultrasonix). The data is processed in realtime with MATLAB in the loop to perform temperature regularization. Results show that we can reliably track the low temperature heating in the presence of motion artifacts (respiration and pulsation).

  6. Magnetic Resonance Lymphography-Guided Selective High-Dose Lymph Node Irradiation in Prostate Cancer

    SciTech Connect

    Meijer, Hanneke J.M.; Debats, Oscar A.; Kunze-Busch, Martina; Kollenburg, Peter van; Leer, Jan Willem; Witjes, J. Alfred; Kaanders, Johannes H.A.M.; Barentsz, Jelle O.; Lin, Emile N.J.Th. van

    2012-01-01

    Purpose: To demonstrate the feasibility of magnetic resonance lymphography (MRL) -guided delineation of a boost volume and an elective target volume for pelvic lymph node irradiation in patients with prostate cancer. The feasibility of irradiating these volumes with a high-dose boost to the MRL-positive lymph nodes in conjunction with irradiation of the prostate using intensity-modulated radiotherapy (IMRT) was also investigated. Methods and Materials: In 4 prostate cancer patients with a high risk of lymph node involvement but no enlarged lymph nodes on CT and/or MRI, MRL detected pathological lymph nodes in the pelvis. These lymph nodes were identified and delineated on a radiotherapy planning CT to create a boost volume. Based on the location of the MRL-positive lymph nodes, the standard elective pelvic target volume was individualized. An IMRT plan with a simultaneous integrated boost (SIB) was created with dose prescriptions of 42 Gy to the pelvic target volume, a boost to 60 Gy to the MRL-positive lymph nodes, and 72 Gy to the prostate. Results: All MRL-positive lymph nodes could be identified on the planning CT. This information could be used to delineate a boost volume and to individualize the pelvic target volume for elective irradiation. IMRT planning delivered highly acceptable radiotherapy plans with regard to the prescribed dose levels and the dose to the organs at risk (OARs). Conclusion: MRL can be used to select patients with limited lymph node involvement for pelvic radiotherapy. MRL-guided delineation of a boost volume and an elective pelvic target volume for selective high-dose lymph node irradiation with IMRT is feasible. Whether this approach will result in improved outcome for these patients needs to be investigated in further clinical studies.

  7. Guided wave propagation in a honeycomb composite sandwich structure in presence of a high density core.

    PubMed

    Sikdar, Shirsendu; Banerjee, Sauvik

    2016-09-01

    A coordinated theoretical, numerical and experimental study is carried out in an effort to interpret the characteristics of propagating guided Lamb wave modes in presence of a high-density (HD) core region in a honeycomb composite sandwich structure (HCSS). Initially, a two-dimensional (2D) semi-analytical model based on the global matrix method is used to study the response and dispersion characteristics of the HCSS with a soft core. Due to the complex structural characteristics, the study of guided wave (GW) propagation in HCSS with HD-core region inherently poses many challenges. Therefore, a numerical simulation of GW propagation in the HCSS with and without the HD-core region is carried out, using surface-bonded piezoelectric wafer transducer (PWT) network. From the numerical results, it is observed that the presence of HD-core significantly decreases both the group velocity and the amplitude of the received GW signal. Laboratory experiments are then conducted in order to verify the theoretical and numerical results. A good agreement between the theoretical, numerical and experimental results is observed in all the cases studied. An extensive parametric study is also carried out for a range of HD-core sizes and densities in order to study the effect due to the change in size and density of the HD zone on the characteristics of propagating GW modes. It is found that the amplitudes and group velocities of the GW modes decrease with the increase in HD-core width and density.

  8. Image-guided drug delivery with magnetic resonance guided high intensity focused ultrasound and temperature sensitive liposomes in a rabbit Vx2 tumor model

    PubMed Central

    Ranjan, Ashish; Jacobs, Genevieve; Woods, David L.; Negussie, Ayele H.; Partanen, Ari; Yarmolenko, Pavel S.; Gacchina, Carmen E.; Sharma, Karun V.; Frenkel, Victor; Wood, Bradford J.; Dreher, Matthew R.

    2012-01-01

    Clinical-grade Doxorubicin encapsulated low temperature sensitive liposomes (LTSLs) were combined with a clinical magnetic resonance-guided high intensity focused ultrasound (MR-HIFU) platform to investigate in-vivo image-guided drug delivery. Plasma pharmacokinetics were determined in 3 rabbits. Fifteen rabbits with Vx2 tumors within superficial thigh muscle were randomly assigned into three treatment groups: 1) free doxorubicin, 2) LTSL and 3) LTSL+MR-HIFU. For the LTSL+MR-HIFU group, mild hyperthermia (40–41°C) was applied to the tumors using an MR-HIFU system. Image-guided non-invasive hyperthermia was applied for a total of 30 min, completed within 1 hour after LTSL infusion. High-pressure liquid chromatography (HPLC) analysis of the harvested tumor and organ/tissue homogenates was performed to determine doxorubicin concentration. Fluorescence microscopy was performed to determine doxorubicin spatial distribution in the tumors. Sonication of Vx2 tumors resulted in accurate (mean=40.5±0.1°C) and spatially homogenous (SD=1.0°C) temperature control in the target region. LTSL+MR-HIFU resulted in significantly higher tumor doxorubicin concentrations (7.6- and 3.4-fold greater compared to free doxorubicin and LTSL respectively, p<0.05, Newman-Keuls). This improved tumor concentration was achieved despite heating <25% of the tumor volume. Free doxorubicin and LTSL treatments appeared to deliver more drug in the tumor periphery as compared to the tumor core. In contrast, LTSL+MR-HIFU treatment suggested an improved distribution with doxorubicin found in both the tumor periphery and core. Doxorubicin bio-distribution in non-tumor organs/tissues was fairly similar between treatment groups. This technique has potential for clinical translation as an image-guided method to deliver drug to a solid tumor. PMID:22210162

  9. Spinal Cord Tolerance for Stereotactic Body Radiotherapy

    SciTech Connect

    Sahgal, Arjun; Ma Lijun; Gibbs, Iris; Gerszten, Peter C.; Ryu, Sam; Soltys, Scott; Weinberg, Vivian; Wong Shun; Chang, Eric; Fowler, Jack; Larson, David A.

    2010-06-01

    Purpose: Dosimetric data are reported for five cases of radiation-induced myelopathy after stereotactic body radiotherapy (SBRT) to spinal tumors. Analysis per the biologically effective dose (BED) model was performed. Methods and Materials: Five patients with radiation myelopathy were compared to a subset of 19 patients with no radiation myelopathy post-SBRT. In all patients, the thecal sac was contoured to represent the spinal cord, and doses to the maximum point, 0.1-, 1-, 2-, and 5-cc volumes, were analyzed. The mean normalized 2-Gy-equivalent BEDs (nBEDs), calculated using an alpha/beta value of 2 for late toxicity with units Gy 2/2, were compared using the t test and analysis of variance test. Results: Radiation myelopathy was observed at the maximum point with doses of 25.6 Gy in two fractions, 30.9 Gy in three fractions, and 14.8, 13.1, and 10.6 Gy in one fraction. Overall, there was a significant interaction between patient subsets and volume based on the nBED (p = 0.0003). Given individual volumes, a significant difference was observed for the mean maximum point nBED (p = 0.01). Conclusions: The maximum point dose should be respected for spine SBRT. For single-fraction SBRT 10 Gy to a maximum point is safe, and up to five fractions an nBED of 30 to 35 Gy 2/2 to the thecal sac also poses a low risk of radiation myelopathy.

  10. Stereotactic Body Radiotherapy for Primary Hepatocellular Carcinoma

    SciTech Connect

    Andolino, David L.; Johnson, Cynthia S.; Maluccio, Mary; Kwo, Paul; Tector, A. Joseph; Zook, Jennifer; Johnstone, Peter A.S.; Cardenes, Higinia R.

    2011-11-15

    Purpose: To evaluate the safety and efficacy of stereotactic body radiotherapy (SBRT) for the treatment of primary hepatocellular carcinoma (HCC). Methods and Materials: From 2005 to 2009, 60 patients with liver-confined HCC were treated with SBRT at the Indiana University Simon Cancer Center: 36 Child-Turcotte-Pugh (CTP) Class A and 24 CTP Class B. The median number of fractions, dose per fraction, and total dose, was 3, 14 Gy, and 44 Gy, respectively, for those with CTP Class A cirrhosis and 5, 8 Gy, and 40 Gy, respectively, for those with CTP Class B. Treatment was delivered via 6 to 12 beams and in nearly all cases was prescribed to the 80% isodose line. The records of all patients were reviewed, and treatment response was scored according to Response Evaluation Criteria in Solid Tumors v1.1. Toxicity was graded according to the Common Terminology Criteria for Adverse Events v4.0. Local control (LC), time to progression (TTP), progression-free survival (PFS), and overall survival (OS) were calculated according to the method of Kaplan and Meier. Results: The median follow-up time was 27 months, and the median tumor diameter was 3.2 cm. The 2-year LC, PFS, and OS were 90%, 48%, and 67%, respectively, with median TTP of 47.8 months. Subsequently, 23 patients underwent transplant, with a median time to transplant of 7 months. There were no {>=}Grade 3 nonhematologic toxicities. Thirteen percent of patients experienced an increase in hematologic/hepatic dysfunction greater than 1 grade, and 20% experienced progression in CTP class within 3 months of treatment. Conclusions: SBRT is a safe, effective, noninvasive option for patients with HCC {<=}6 cm. As such, SBRT should be considered when bridging to transplant or as definitive therapy for those ineligible for transplant.

  11. Stereotactic Body Radiation Therapy in Spinal Metastases

    SciTech Connect

    Ahmed, Kamran A.; Stauder, Michael C.; Miller, Robert C.; Bauer, Heather J.; Rose, Peter S.; Olivier, Kenneth R.; Brown, Paul D.; Brinkmann, Debra H.; Laack, Nadia N.

    2012-04-01

    Purpose: Based on reports of safety and efficacy, stereotactic body radiotherapy (SBRT) for treatment of malignant spinal tumors was initiated at our institution. We report prospective results of this population at Mayo Clinic. Materials and Methods: Between April 2008 and December 2010, 85 lesions in 66 patients were treated with SBRT for spinal metastases. Twenty-two lesions (25.8%) were treated for recurrence after prior radiotherapy (RT). The mean age of patients was 56.8 {+-} 13.4 years. Patients were treated to a median dose of 24 Gy (range, 10-40 Gy) in a median of three fractions (range, 1-5). Radiation was delivered with intensity-modulated radiotherapy (IMRT) and prescribed to cover 80% of the planning target volume (PTV) with organs at risk such as the spinal cord taking priority over PTV coverage. Results: Tumor sites included 48, 22, 12, and 3 in the thoracic, lumbar, cervical, and sacral spine, respectively. The mean actuarial survival at 12 months was 52.2%. A total of 7 patients had both local and marginal failure, 1 patient experienced marginal but not local failure, and 1 patient had local failure only. Actuarial local control at 1 year was 83.3% and 91.2% in patients with and without prior RT. The median dose delivered to patients who experienced local/marginal failure was 24 Gy (range, 18-30 Gy) in a median of three fractions (range, 1-5). No cases of Grade 4 toxicity were reported. In 1 of 2 patients experiencing Grade 3 toxicity, SBRT was given after previous radiation. Conclusion: The results indicate SBRT to be an effective measure to achieve local control in spinal metastases. Toxicity of treatment was rare, including those previously irradiated. Our results appear comparable to previous reports analyzing spine SBRT. Further research is needed to determine optimum dose and fractionation to further improve local control and prevent toxicity.

  12. High-efficiency FEL-oscillator with Bragg resonator operated in reversed guide field regime

    SciTech Connect

    Kaminsky, A.K.; Sedykh, S.N.; Sergeyev, A.P.

    1995-12-31

    The aim of the present work was to develop a narrow-band FEL-oscillator working in millimeter wavelength with, high efficiency. It looked promising to combine the high selective property of Bragg resonator with high efficiency and other advantages of FEL operation in the reversed guide-field regime. An experimental study of the FEL was performed using lilac LIU-3000 (JINR, Dubna) with the electron energy of 1 MeV, beam current up to 200 A and pulse duration of 200 ns. The beam was injected into the internction region with guide magnetic field of 2.9 kGs. Transverse oscillations of electrons were pumped by the helical wiggler with the period length of 6 cm and the field slowly up-tapering over the initial 6 periods. The FEI electrodynamic system consisted of a circular waveguide with diameter 20 mm and two Bragg reflectors. The H wave of the circular waveguide was shown for operation. Two effective feedback waves were observed in {open_quotes}cold{close_quotes} electrodynamic measurement in correspondence with calculations; the E wave near the frequency of 31. 5 GHz and the E wave - 37.5 GHz. The width of the both reflection resonances was about 2%. In {open_quotes}hot{close_quotes} experiments the radiation on the designed H wave and frequencies corresponding to the both feedback waves was registered separately. Selection of the frequency was realized by varying of the wiggler field strength. The spectrum was measured with a set of the cut--off waveguide filters with inaccuracy less than 2%. Calibrated Semiconductor detectors wire used to measure the radiation power. The radiation with the frequencies of 37.5 and 31.5 GHz was observed in vicinity of the wiggler field amplitude of 2.5 kGs. The measured spectrum width of the output FEL-oscillator radiation did not exceed the width of the Bragg reflector resonances for the both feedback waves.

  13. The Technique, Resources and Costs of Stereotactic Body Radiotherapy of Prostate Cancer: A Comparison of Dose Regimens and Delivery Systems.

    PubMed

    Sharieff, Waseem; Greenspoon, Jeffrey N; Dayes, Ian; Chow, Tom; Wright, James; Lukka, Himu

    2016-02-01

    Robotic system has been used for stereotactic body radiotherapy (SBRT) of prostate cancer. Arc-based and fixed-gantry systems are used for hypofractionated regimens (10-20 fractions) and the standard regimen (39 fractions); they may also be used to deliver SBRT. Studies are currently underway to compare efficacy and safety of these systems and regimens. Thus, we describe the technique and required resources for the provision of robotic SBRT in relation to the standard regimen and other systems to guide investment decisions. Using administrative data of resource volumes and unit prices, we computed the cost per patient, cost per cure and cost per quality adjusted life year (QALY) of four regimens (5, 12, 20 and 39 fractions) and three delivery systems (robotic, arc-based and fixed-gantry) from a payer's perspective. We performed sensitivity analyses to examine the effects of daily hours of operation and in-room treatment delivery times on cost per patient. In addition, we estimated the budget impact when a robotic system is preferred over an arc-based or fixed-gantry system. Costs of SBRT were $6333/patient (robotic), $4368/patient (arc-based) and $4443/patient (fixed-gantry). When daily hours of operation were varied, the cost of robotic SBRT varied from $9324/patient (2 hours daily) to $5250/patient (10 hours daily). This was comparable to the costs of 39 fraction standard regimen which were $5935/patient (arc-based) and $7992/ patient (fixed-gantry). In settings of moderate to high patient volume, robotic SBRT is cost effective compared to the standard regimen. If SBRT can be delivered with equivalent efficacy and safety, the arc-based system would be the most cost effective system.

  14. Integration of Functional MRI and White Matter Tractography in Stereotactic Radiosurgery Clinical Practice

    SciTech Connect

    Pantelis, Evaggelos; Papadakis, Nikolaos; Verigos, Kosmas; Stathochristopoulou, Irene; Antypas, Christos; Lekas, Leonidas; Tzouras, Argyrios; Georgiou, Evangelos; Salvaras, Nikolaos

    2010-09-01

    Purpose: To study the efficacy of the integration of functional magnetic resonance imaging (fMRI) and diffusion tensor imaging tractography data into stereotactic radiosurgery clinical practice. Methods and Materials: fMRI and tractography data sets were acquired and fused with corresponding anatomical MR and computed tomography images of patients with arteriovenous malformation (AVM), astrocytoma, brain metastasis, or hemangioma and referred for stereotactic radiosurgery. The acquired data sets were imported into a CyberKnife stereotactic radiosurgery system and used to delineate the target, organs at risk, and nearby functional structures and fiber tracts. Treatment plans with and without the incorporation of the functional structures and the fiber tracts into the optimization process were developed and compared. Results: The nearby functional structures and fiber tracts could receive doses of >50% of the maximum dose if they were excluded from the planning process. In the AVM case, the doses received by the Broadmann-17 structure and the optic tract were reduced to 700 cGy from 1,400 cGy and to 1,200 cGy from 2,000 cGy, respectively, upon inclusion into the optimization process. In the metastasis case, the motor cortex received 850 cGy instead of 1,400 cGy; and in the hemangioma case, the pyramidal tracts received 780 cGy instead of 990 cGy. In the astrocytoma case, the dose to the motor cortex bordering the lesion was reduced to 1,900 cGy from 2,100 cGy, and therefore, the biologically equivalent dose in three fractions was delivered instead. Conclusions: Functional structures and fiber tracts could receive high doses if they were not considered during treatment planning. With the aid of fMRI and tractography images, they can be delineated and spared.

  15. Quality of Life After Stereotactic Radiotherapy for Stage I Non-Small-Cell Lung Cancer

    SciTech Connect

    Voort van Zyp, Noelle C. van der; Prevost, Jean-Briac; Holt, Bronno van der; Braat, Cora; Klaveren, Robertus J. van; Pattynama, Peter M.; Levendag, Peter C.; Nuyttens, Joost J.

    2010-05-01

    Purpose: To determine the impact of stereotactic radiotherapy on the quality of life of patients with inoperable early-stage non-small-cell lung cancer (NSCLC). Overall survival, local tumor control, and toxicity were also evaluated in this prospective study. Methods and Materials: From January 2006 to February 2008, quality of life, overall survival, and local tumor control were assessed in 39 patients with pathologically confirmed T1 to 2N0M0 NSCLC. These patients were treated with stereotactic radiotherapy. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ) C30 and the QLQ LC13 lung cancer-specific questionnaire were used to investigate changes in quality of life. Assessments were done before treatment, at 3 weeks, and at 2, 4, 6, 9, and 12 months after treatment, until death or progressive disease. Toxicity was evaluated using common terminology criteria for adverse events version 3.0. Results: Emotional functioning improved significantly after treatment. Other function scores and QLQ C30 and QLQ LC13 lung symptoms (such as dyspnea and coughing) showed no significant changes. The overall 2-year survival rate was 62%. After a median follow-up of 17 months, 1 patient had a local recurrence (3%). No grade 4 or 5 treatment-related toxicity occurred. Grade 3 toxicity consisted of thoracic pain, which occurred in 1 patient within 4 months of treatment, while it occurred thereafter in 2 patients. Conclusions: Quality of life was maintained, and emotional functioning improved significantly after stereotactic radiotherapy for stage I NSCLC, while survival was acceptable, local tumor control was high, and toxicity was low.

  16. MR-Guided High-Intensity Focused Ultrasound: Current Status of an Emerging Technology

    SciTech Connect

    Napoli, Alessandro Anzidei, Michele Ciolina, Federica Marotta, Eugenio Cavallo Marincola, Beatrice Brachetti, Giulia Mare, Luisa Di Cartocci, Gaia Boni, Fabrizio Noce, Vincenzo Bertaccini, Luca Catalano, Carlo

    2013-10-15

    The concept of ideal tumor surgery is to remove the neoplastic tissue without damaging adjacent normal structures. High-intensity focused ultrasound (HIFU) was developed in the 1940s as a viable thermal tissue ablation approach. In clinical practice, HIFU has been applied to treat a variety of solid benign and malignant lesions, including pancreas, liver, prostate, and breast carcinomas, soft tissue sarcomas, and uterine fibroids. More recently, magnetic resonance guidance has been applied for treatment monitoring during focused ultrasound procedures (magnetic resonance-guided focused ultrasound, MRgFUS). Intraoperative magnetic resonance imaging provides the best possible tumor extension and dynamic control of energy deposition using real-time magnetic resonance imaging thermometry. We introduce the fundamental principles and clinical indications of the MRgFUS technique; we also report different treatment options and personal outcomes.

  17. Symmetry-guided synthesis of highly porous metal-organic frameworks with fluorite topology.

    PubMed

    Zhang, Muwei; Chen, Ying-Pin; Bosch, Mathieu; Gentle, Thomas; Wang, Kecheng; Feng, Dawei; Wang, Zhiyong U; Zhou, Hong-Cai

    2014-01-13

    Two stable, non-interpenetrated MOFs, PCN-521 and PCN-523, were synthesized by a symmetry-guided strategy. Augmentation of the 4-connected nodes in the fluorite structure with a rigid tetrahedral ligand and substitution of the 8-connected nodes by the Zr/Hf clusters yielded MOFs with large octahedral interstitial cavities. They are the first examples of Zr/Hf MOFs with tetrahedral linkers. PCN-521 has the largest BET surface area (3411 m(2) g(-1)), pore size (20.5×20.5×37.4 Å) and void volume (78.5%) of MOFs formed from tetrahedral ligands. This work not only demonstrates a successful implementation of rational design of MOFs with desired topology, but also provides a systematic way of constructing non-interpenetrated MOFs with high porosity.

  18. Design of guided Bloch surface wave resonance bio-sensors with high sensitivity

    NASA Astrophysics Data System (ADS)

    Kang, Xiu-Bao; Wen, Li-Wei; Wang, Zhi-Guo

    2017-01-01

    The sensing performance of bio-sensors based on guided Bloch surface wave (BSW) resonance (GBR) is studied. GBR is realized by coupling the propagating electromagnetic wave with BSW on one side of a one-dimensional photonic crystal slab via the grating on the other side. The sensitivity of the designed bio-sensors is proportional to the grating constant when the wavelength spectrum is analyzed, and inversely proportional to the normal wave vector of the incident electromagnetic wave when the angular spectrum is resolved. For a GBR bio-sensor designed to operate near 70° angle of incidence from air, the angular sensitivity is very high, reaching 128 deg RIU-1. The sensitivity can be substantially increased by designing bio-sensors for operating at larger angles of incidence.

  19. Adverse Events of Extracorporeal Ultrasound-Guided High Intensity Focused Ultrasound Therapy

    PubMed Central

    Yu, Tinghe; Luo, Jun

    2011-01-01

    Background High-intensity focused ultrasound (HIFU) is considered to be an alternative to surgery. Extracorporeal ultrasound-guided HIFU (USgFU) has been clinically used to treat solid tumors. Preliminary trials in a small sample of a Western population suggested that this modality was safe. Most trials are performed in China thereby providing comprehensive data for understanding the safety profile. The aim of this study was to evaluate adverse events of USgFU therapy. Methods and Findings Clinical data were searched in 2 Chinese databases. Adverse events of USgFU were summarized and compared with those of magnetic resonance-guided HIFU (MRgFU; for uterine, bone or breast tumor) and transrectal ultrasound-guided HIFU (for prostate cancer or benign prostate hyperplasia). USgFU treatment was performed using 7 types of device. Side effects were evaluated in 13262 cases. There were fewer adverse events in benign lesions than in malignant lesions (11.81% vs. 21.65%, p<0.0001). Rates of adverse events greatly varied between the disease types (0–280%, p<0.0001) and between the applied HIFU devices in both malignant (10.58–44.38%, p<0.0001) and benign lesions (1.67–17.57%, p<0.0001). Chronological analysis did not demonstrate a decrease in the rate of adverse events. Based upon evaluable adverse events, incidences in USgFU were consistent with those in MRgFU or transrectal HIFU. Some side effects frequently occurred following transrectal HIFU were not reported in USgFU. Several events including intrahepatic metastasis, intraoperative high fever, and occlusions of the superior mesenteric artery should be of particular concern because they have not been previously noted. The types of adverse events suggested that they were ultrasonic lesions. Conclusion The frequency of adverse events depended on the location of the lesion and the type of HIFU device; however, side effects of USgFU were not yet understood. USgFU did not decrease the incidence of adverse events compared

  20. Stereotactic diffusion tensor imaging tractography for Gamma Knife radiosurgery.

    PubMed

    Gavin, Cormac G; Ian Sabin, H

    2016-12-01

    OBJECTIVE The integration of modern neuroimaging into treatment planning has increased the therapeutic potential and safety of stereotactic radiosurgery. The authors report their method of integrating stereotactic diffusion tensor imaging (DTI) tractography into conventional treatment planning for Gamma Knife radiosurgery (GKRS). The aim of this study was to demonstrate the feasibility of this technique and to address some of the technical limitations of previously reported techniques. METHODS Twenty patients who underwent GKRS composed the study cohort. They consisted of 1 initial test case (a patient with a vestibular schwannoma), 5 patients with arteriovenous malformations, 9 patients with cerebral metastases, 1 patient with parasagittal meningioma, and 4 patients with vestibular schwannoma. DT images were obtained at the time of standard GKRS protocol MRI (T1 and T2 weighted) for treatment, with the patient's head secured by a Leksell stereotactic frame. All studies were performed using a 1.5-T magnet with a single-channel head coil. DTI was performed with diffusion gradients in 32 directions and coregistered with the volumetric T1-weighted study. DTI postprocessing by means of commercially available software allowed tensor computation and the creation of directionally encoded color-, apparent diffusion coefficient-, and fractional anisotropy-mapped sequences. In addition, the software allowed visualized critical tracts to be exported as a structural volume and integrated into GammaPlan as an "organ at risk" during shot planning. Combined images were transferred to GammaPlan and integrated into treatment planning. RESULTS Stereotactic DT images were successfully acquired in all patients, with generation of correct directionally encoded color images. Tract generation with the software was straightforward and reproducible, particularly for axial tracts such as the optic radiation and the arcuate fasciculus. Corticospinal tract visualization was hampered by some

  1. Fractionated Stereotactic Radiotherapy in Patients With Optic Nerve Sheath Meningioma

    SciTech Connect

    Paulsen, Frank; Doerr, Stefan; Wilhelm, Helmut; Becker, Gerd; Bamberg, Michael; Classen, Johannes

    2012-02-01

    Purpose: To evaluate the effectiveness of fractionated stereotactic radiotherapy (SFRT) in the treatment of optic nerve sheath meningioma (ONSM). Methods and Materials: Between 1993 and 2005, 109 patients (113 eyes) with primary (n = 37) or secondary (n = 76) ONSM were treated according to a prospective protocol with SFRT to a median dose of 54 Gy. All patients underwent radiographic, ophthalmologic, and endocrine analysis before and after SFRT. Radiographic response, visual control, and late side effects were endpoints of the analysis. Results: Median time to last clinical, radiographic, and ophthalmologic follow up was 30.2 months (n = 113), 42.7 months (n = 108), and 53.7 months (n = 91), respectively. Regression of the tumor was observed in 5 eyes and progression in 4 eyes, whereas 104 remained stable. Visual acuity improved in 12, deteriorated in 11, and remained stable in 68 eyes. Mean visual field defects reduced from 33.6% (n = 90) to 17.8% (n = 56) in ipsilateral and from 10% (n = 94) to 6.7% (n = 62) in contralateral eyes. Ocular motility improved in 23, remained stable in 65, and deteriorated in 3 eyes. Radiographic tumor control was 100% at 3 years and 98% at 5 years. Visual acuity was preserved in 94.8% after 3 years and in 90.9% after 5 years. Endocrine function was normal in 90.8% after 3 years and in 81.3% after 5 years. Conclusions: SFRT represents a highly effective treatment for ONSM. Interdisciplinary counseling of the patients is recommended. Because of the high rate of preservation of visual acuity we consider SFRT the standard approach for the treatment of ONSM. Prolonged observation is warranted to more accurately assess late visual impairment. Moderate de-escalation of the radiation dose might improve the preservation of visual acuity and pituitary gland function.

  2. Adjuvant Stereotactic Radiosurgery After Resection of Intracranial Hemangiopericytomas

    SciTech Connect

    Kano, Hideyuki; Niranjan, Ajay; Kondziolka, Douglas; Flickinger, John C.; Lunsford, L. Dade

    2008-12-01

    Purpose: To evaluate adjuvant stereotactic radiosurgery (SRS) in the management of recurrent or residual intracranial hemangiopericytomas (HPCs), we assessed tumor control, survival, and complications in patients who had undergone gamma knife SRS as part of multimodal therapy. Methods and Materials: We retrospectively reviewed the records of consecutive 20 HPC patients who had undergone SRS for 29 tumors. The median patient age was 51.5 years (range, 8.9-80.2). All patients had undergone previous surgical resection of their tumors. In addition, 12 patients underwent fractionated radiotherapy before SRS. Of the 20 patients, 16 patients had low-grade HPCs (20 tumors) and 4 had high-grade anaplastic HPCs (9 tumors). The median radiosurgery target volume was 4.5 cm{sup 3} (range, 0.07-34.3), and the median marginal dose was 15.0 Gy (range, 10-20). Results: At an average of 48.2 months (range, 7.2-124.1), 5 patients had died of metastases and 3 patients had died of disease progression. The overall survival after radiosurgery was 100%, 85.9%, and 13.8% at 1, 5, and 10 years, respectively. The follow-up imaging studies demonstrated tumor control in 21 (72.4%) of 29 tumors. The progression-free survival rate after SRS at 1, 3, and 5 years was 89.1% for low-grade HPCs and 88.9%, 66.7%, and 0%, respectively, for high-grade HPCs. The factors associated with improved progression-free survival included lower grade and higher marginal dose. Eight patients had intracranial or extracranial metastasis after the initial diagnosis, which correlated with the shorter survival. Conclusion: The results of our study have shown that adjuvant SRS after tumor resection is an important management option for patients with residual or recurrent HPCs and is particularly effective for less-aggressive tumors.

  3. Plasma devices to guide and collimate a high density of MeV electrons

    NASA Astrophysics Data System (ADS)

    Kodama, R.; Sentoku, Y.; Chen, Z. L.; Kumar, G. R.; Hatchett, S. P.; Toyama, Y.; Cowan, T. E.; Freeman, R. R.; Fuchs, J.; Izawa, Y.; Key, M. H.; Kitagawa, Y.; Kondo, K.; Matsuoka, T.; Nakamura, H.; Nakatsutsumi, M.; Norreys, P. A.; Norimatsu, T.; Snavely, R. A.; Stephens, R. B.; Tampo, M.; Tanaka, K. A.; Yabuuchi, T.

    2004-12-01

    The development of ultra-intense lasers has facilitated new studies in laboratory astrophysics and high-density nuclear science, including laser fusion. Such research relies on the efficient generation of enormous numbers of high-energy charged particles. For example, laser-matter interactions at petawatt (1015W) power levels can create pulses of MeV electrons with current densities as large as 1012Acm-2. However, the divergence of these particle beams usually reduces the current density to a few times 106Acm-2 at distances of the order of centimetres from the source. The invention of devices that can direct such intense, pulsed energetic beams will revolutionize their applications. Here we report high-conductivity devices consisting of transient plasmas that increase the energy density of MeV electrons generated in laser-matter interactions by more than one order of magnitude. A plasma fibre created on a hollow-cone target guides and collimates electrons in a manner akin to the control of light by an optical fibre and collimator. Such plasma devices hold promise for applications using high energy-density particles and should trigger growth in charged particle optics.

  4. High efficiency guiding of terawatt subpicosecond laser pulses in a capillary discharge plasma channel

    NASA Astrophysics Data System (ADS)

    Kaganovich, D.; Ting, A.; Moore, C. I.; Zigler, A.; Burris, H. R.; Ehrlich, Y.; Hubbard, R.; Sprangle, P.

    1999-05-01

    Transmission efficiencies in excess of 75% were obtained in the optical guiding of subpicosecond, terawatt laser pulses in a 2-cm-long capillary discharge plasma channel at the Naval Research Laboratory. The guided laser beam size at the exit of the channel was measured using far field imaging and Thomson scattering techniques. The guided laser intensity was >1×1017 W/cm2 at a guided beam diameter of 35 μm for a propagation length of 22 Rayleigh ranges. There is evidence that the plasma channel extends beyond the ends of the capillary and affects the far field beam structure of the transmitted laser pulse.

  5. Sparse SVD Method for High-Resolution Extraction of the Dispersion Curves of Ultrasonic Guided Waves.

    PubMed

    Xu, Kailiang; Minonzio, Jean-Gabriel; Ta, Dean; Hu, Bo; Wang, Weiqi; Laugier, Pascal

    2016-10-01

    The 2-D Fourier transform analysis of multichannel signals is a straightforward method to extract the dispersion curves of guided modes. Basically, the time signals recorded at several positions along the waveguide are converted to the wavenumber-frequency space, so that the dispersion curves (i.e., the frequency-dependent wavenumbers) of the guided modes can be extracted by detecting peaks of energy trajectories. In order to improve the dispersion curve extraction of low-amplitude modes propagating in a cortical bone, a multiemitter and multireceiver transducer array has been developed together with an effective singular vector decomposition (SVD)-based signal processing method. However, in practice, the limited number of positions where these signals are recorded results in a much lower resolution in the wavenumber axis than in the frequency axis. This prevents a clear identification of overlapping dispersion curves. In this paper, a sparse SVD (S-SVD) method, which combines the signal-to-noise ratio improvement of the SVD-based approach with the high wavenumber resolution advantage of the sparse optimization, is presented to overcome the above-mentioned limitation. Different penalty constraints, i.e., l1 -norm, Frobenius norm, and revised Cauchy norm, are compared with the sparse characteristics. The regularization parameters are investigated with respect to the convergence property and wavenumber resolution. The proposed S-SVD method is investigated using synthetic wideband signals and experimental data obtained from a bone-mimicking phantom and from an ex-vivo human radius. The analysis of the results suggests that the S-SVD method has the potential to significantly enhance the wavenumber resolution and to improve the extraction of the dispersion curves.

  6. Stereotactic Ablative Body Radiation Therapy for Octogenarians With Non-Small Cell Lung Cancer

    SciTech Connect

    Takeda, Atsuya; Sanuki, Naoko; Eriguchi, Takahisa; Kaneko, Takeshi; Morita, Satoshi; Handa, Hiroshi; Aoki, Yousuke; Oku, Yohei; Kunieda, Etsuo

    2013-06-01

    Purpose: To retrospectively investigate treatment outcomes of stereotactic ablative body radiation therapy (SABR) for octogenarians with non-small cell lung cancer (NSCLC). Methods and Materials: Between 2005 and 2012, 109 patients aged ≥80 years with T1-2N0M0 NSCLC were treated with SABR: 47 patients had histology-unproven lung cancer; 62 patients had pathologically proven NSCLC. The prescribed doses were either 50 Gy/5 fractions for peripheral tumors or 40 Gy/5 fractions for centrally located tumors. The treatment outcomes, toxicities, and the correlating factors for overall survival (OS) were evaluated. Results: The median follow-up duration after SABR was 24.2 (range, 3.0-64.6) months. Only limited toxicities were observed, except for 1 grade 5 radiation pneumonitis. The 3-year local, regional, and distant metastasis-free survival rates were 82.3%, 90.1%, and 76.8%, respectively. The OS and lung cancer-specific survival rates were 53.7% and 70.8%, respectively. Multivariate analysis revealed that medically inoperable, low body mass index, high T stage, and high C-reactive protein were the predictors for short OS. The OS for the operable octogenarians was significantly better than that for inoperable (P<.01). Conclusions: Stereotactic ablative body radiation therapy for octogenarians was feasible, with excellent OS. Multivariate analysis revealed that operability was one of the predictors for OS. For medically operable octogenarians with early-stage NSCLC, SABR should be prospectively compared with resection.

  7. Stereotactic radiosurgery of prostate cancer - dose distribution for VMAT and CyberKnife techniques

    NASA Astrophysics Data System (ADS)

    Ślosarek, Krzysztof; Osewski, Wojciech; Grządziel, Aleksandra; Stąpór-Fudzińska, Małgorzata; Szlag, Marta

    2016-06-01

    New capabilities of biomedical accelerators allow for very precise depositing of the radiation dose and imaging verification during the therapy. In addition, computer algorithms calculating dose distributions are taking into account the increasing number of physical effects. Therefore, administration of high dose fractionation, which is consistent with radiobiology used in oncology, becomes safer and safer. Stereotactic radiosurgery (SRS), which is very precise irradiation with high dose fractionation is increasingly widespread use in radiotherapy of prostate cancer. For this purpose different biomedical accelerators are used. The aim of this study is to compare dose distributions for two techniques: VMAT and CyberKnife. Statistical analysis was performed for the two groups of patients treated by VMAT technique (25 patients), and CyberKnife technique (15 patients). The analysis shows that the dose distributions are comparable, both in the treated area (prostate) and in the critical organs (rectum, urinary bladder, femoral heads). The results show that stereotactic radiosurgery of prostate cancer can be carried out on CyberKnife accelerator as well as on the classical accelerator with the use of VMAT technique.

  8. In-vivo reflection spectroscopy measurements in pig brain during stereotactic surgery

    NASA Astrophysics Data System (ADS)

    Antonsson, Johan; Eriksson, Ola; Wardell, Karin

    2003-07-01

    Radio frequency (RF) lesioning in the human brain is a common surgical therapy for relieving severe pain as well as for movement disorders such as Parkinsonia. During the procedure a small electrode is introduced by stereotactic means towards a target area localized by CT or MRI. An RF-current is applied through the electrode tip when positioned in the target area. The tissue in the proximity of the tip is heated by the current and finally coagulated. The overall aim of this study was to improve the RF-technique and its ability to estimate lesion size by means of optical methods. Therefore, the optical differences between white and gray matter, as well as lesioned and unlesioned tissue were investigated. Reflection spectroscopy measurements in the range of 450-800 nm were conducted on fully anesthetized pigs during stereotactic RF-lesioning (n=6). Light from a tungsten lamp was guided to the electrode tip through optical fibers, inserted along a 2 mm in diameter monopolar RF-electrode. Measurements were performed in steps of 0-10 mm from the target in each hemisphere towards the entry point of the skull. In the central gray of the porcine brain measurements were performed both before and after the creation of a lesion. A total of 55 spectra were collected during this study. Correlation to tissue type was done using post-operative MR-images. The spectral signature for white and gray matter differs significantly for the entire spectral range of 450-800 nm. Pre- and post-lesioning reflection spectroscopy showed the largest differences below 600 and above 620 nm, which implies that lasers within this wavelength range may be useful for in-vivo measurements of tissue optical changes during RF-lesioning.

  9. Effect of spine hardware on small spinal stereotactic radiosurgery dosimetry.

    PubMed

    Wang, Xin; Yang, James N; Li, Xiaoqiang; Tailor, Ramesh; Vassilliev, Oleg; Brown, Paul; Rhines, Laurence; Chang, Eric

    2013-10-07

    Monte Carlo (MC) modeling of a 6 MV photon beam was used to study the dose perturbation from a titanium rod 5 mm in diameter in various small fields range from 2 × 2 to 5 × 5 cm(2). The results showed that the rod increased the dose to water by ∼6% at the water-rod interface because of electron backscattering and decreased the dose by ∼7% in the shadow of the rod because of photon attenuation. The Pinnacle(3) treatment planning system calculations matched the MC results at the depths more than 1 cm past the rod when the correct titanium density of 4.5 g cm(-3) was used, but significantly underestimated the backscattering dose at the water-rod interface. A CT-density table with a top density of 1.82 g cm(-3) (cortical bone) is a practical way to reduce the dosimetric error from the artifacts by preventing high density assignment to them, but can underestimates the attenuation by the titanium rod by 6%. However, when multi-beam with intensity modulation is used in actual patient spinal stereotactic radiosurgery treatment, the dosimetric effect of assigning 4.5 instead of 1.82 g cm(-3) to titanium implants is complicated. It ranged from minimal effect to 2% dose difference affecting 15% target volume in the study. When hardware is in the beam path, density override to the titanium hardware is recommended.

  10. Monitor Unit Checking in Heterogeneous Stereotactic Body Radiotherapy Treatment Planning

    SciTech Connect

    Higgins, Patrick D.; Adolfson, Troy; Cho, L. Chinsoo; Saxena, Rishik

    2011-10-01

    Treatment of lung cancer using very-high-dose fractionation in small fields requires well-tested dose modeling, a method for density-averaging compound targets constructed from different parts of the breathing cycle, and monitor unit verification of the heterogeneity-corrected treatment plans. The quality and safety of each procedure are dependent on these factors. We have evaluated the dosimetry of our first 26 stereotactic body radiotherapy (SBRT) patients, including 260 treatment fields, planned with the Pinnacle treatment planning system. All targets were combined from full expiration and inspiration computed tomography scans and planned on the normal respiration scan with 6-MV photons. Combined GTVs (cGTVs) have been density-averaged in different ways for comparison of the effect on total monitor units. In addition, we have compared planned monitor units against hand calculations using 2 classic 1D correction methods: (1) effective attenuation and (2) ratio of Tissue-Maximum Ratios (TMRs) to determine the range of efficacy of simple verification methods over difficult-to-perform measurements. Different methods of density averaging for combined targets have been found to have minimal impact on total dose as evidenced by the range of total monitor units generated for each method. Nondensity-corrected treatment plans for the same fields were found to require about 8% more monitor units on average. Hand calculations, using the effective attenuation method were found to agree with Pinnacle calculations for nonproblematic fields to within {+-}10% for >95% of the fields tested. The ratio of TMRs method was found to be unacceptable. Reasonable choices for density-averaging of cGTVs using full inspiration/expiration scans should not strongly affect the planning dose. Verification of planned monitor units, as a check for problematic fields, can be done for 6-MV fields with simple 1D effective attenuation-corrected hand calculations.

  11. Image-Guided Radiotherapy for Cervix Cancer: High-Tech External Beam Therapy Versus High-Tech Brachytherapy

    SciTech Connect

    Georg, Dietmar Kirisits, Christian; Hillbrand, Martin; Dimopoulos, Johannes; Poetter, Richard

    2008-07-15

    Purpose: Many studies comparing external-beam therapy (EBT) and brachytherapy (BT) are biased because advanced EBT is compared with conventional BT. This study compares high-tech EBT against high-tech BT. Methods and Materials: Nine patients were selected with locally advanced cervix cancer, representing typical clinical situations according to initial tumor extension and response after EBT. Patients were treated either with intracavitary, combined interstitial/intracavitary, or complex interstitial BT. Gross tumor volume, high-risk clinical target volume (CTV), intermediate-risk CTV, bladder, rectum, and sigmoid were delineated. Magnetic resonance-guided BT planning was manually optimized with respect to organ dose limits. Margins (3 and 5 mm) were added to BT CTVs to construct planning target volumes (PTVs) for EBT. Inversely planned EBT with photons (IMRT) and protons (IMPT) was challenged to deliver the highest possible doses to PTVs while respecting D{sub 1cc} and D{sub 2cc} limits from BT, assuming the same fractionation (4 x 7 Gy). The D90 for target structures and normal tissue volumes receiving fractionated doses between 3 and 7 Gy were compared. Results: High-risk CTV doses depended on the clinical situation and radiation quality. If IMRT was limited to D{sub 2cc} and D{sub 1cc} from BT, the D90 for high-risk PTV and intermediate-risk PTV was mostly lower. Volumes receiving 60 Gy (in equivalent dose in 20 Gy fractions) were approximately twice as large for IMRT compared with BT. For IMPT, this volume ratio was lower. Planning target volume doses of IMPT plans with 3-mm margins were comparable to those with BT. Gross tumor volume doses were mostly lower for both IMRT and IMPT. Conclusion: For benchmarking high-tech EBT, high-tech BT techniques have to be used. For cervix cancer boost treatments, both IMRT and IMPT seem to be inferior to advanced BT.

  12. Clinical Application of High-Dose, Image-Guided Intensity-Modulated Radiotherapy in High-Risk Prostate Cancer

    SciTech Connect

    Bayley, Andrew; Rosewall, Tara; Craig, Tim; Bristow, Rob; Chung, Peter; Gospodarowicz, Mary; Menard, Cynthia; Milosevic, Michael; Warde, Padraig; Catton, Charles

    2010-06-01

    Purpose: To report the feasibility and early toxicity of dose-escalated image-guided IMRT to the pelvic lymph nodes (LN), prostate (P), and seminal vesicles (SV). Methods and Materials: A total of 103 high-risk prostate cancer patients received two-phase, dose-escalated, image-guided IMRT with 3 years of androgen deprivation therapy. Clinical target volumes (CTVs) were delineated using computed tomography/magnetic resonance co-registration and included the prostate, portions of the SV, and the LN. Planning target volume margins (PTV) used were as follows: P (10 mm, 7 mm posteriorly), SV (10 mm), and LN (5 mm). Organs at risk (OaR) were the rectal and bladder walls, femoral heads, and large and small bowel. The IMRT was planned with an intended dose of 55.1 Gy in 29 fractions to all CTVs (Phase 1), with P+SV consecutive boost of 24.7 Gy in 13 fractions. Daily online image guidance was performed using bony landmarks and intraprostatic markers. Feasibility criteria included delivery of intended doses in 80% of patients, 95% of CTV displacements incorporated within PTV during Phase 1, and acute toxicity rate comparable to that of lower-dose pelvic techniques. Results: A total of 91 patients (88%) received the total prescription dose. All patients received at least 72 Gy. In Phase 1, 63 patients (61%) received the intended 55.1 Gy, whereas 87% of patients received at least 50 Gy. Dose reductions were caused by small bowel and rectal wall constraints. All CTVs received the planned dose in >95% of treatment fractions. There were no Radiation Therapy Oncology Group acute toxicities greater than Grade 3, although there were five incidences equivalent to Grade 3 within a median follow-up of 23 months. Conclusion: These results suggest that dose escalation to the PLN+P+SV using IMRT is feasible, with acceptable rates of acute toxicity.

  13. Individualized Education Program (IEP) Planning Guide for Special Education Students Entering High School Vocational Education Programs.

    ERIC Educational Resources Information Center

    Burrell, Lewis P.

    This guide is designed to assist school program planners who are working with mainstreamed special education students in vocational education programs. The guide, covering grades 11 and 12, contains vocational program goals, objectives, and evaluation measures for 30 secondary vocational education programs in 15 curriculum areas, as well as for…

  14. Building a Linked Learning Pathway: A Guide for Transforming High Schools for College and Career Success

    ERIC Educational Resources Information Center

    Atterbury, Rob

    2014-01-01

    This guide provides an overview of a more robust online guide and toolkit available through ConnectEd Studios. It supplies a glimpse of the sequence of steps involved in creating a new Linked Learning pathway. This publication can help coaches, district leadership, and pathway teams gain an understanding of the overall process of designing and…

  15. Wetlands & Wildlife: Alaska Wildlife Curriculum Junior & Senior High Teacher's Guide 7-12.

    ERIC Educational Resources Information Center

    Sigman, Marilyn; And Others

    This curriculum guide was designed to give students at the secondary level an awareness of Alaska's wetlands and the fish and wildlife that live there. The guide is divided into the following sections which include related learning activities: (1) definition and location of wetlands; (2) wetland functions in energy flow and ecological balance; (3)…

  16. Selective Service Presents a Teacher's Guide. Information Important to Pupils [Pupae] of the High School Species.

    ERIC Educational Resources Information Center

    Selective Service System, Arlington, VA.

    This guide is designed to help teachers prepare lessons about the purpose, history, organization, and functions of the selective service system. The following topics are covered in the guide's seven sections: the selective service system today; history of conscription in the United States; history of the selective service system; organization and…

  17. Measurement of viscosity of highly viscous non-Newtonian fluids by means of ultrasonic guided waves.

    PubMed

    Kazys, Rymantas; Mazeika, Liudas; Sliteris, Reimondas; Raisutis, Renaldas

    2014-04-01

    In order to perform monitoring of the polymerisation process, it is necessary to measure viscosity. However, in the case of non-Newtonian highly viscous fluids, viscosity starts to be dependent on the vibration or rotation frequency of the sensing element. Also, the sensing element must possess a sufficient mechanical strength. Some of these problems may be solved applying ultrasonic measurement methods, however until now most of the known investigations were devoted to measurements of relatively low viscosities (up to a few Pas) of Newtonian liquids. The objective of the presented work is to develop ultrasonic method for measurement of viscosity of high viscous substances during manufacturing process in extreme conditions. For this purpose the method based on application of guided Lamb waves possessing the predominant component of in-plane displacements (the S0 and the SH0 modes) and propagating in an aluminium planar waveguide immersed in a viscous liquid has been investigated. The simulations indicated that in the selected modes mainly in-plane displacements are dominating, therefore the attenuation of those modes propagating in a planar waveguide immersed in a viscous liquid is mainly caused by viscosity of the liquid. The simulation results were confirmed by experiments. All measurements were performed in the viscosity standard Cannon N2700000. Measurements with the S0 wave mode were performed at the frequency of 500kHz. The SH0 wave mode was exited and used for measurements at the frequency of 580kHz. It was demonstrated that by selecting the particular mode of guided waves (S0 or SH0), the operation frequency and dimensions of the aluminium waveguide it is possible to get the necessary viscosity measurement range and sensitivity. The experiments also revealed that the measured dynamic viscosity is strongly frequency dependent and as a characteristic feature of non-Newtonian liquids is much lower than indicated by the standards. Therefore, in order to get the

  18. Dynamic T2-mapping during magnetic resonance guided high intensity focused ultrasound ablation of bone marrow

    NASA Astrophysics Data System (ADS)

    Waspe, Adam C.; Looi, Thomas; Mougenot, Charles; Amaral, Joao; Temple, Michael; Sivaloganathan, Siv; Drake, James M.

    2012-11-01

    Focal bone tumor treatments include amputation, limb-sparing surgical excision with bone reconstruction, and high-dose external-beam radiation therapy. Magnetic resonance guided high intensity focused ultrasound (MR-HIFU) is an effective non-invasive thermotherapy for palliative management of bone metastases pain. MR thermometry (MRT) measures the proton resonance frequency shift (PRFS) of water molecules and produces accurate (<1°C) and dynamic (<5s) thermal maps in soft tissues. PRFS-MRT is ineffective in fatty tissues such as yellow bone marrow and, since accurate temperature measurements are required in the bone to ensure adequate thermal dose, MR-HIFU is not indicated for primary bone tumor treatments. Magnetic relaxation times are sensitive to lipid temperature and we hypothesize that bone marrow temperature can be determined accurately by measuring changes in T2, since T2 increases linearly in fat during heating. T2-mapping using dual echo times during a dynamic turbo spin-echo pulse sequence enabled rapid measurement of T2. Calibration of T2-based thermal maps involved heating the marrow in a bovine femur and simultaneously measuring T2 and temperature with a thermocouple. A positive T2 temperature dependence in bone marrow of 20 ms/°C was observed. Dynamic T2-mapping should enable accurate temperature monitoring during MR-HIFU treatment of bone marrow and shows promise for improving the safety and reducing the invasiveness of pediatric bone tumor treatments.

  19. Laminin-guided highly efficient endothelial commitment from human pluripotent stem cells

    PubMed Central

    Ohta, Ryo; Niwa, Akira; Taniguchi, Yukimasa; Suzuki, Naoya M.; Toga, Junko; Yagi, Emiko; Saiki, Norikazu; Nishinaka-Arai, Yoko; Okada, Chihiro; Watanabe, Akira; Nakahata, Tatsutoshi; Sekiguchi, Kiyotoshi; Saito, Megumu K.

    2016-01-01

    Obtaining highly purified differentiated cells via directed differentiation from human pluripotent stem cells (hPSCs) is an essential step for their clinical application. Among the various conditions that should be optimized, the precise role and contribution of the extracellular matrix (ECM) during differentiation are relatively unclear. Here, using a short fragment of laminin 411 (LM411-E8), an ECM predominantly expressed in the vascular endothelial basement membrane, we demonstrate that the directed switching of defined ECMs robustly yields highly-purified (>95%) endothelial progenitor cells (PSC-EPCs) without cell sorting from hPSCs in an integrin-laminin axis-dependent manner. Single-cell RNA-seq analysis revealed that LM411-E8 resolved intercellular transcriptional heterogeneity and escorted the progenitor cells to the appropriate differentiation pathway. The PSC-EPCs gave rise to functional endothelial cells both in vivo and in vitro. We therefore propose that sequential switching of defined matrices is an important concept for guiding cells towards desired fate. PMID:27804979

  20. High-capacity, low-tortuosity, and channel-guided lithium metal anode.

    PubMed

    Zhang, Ying; Luo, Wei; Wang, Chengwei; Li, Yiju; Chen, Chaoji; Song, Jianwei; Dai, Jiaqi; Hitz, Emily M; Xu, Shaomao; Yang, Chunpeng; Wang, Yanbin; Hu, Liangbing

    2017-04-04

    Lithium metal anode with the highest capacity and lowest anode potential is extremely attractive to battery technologies, but infinite volume change during the Li stripping/plating process results in cracks and fractures of the solid electrolyte interphase, low Coulombic efficiency, and dendritic growth of Li. Here, we use a carbonized wood (C-wood) as a 3D, highly porous (73% porosity) conductive framework with well-aligned channels as Li host material. We discovered that molten Li metal can infuse into the straight channels of C-wood to form a Li/C-wood electrode after surface treatment. The C-wood channels function as excellent guides in which the Li stripping/plating process can take place and effectively confine the volume change that occurs. Moreover, the local current density can be minimized due to the 3D C-wood framework. Therefore, in symmetric cells, the as-prepared Li/C-wood electrode presents a lower overpotential (90 mV at 3 mA⋅cm(-2)), more-stable stripping/plating profiles, and better cycling performance (∼150 h at 3 mA⋅cm(-2)) compared with bare Li metal electrode. Our findings may open up a solution for fabricating stable Li metal anode, which further facilitates future application of high-energy-density Li metal batteries.

  1. Stereotactic radiosurgery using the Leksell Gamma Knife: current trends and future directives.

    PubMed

    Jawahar, Ajay; Jawahar, Lisa L; Nanda, Anil; Sharp, Christopher D; Warren, April; Elrod, John W; Jennings, Merilyn; Alexander, J Steven; Minagar, Alireza

    2004-01-01

    Stereotactic radiosurgery is the extremely precise administration of a radiation dosage in three-dimensional space to treat an increasingly broad spectrum of intracranial and skull-base lesions. 455 patients with various indications were treated using the 201 Source Co-60 Leksell Model "B" Gamma Knife(r) at Louisiana State University Health Sciences Center in Shreveport, Louisiana. 273 (60.2%) patients received radiosurgery as the first line of treatment for their disease. The mean Karnofsky Performance Score (KPS) of the patients was 70. Cerebral metastases were the main indications for radiosurgery at our center accounting for 27% of the patients, while meningioma, AVM, trigeminal neuralgia, movement disorders, and primary CNS malignant tumors were the other indications. Our institutional experience and results indicate that low incidence of complications coupled with a high tumor control rate makes Gamma Knife stereotactic radiosurgery a viable option for patients who must undergo neurosurgery. As the Gamma Knife continues to prove itself as a first-line treatment of many complex brain disorders, new indications for this technology will continue to emerge, further broadening the scope of patient care.

  2. Early experiences of planning stereotactic radiosurgery using 3D printed models of eyes with uveal melanomas

    PubMed Central

    Furdová, Alena; Sramka, Miron; Thurzo, Andrej; Furdová, Adriana

    2017-01-01

    Objective The objective of this study was to determine the use of 3D printed model of an eye with intraocular tumor for linear accelerator-based stereotactic radiosurgery. Methods The software for segmentation (3D Slicer) created virtual 3D model of eye globe with tumorous mass based on tissue density from computed tomography and magnetic resonance imaging data. A virtual model was then processed in the slicing software (Simplify3D®) and printed on 3D printer using fused deposition modeling technology. The material that was used for printing was polylactic acid. Results In 2015, stereotactic planning scheme was optimized with the help of 3D printed model of the patient’s eye with intraocular tumor. In the period 2001–2015, a group of 150 patients with uveal melanoma (139 choroidal melanoma and 11 ciliary body melanoma) were treated. The median tumor volume was 0.5 cm3 (0.2–1.6 cm3). The radiation dose was 35.0 Gy by 99% of dose volume histogram. Conclusion The 3D printed model of eye with tumor was helpful in planning the process to achieve the optimal scheme for irradiation which requires high accuracy of defining the targeted tumor mass and critical structures. PMID:28203052

  3. Biological equivalent dose studies for dose escalation in the stereotactic synchrotron radiation therapy clinical trials

    SciTech Connect

    Prezado, Y.; Fois, G.; Edouard, M.; Nemoz, C.; Renier, M.; Requardt, H.; Esteve, F.; Adam, JF.; Elleaume, H.; Bravin, A.

    2009-03-15

    Synchrotron radiation is an innovative tool for the treatment of brain tumors. In the stereotactic synchrotron radiation therapy (SSRT) technique a radiation dose enhancement specific to the tumor is obtained. The tumor is loaded with a high atomic number (Z) element and it is irradiated in stereotactic conditions from several entrance angles. The aim of this work was to assess dosimetric properties of the SSRT for preparing clinical trials at the European Synchrotron Radiation Facility (ESRF). To estimate the possible risks, the doses received by the tumor and healthy tissues in the future clinical conditions have been calculated by using Monte Carlo simulations (PENELOPE code). The dose enhancement factors have been determined for different iodine concentrations in the tumor, several tumor positions, tumor sizes, and different beam sizes. A scheme for the dose escalation in the various phases of the clinical trials has been proposed. The biological equivalent doses and the normalized total doses received by the skull have been calculated in order to assure that the tolerance values are not reached.

  4. [Linear accelerator-based stereotactic radiation treatment of patients with medial middle fossa meningiomas].

    PubMed

    Golanov, A V; Cherekaev, V A; Serova, N K; Pronin, I N; Gorlachev, G E; Kotel'nikova, T M; Podoprigora, A E; Kudriavtseva, P A; Galkin, M V

    2010-01-01

    Medial middle fossa meningiomas are challenging for neurosurgical treatment. Invasion of cranial nerves and vessels leads to high risk of complications after removal of such meningiomas. Currently methods of conformal stereotactic radiation treatment are applied wider and wider for the discussed lesions. During a 3.5-year period 80 patients with medial middle fossa meningiomas were treated in Burdenko Moscow Neurosurgical Institute using linear accelerator "Novalis". In 31 case radiation treatment was preceded by surgical resection. In majority of patients symptoms included cranial nerve dysfunction: oculomotor disturbances in 62.5%, trigeminal impairment--in 37.5%, visual deficit--in 43.8%, facial nerve palsy--in 1.25%. 74 patients underwent radiotherapy with classical fractioning, 2--in hypofractionated mode and 4 received radiosurgery. In cases of classical fractioning mean marginal dose reached 46.3 Gy during 28-33 fractions, in hypofractioning (7 fractions)--31.5 Gy, in radiosurgery--16.25 Gy. Mean follow-up period was 18.4 months (6-42 months). Control of tumor growth was achieved in 97.5% of cases (78 patients): in 42 (52.5%) lesion shrinked, in 36 (45%) stabilization was observed. Clinical examination revealed improvement of visual function in 15 patients (18%) and deterioration in 2 (2.5%). No new neuropathies were found. Stereotactic radiation treatment is the method of choice for medial anterior and middle fossa meningiomas due to effective control of tumor progression and minimal rate of complications.

  5. Treatment of hepatic metastases of colorectal cancer by robotic stereotactic radiation (Cyberknife ®).

    PubMed

    Peiffert, D; Baumann, A-S; Marchesi, V

    2014-04-01

    Cyberknife(®) is a dedicated stereotactic radiotherapy device. This new technology permits precise delivery of high dose gradient radiation therapy while sparing the surrounding organs at risk. Hepatic metastases of colorectal cancer (HMCRC) are an example of a lesion where treatment with Cyberknife(®) is indicated because they are located in a radio-sensitive organ and curative treatment is based on focal eradication (resection, radiofrequency ablation,...). The local control rate at one year is reported to be 70 to 100% depending on the study. Tolerance is excellent with less than a 5% rate of acute grade 3 or 4 side effects (nausea, vomiting, gastro-duodenal ulcer). The specific hepatotoxicity of radiotherapy, so-called radiation-induced liver disease (RILD), was found in only one study. Candidates for stereotactic radiotherapy are patients in whom disease is controlled except for intrahepatic disease with 1-3 hepatic metastases ≤ 6 cm in size who have contraindications for surgery, a WHO stage ≤ 2, a volume of healthy liver ≥ 700 cm(3) and normal liver function. It is actually a very simple treatment that results in very good local control with few contraindications. Its place in the management strategy of liver metastases needs further clarification.

  6. Let's Poem: The Essential Guide to Teaching Poetry in a High-Stakes, Multimodal World (Middle through High School). Language & Literacy Practitioners Bookshelf

    ERIC Educational Resources Information Center

    Dressman, Mark

    2010-01-01

    This cutting-edge guide presents multiple approaches to teaching poetry at the middle and high school levels. The author provides field-tested activities with detailed how-to instructions, as well as advice for how educators can "justify" their teaching within a high-stakes curriculum environment. "Let's Poem" will show pre- and inservice teachers…

  7. Topology-Guided Design and Syntheses of Highly Stable Mesoporous Porphyrinic Zirconium Metal-Organic Frameworks with High Surface Area

    SciTech Connect

    Liu, TF; Feng, DW; Chen, YP; Zou, LF; Bosch, M; Yuan, S; Wei, ZW; Fordham, S; Wang, KC; Zhou, HC

    2015-01-14

    Through a topology-guided strategy, a series of Zr-6-containing isoreticular porphyrinic metalorganic frameworks (MOFs), PCN-228, PCN-229, and PCN-230, with ftw-a topology were synthesized using the extended porphyrinic linkers. The bulky porphyrin ring ligand effectively prevents the network interpenetration which often appears in MOFs with increased linker length. The pore apertures of the structures range from 2.5 to 3.8 nm, and PCN-229 demonstrates the highest porosity and BET surface area among the previously reported Zr-MOFs. Additionally, by changing the relative direction of the terminal phenyl rings, this series replaces a Zr-8 cluster with a smaller Zr-6 cluster in a topologically identical framework. The high connectivity of the Zr-6 cluster yields frameworks with enhanced stability despite high porosity and ultralarge linker. As a representative example, PCN-230, constructed with the most extended porphyrinic linker, shows excellent stability in aqueous solutions with pH values ranging from 0 to 12 and demonstrates one of the highest pH tolerances among all porphyrinic MOFs. This work not only presents a successful example of rational design of MOFs with desired topology, but also provides a strategy for construction of stable mesoporous MOFs.

  8. Topology-guided design and syntheses of highly stable mesoporous porphyrinic zirconium metal-organic frameworks with high surface area

    SciTech Connect

    Liu, Tian -Fu; Feng, Dawei; Chen, Ying -Pin; Zou, Lanfang; Bosch, Mathieu; Yuan, Shuai; Wei, Zhangwen; Fordham, Stephen; Wang, Kecheng; Zhou, Hong -Cai

    2015-01-14

    Through a topology-guided strategy, a series of Zr₆-containing isoreticular porphyrinic metal–organic frameworks (MOFs), PCN-228, PCN-229, and PCN-230, with ftw-a topology were synthesized using the extended porphyrinic linkers. The bulky porphyrin ring ligand effectively prevents the network interpenetration which often appears in MOFs with increased linker length. The pore apertures of the structures range from 2.5 to 3.8 nm, and PCN-229 demonstrates the highest porosity and BET surface area among the previously reported Zr-MOFs. Additionally, by changing the relative direction of the terminal phenyl rings, this series replaces a Zr₈ cluster with a smaller Zr₆ cluster in a topologically identical framework. The high connectivity of the Zr₆ cluster yields frameworks with enhanced stability despite high porosity and ultralarge linker. As a representative example, PCN-230, constructed with the most extended porphyrinic linker, shows excellent stability in aqueous solutions with pH values ranging from 0 to 12 and demonstrates one of the highest pH tolerances among all porphyrinic MOFs. This work not only presents a successful example of rational design of MOFs with desired topology, but also provides a strategy for construction of stable mesoporous MOFs.

  9. Non-periodic multi-slit masking for a single counter rotating 2-disc chopper and channeling guides for high resolution and high intensity neutron TOF spectroscopy

    NASA Astrophysics Data System (ADS)

    Bartkowiak, M.; Hofmann, T.; Stüßer, N.

    2017-02-01

    Energy resolution is an important design goal for time-of-flight instruments and neutron spectroscopy. For high-resolution applications, it is required that the burst times of choppers be short, going down to the μs-range. To produce short pulses while maintaining high neutron flux, we propose beam masks with more than two slits on a counter-rotating 2-disc chopper, behind specially adapted focusing multi-channel guides. A novel non-regular arrangement of the slits ensures that the beam opens only once per chopper cycle, when the masks are congruently aligned. Additionally, beam splitting and intensity focusing by guides before and after the chopper position provide high intensities even for small samples. Phase-space analysis and Monte Carlo simulations on examples of four-slit masks with adapted guide geometries show the potential of the proposed setup.

  10. NAGC Pre-K-Grade 12 Gifted Education Programming Standards: A Guide to Planning and Implementing High-Quality Services

    ERIC Educational Resources Information Center

    Johnsen, Susan K., Ed.

    2012-01-01

    The new Pre-K-Grade 12 Gifted Education Programming Standards should be part of every school district's repertoire of standards to ensure that the learning needs of advanced students are being met. "NAGC Pre-K-Grade 12 Gifted Education Programming Standards: A Guide to Planning and Implementing High-Quality Services" details six standards that…

  11. A Curriculum Guide for Occupational Orientation and Exploration in Junior High School Home Economics and Industrial Arts.

    ERIC Educational Resources Information Center

    Williams, Grace

    The specific purpose of the curriculum guide is utilization in industrial arts and home economics of part of the junior high phase of the SPAN Project--An Accelerated Project for a System Program Approaching Non-Unemployment of Vocational Students, or "Start Planning Ahead Now". The document is designed to assist the teacher in providing…

  12. Helping Students Navigate the Path to College: What High Schools Can Do. IES Practice Guide. NCEE 2009-4066

    ERIC Educational Resources Information Center

    Tierney, William G.; Bailey, Thomas; Constantine, Jill; Finkelstein, Neal; Hurd, Nicole Farmer

    2009-01-01

    Access to higher education remains a challenge for many students who face academic and informational barriers to college entry. This guide targets high schools and school districts, and focuses on effective practices that prepare students academically for college, assist them in completing the steps to college entry, and improve their likelihood…

  13. Failure Is Not an Option (TM). Six Principles That Guide Student Achievement in High-Performing Schools

    ERIC Educational Resources Information Center

    Blankstein, Alan M.

    2004-01-01

    The author builds upon a foundation which identifies courageous school leadership and the professional learning community as the center of effective school reform. The author offers six guiding principles steps for creating and sustaining a high-performing school: (1) Common mission, vision, values, and goals: (2) Systems for prevention and…

  14. High School Senior's Guide to Merit and Other No-Need Funding, 1998-2000, 2nd Edition.

    ERIC Educational Resources Information Center

    Schlachter, Gail Ann; Webber, R. David

    This volume provides information on 1,100 merit scholarships and other no-need funding programs available specifically to high school seniors applying to college. Programs listed in the guide make decisions based upon student academic records, writing or artistic ability, speech-making skills, religious or ethnic background, parents'…

  15. Foods and Nutrition Curriculum Guide for Junior High, Secondary, and Adult Vocational Home Economics Programs. Bulletin 1595.

    ERIC Educational Resources Information Center

    Louisiana State Dept. of Education, Baton Rouge. Div. of Vocational Education.

    This comprehensive curriculum guide for junior high through adult levels presents foods and nutrition as they relate to quality living, career orientation, and occupational training. The first section is a conceptual outline of core material in foods and nutrition. Five instructional levels are I (grades 7-9), II (9-10), III (10-11), IV (11-12),…

  16. Alcohol and Alcohol Safety: A Curriculum Manual for Junior High Level. Volume II, A Teacher's Activities Guide.

    ERIC Educational Resources Information Center

    Finn, Peter; Platt, Judith

    This curriculum manual on Alcohol and Alcohol Safety is designed as a teacher's guide for junior high level students. The topics it covers are: (1) safety; (2) attitudes toward alcohol and reasons people drink; (3) physical and behavioral effects; (4) interpersonal situations; (5) laws and customs; and (6) problem drinking and alcoholism. Each…

  17. Alcohol and Alcohol Safety: A Curriculum Manual for Senior High Level. Volume II, A Teacher's Activities Guide.

    ERIC Educational Resources Information Center

    Finn, Peter; Platt, Judith

    This curriculum manual on Alcohol and Alcohol Safety is designed as a teacher's guide for senior high level students. The topics it covers are: (1) safety; (2) attitudes toward alcohol and reasons people drink; (3) physical and behavioral effects; (4) alcohol industry; (5) interpersonal situations; (6) laws and customs; and (7) problem drinking…

  18. 48 CFR 570.117-2 - Guiding principles for federal leadership in high performance and sustainable buildings.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 4 2012-10-01 2012-10-01 false Guiding principles for federal leadership in high performance and sustainable buildings. 570.117-2 Section 570.117-2 Federal Acquisition Regulations System GENERAL SERVICES ADMINISTRATION SPECIAL CONTRACTING PROGRAMS ACQUIRING LEASEHOLD INTERESTS IN REAL PROPERTY...

  19. 48 CFR 570.117-2 - Guiding principles for federal leadership in high performance and sustainable buildings.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 4 2013-10-01 2013-10-01 false Guiding principles for federal leadership in high performance and sustainable buildings. 570.117-2 Section 570.117-2 Federal Acquisition Regulations System GENERAL SERVICES ADMINISTRATION SPECIAL CONTRACTING PROGRAMS ACQUIRING LEASEHOLD INTERESTS IN REAL PROPERTY...

  20. 48 CFR 570.117-2 - Guiding principles for federal leadership in high performance and sustainable buildings.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 4 2014-10-01 2014-10-01 false Guiding principles for federal leadership in high performance and sustainable buildings. 570.117-2 Section 570.117-2 Federal Acquisition Regulations System GENERAL SERVICES ADMINISTRATION SPECIAL CONTRACTING PROGRAMS ACQUIRING LEASEHOLD INTERESTS IN REAL PROPERTY...

  1. A PLANNING GUIDE FOR VOCATIONAL-INDUSTRIAL AND VOCATIONAL-TECHNICAL BUILDING FACILITIES FOR COMPREHENSIVE HIGH SCHOOLS, NUMBER 18.

    ERIC Educational Resources Information Center

    State Univ. of New York, Albany.

    THIS BOOKLET IS INTENDED AS A GUIDE FOR THOSE RESPONSIBLE FOR PLANNING VOCATIONAL HIGH SCHOOL FACILITIES. DISCUSSION OF TYPES OF INDUSTRIAL EDUCATION, PLANNING PROCEDURES, AND GENERAL CONSIDERATIONS ARE INCLUDED AND INFORMATION IS GIVEN ON--(1) SIZES, SHAPES, AND NUMBER OF SHOPS, (2) BUILDING FLEXIBILITY, (3) LAYOUT OF FLOOR SPACE, (4) SERVICES IN…

  2. A Curriculum Activities Guide to Selected Environmental Topics for Use With Elementary and Junior High School Students.

    ERIC Educational Resources Information Center

    Sexton, Alan D., Ed.

    This guide contains learning activities in environmental education developed by teachers and intended for use at the elementary or junior high school levels. Topics covered include: water, esthetics, air, soil and sediment, solid waste, energy, noise, population, and transportation. Generally, each activity contains an introduction, a listing of…

  3. Using adverse outcome pathway analysis to guide development of high-throughput screening assays for thyroid-disruptors

    EPA Science Inventory

    Using Adverse Outcome Pathway Analysis to Guide Development of High-Throughput Screening Assays for Thyroid-Disruptors Katie B. Paul1,2, Joan M. Hedge2, Daniel M. Rotroff4, Kevin M. Crofton4, Michael W. Hornung3, Steven O. Simmons2 1Oak Ridge Institute for Science Education Post...

  4. Image-guided high-dose-rate brachytherapy of malignancies in various inner organs – technique, indications, and perspectives

    PubMed Central

    Bretschneider, Tina; Ricke, Jens; Gebauer, Bernhard

    2016-01-01

    In the last few years, minimally invasive tumor ablation performed by interventional radiologists has gained increasing relevance in oncologic patient care. Limitations of thermal ablation techniques such as radiofrequency ablation (RFA), microwave ablation (MWA), and laser-induced thermotherapy (LITT), including large tumor size, cooling effects of adjacent vessels, and tumor location near thermosensitive structures, have led to the development of image-guided high-dose-rate (HDR) brachytherapy, especially for the treatment of liver malignancies. This article reviews technical properties of image-guided brachytherapy, indications and its current clinical role in multimodal cancer treatment. Furthermore, perspectives of this novel therapy option will be discussed. PMID:27504135

  5. Intensity-based 2D 3D registration for lead localization in robot guided deep brain stimulation.

    PubMed

    Hunsche, Stefan; Sauner, Dieter; Majdoub, Faycal El; Neudorfer, Clemens; Poggenborg, Jörg; Goßmann, Axel; Maarouf, Mohammad

    2017-03-21

    Intraoperative assessment of lead localization has become a standard procedure during deep brain stimulation surgery in many centers, allowing immediate verification of targeting accuracy and, if necessary, adjustment of the trajectory. The most suitable imaging modality to determine lead positioning, however, remains controversially discussed. Current approaches entail the implementation of computed tomography and magnetic resonance imaging. In the present study, we adopted the technique of intensity-based 2D 3D registration that is commonly employed in stereotactic radiotherapy and spinal surgery. For this purpose, intraoperatively acquired 2D x-ray images were fused with preoperative 3D computed tomography (CT) data to verify lead placement during stereotactic robot assisted surgery. Accuracy of lead localization determined from 2D 3D registration was compared to conventional 3D 3D registration in a subsequent patient study. The mean Euclidian distance of lead coordinates estimated from intensity-based 2D 3D registration versus flat-panel detector CT 3D 3D registration was 0.7 mm  ±  0.2 mm. Maximum values of these distances amounted to 1.2 mm. To further investigate 2D 3D registration a simulation study was conducted, challenging two observers to visually assess artificially generated 2D 3D registration errors. 95% of deviation simulations, which were visually assessed as sufficient, had a registration error below 0.7 mm. In conclusion, 2D 3D intensity-based registration revealed high accuracy and reliability during robot guided stereotactic neurosurgery and holds great potential as a low dose, cost effective means for intraoperative lead localization.

  6. Intensity-based 2D 3D registration for lead localization in robot guided deep brain stimulation

    NASA Astrophysics Data System (ADS)

    Hunsche, Stefan; Sauner, Dieter; El Majdoub, Faycal; Neudorfer, Clemens; Poggenborg, Jörg; Goßmann, Axel; Maarouf, Mohammad

    2017-03-01

    Intraoperative assessment of lead localization has become a standard procedure during deep brain stimulation surgery in many centers, allowing immediate verification of targeting accuracy and, if necessary, adjustment of the trajectory. The most suitable imaging modality to determine lead positioning, however, remains controversially discussed. Current approaches entail the implementation of computed tomography and magnetic resonance imaging. In the present study, we adopted the technique of intensity-based 2D 3D registration that is commonly employed in stereotactic radiotherapy and spinal surgery. For this purpose, intraoperatively acquired 2D x-ray images were fused with preoperative 3D computed tomography (CT) data to verify lead placement during stereotactic robot assisted surgery. Accuracy of lead localization determined from 2D 3D registration was compared to conventional 3D 3D registration in a subsequent patient study. The mean Euclidian distance of lead coordinates estimated from intensity-based 2D 3D registration versus flat-panel detector CT 3D 3D registration was 0.7 mm  ±  0.2 mm. Maximum values of these distances amounted to 1.2 mm. To further investigate 2D 3D registration a simulation study was conducted, challenging two observers to visually assess artificially generated 2D 3D registration errors. 95% of deviation simulations, which were visually assessed as sufficient, had a registration error below 0.7 mm. In conclusion, 2D 3D intensity-based registration revealed high accuracy and reliability during robot guided stereotactic neurosurgery and holds great potential as a low dose, cost effective means for intraoperative lead localization.

  7. Federal High Performance and Sustainable Buildings: Guiding Principles for the Laboratory Support Building (LSB)

    SciTech Connect

    Pope, Jason E.

    2014-09-01

    This report documents the federal Guiding Principles conformance effort for LSB at PNNL. The effort is part of continued progress toward a campus building inventory that is 100% compliant with the Guiding Principles. The report documentation provides a narrative of how the LSB complies with each of the Guiding Principles requirements. These narratives draw from the many sources that are explained in the text and rely on extensive data collection. The descriptions point to each of these sources, providing the reader with specific policies, procedures, and data points.

  8. Image-guided robotic radiosurgery (CyberKnife) for pancreatic insulinoma: is laparoscopy becoming old?

    PubMed

    Huscher, Cristiano Germano Sigismondo; Mingoli, Andrea; Sgarzini, Giovanna; Mereu, Andrea; Gasperi, Maurizio

    2012-03-01

    Insulinomas constitute about 25% of endocrine pancreatic tumors. Laparoscopic surgery is the treatment of choice. However, pancreas-related complications rate is very high, even in experienced hands, ranging up to 37%. Alternative procedures such as embolization with trisacryl have not been accepted by the surgical community. Image-guided robotic radiosurgery or stereotactic radiosurgery (CyberKnife) is a minimally invasive procedure delivering large doses of ionizing radiation to a well-defined target. CyberKnife radiosurgery is successfully used in brain cancer, lung cancer, prostate cancer, liver metastases, kidney cancer, and pancreatic cancer. The authors present the first case to their knowledge of a benign functioning insulinoma successfully treated by a CyberKnife technique with a 3-year follow-up.

  9. Work-up and management of a high-risk patient with primary central nervous system lymphoma

    PubMed Central

    Zeynalova, Pervin A.; Tumyan, Gayane S.; Dolgushin, Mikhail B.; Akhmedov, Mobil I.

    2016-01-01

    Primary central nervous system lymphoma (PCNSL) is a rare disorder that, in 95% of cases, represents diffuse large B-cell lymphoma. As such, making an accurate diagnosis is important. At present, stereotactic-guided biopsy is a recognized method of choice for tissue analysis. However, the diagnostic work-up for high-risk patients is determined by their performance status. Here, we report a case of PCNSL in a high-risk patient, for whom diagnosis was established by cerebrospinal fluid cytology and flow cytometry, which significantly shortened a diagnostic work-up period and allowed for the immediate treatment of the patient. PMID:28154784

  10. High volume image-guided Injections for patellar tendinopathy: a combined retrospective and prospective case series

    PubMed Central

    Morton, Sarah; Chan, Otto; King, John; Perry, David; Crisp, Tom; Maffulli, Nicola; Morrissey, Dylan

    2014-01-01

    Summary Background: the aim was to quantify the effect of a novel high volume-image guided injection (HVIGI) technique for recalcitrant patellar tendinopathy (PT). Methods: twenty patients (8 prospective; 12 retrospective) with ultrasonographically confirmed proximal PT were recruited. A HVIGI under ultra-sound guidance of 10 ml 0.5% Bupivacaine, 25 mg Hydrocortisone and 30 ml normal saline at the interface of the patellar tendon and Hoffa’s fat pad was administered. A standardised eccentric loading rehabilitation protocol was prescribed. Results: the VISA-P score improved from 45.0 to 64.0 (p<0.01) for all subjects, likely to be clinically significant. There was no statistically significant difference between the increase in the retrospective group of 19.9 (± 23.5) and the prospective of 16.4 (± 11.3) p = 0.7262.5% of prospective subjects agreed that they had significantly improved, with 37.5% returning to sport within 12 weeks. Conclusions: HVIGI should be considered in the management of recalcitrant PT. Randomised controlled trials are warranted. PMID:25332938

  11. Use of a visual guide to improve the quality of VOR responses evoked by high-velocity rotational stimuli

    PubMed Central

    Gianna-Poulin, C.C.; Peterka, R.J.

    2008-01-01

    High-velocity rotational stimuli have the potential to improve the diagnostic capabilities of clinical rotation testing by revealing nonlinear vestibulo-ocular reflex (VOR) responses that are indicative of asymmetric vestibular function. However, eye movements evoked by high-velocity rotations often are inconsistent over time and therefore do not yield reliable diagnostic measures. This study investigated whether use of a novel “visual guide” could improve the consistency and quality of VORs obtained during testing with pulse-step-sine (PSS) stimuli providing periodic high-velocity, horizontal-plane rotations with peak velocities up to 290 deg/s. The visual guide (narrow phosphorescent line spanning 180° field of view) was mounted horizontally on the rotation chair at the subject's eye level. Eight healthy human subjects were tested either in complete darkness while performing an alerting task, or while viewing the visual guide in an otherwise dark room. We found that the visual guide improved the quality of VOR responses as shown by an increased proportion of slow-phase velocity data segments retained for analysis, by a decreased variance of the processed eye velocity data, and by a reduction of outlying VOR response measures. We also found that the visual guide did not induce visual suppression because VOR gain measures were not diminished. PMID:18776595

  12. The interaction of high-m guided poloidal alfven waves with magnetospheric electrons and the ionosphere

    NASA Astrophysics Data System (ADS)

    Rankin, R.; Sydorenko, D.

    2014-12-01

    Poloidal mode Alfven waves are often generated in Earth's magnetosphere following interplanetary shocks and/or pressure pulses acting on the magnetopause. These disturbances can excite resonant field line oscillations with frequencies in the mHz range by launching fast mode waves that couple energy to field line resonances. This direct action of the solar wind on the magnetosphere can perhaps explain waves with relatively small azimuthal wavenumbers (m), but not the observed range of waves with m~40-50 on L-shells around 5 or 6. These waves are strongly guided along geomagnetic field lines to the ionosphere, and are generally thought to particle driven, e.g., as a result of bounce-resonance wave-particle interactions following activation of the ring current. This is not the only possible source mechanism as there is evidence of wave generation before the ring current has reacted significantly to shock passage. Putting aside the source mechanism, high-m poloidal modes with strong east west directed electric fields are important primarily because they can elevate differential energy flux for electron energies in the range of 100's of keV to several MeV. In this paper we use observations of guided poloidal mode Alfven waves to constrain a ULF wave model that describes not only how waves evolve on geomagnetic field lines, but also their interaction with a dynamic height-resolved ionosphere. The ionosphere and neutral atmosphere are specified in the model using the IRI and MSIS models. These regions react to waves and precipitation through heating and cooling, ionization, recombination, and chemical reactions. We present detailed results of the interaction of a poloidal wave observed by the Eiscat radar, and demonstrate that the model used can reproduce all aspects of the radar observations. We consider mechanisms for pulsed precipitation accompanying this wave, which causes a phase difference of ~90 degrees between observed temperature and density spikes. We also

  13. Predictors of Toxicity After Image-guided High-dose-rate Interstitial Brachytherapy for Gynecologic Cancer

    SciTech Connect

    Lee, Larissa J.; Viswanathan, Akila N.

    2012-12-01

    Purpose: To identify predictors of grade 3-4 complications and grade 2-4 rectal toxicity after three-dimensional image-guided high-dose-rate (HDR) interstitial brachytherapy for gynecologic cancer. Methods and Materials: Records were reviewed for 51 women (22 with primary disease and 29 with recurrence) treated with HDR interstitial brachytherapy. A single interstitial insertion was performed with image guidance by computed tomography (n = 43) or magnetic resonance imaging (n = 8). The median delivered dose in equivalent 2-Gy fractions was 72.0 Gy (45 Gy for external-beam radiation therapy and 24 Gy for brachytherapy). Toxicity was reported according to the Common Toxicity Criteria for Adverse Events. Actuarial toxicity estimates were calculated by the Kaplan-Meier method. Results: At diagnosis, the median patient age was 62 years and the median tumor size was 3.8 cm. The median D90 and V100 were 71.4 Gy and 89.5%; the median D2cc for the bladder, rectum, and sigmoid were 64.6 Gy, 61.0 Gy, and 52.7 Gy, respectively. The actuarial rates of all grade 3-4 complications at 2 years were 20% gastrointestinal, 9% vaginal, 6% skin, 3% musculoskeletal, and 2% lymphatic. There were no grade 3-4 genitourinary complications and no grade 5 toxicities. Grade 2-4 rectal toxicity was observed in 10 patients, and grade 3-4 complications in 4; all cases were proctitis with the exception of 1 rectal fistula. D2cc for rectum was higher for patients with grade 2-4 (68 Gy vs 57 Gy for grade 0-1, P=.03) and grade 3-4 (73 Gy vs 58 Gy for grade 0-2, P=.02) rectal toxicity. The estimated dose that resulted in a 10% risk of grade 2-4 rectal toxicity was 61.8 Gy (95% confidence interval, 51.5-72.2 Gy). Discussion: Image-guided HDR interstitial brachytherapy results in acceptable toxicity for women with primary or recurrent gynecologic cancer. D2cc for the rectum is a reliable predictor of late rectal complications. Three-dimensional-based treatment planning should be performed to ensure

  14. Transvaginal 3D Image-Guided High Intensity Focused Ultrasound Array

    NASA Astrophysics Data System (ADS)

    Held, Robert; Nguyen, Thuc Nghi; Vaezy, Shahram

    2005-03-01

    The goal of this project is to develop a transvaginal image-guided High Intensity Focused Ultrasound (HIFU) device using piezocomposite HIFU array technology, and commercially-available ultrasound imaging. Potential applications include treatment of uterine fibroids and abnormal uterine bleeding. The HIFU transducer was an annular phased array, with a focal length range of 30-60 mm, an elliptically-shaped aperture of 35×60 mm, and an operating frequency of 3 MHz. A pillow-shaped bag with water circulation will be used for coupling the HIFU energy into the tissue. An intra-cavity imaging probe (C9-5, Philips) was integrated with the HIFU array such that the focal axis of the HIFU transducer was within the image plane. The entire device will be covered by a gel-filled condom when inserted in the vaginal cavity. To control it, software packages were developed in the LabView programming environment. An imaging algorithm processed the ultrasound image to remove noise patterns due to the HIFU signal. The device will be equipped with a three-dimensional tracking system, using a six-degrees-of-freedom articulating arm. Necrotic lesions were produced in a tissue-mimicking phantom and a turkey breast sample for all focal lengths. Various HIFU doses allow various necrotic lesion shapes, including thin ellipsoidal, spherical, wide cylindrical, and teardrop-shaped. Software control of the device allows multiple foci to be activated sequentially for desired lesion patterns. Ultrasound imaging synchronization can be achieved using hardware signals obtained from the imaging system, or software signals determined empirically for various imaging probes. The image-guided HIFU device will provide a valuable tool in visualization of uterine fibroid tumors for the purposes of planning and subsequent HIFU treatment of the tumor, all in a 3D environment. The control system allows for various lesions of different shapes to be optimally positioned in the tumor to cover the entire tumor

  15. Progressive multifocal leukoencephalopathy in patients with HIV infection: lack of impact of early diagnosis by stereotactic brain biopsy.

    PubMed

    Karahalios, D; Breit, R; Dal Canto, M C; Levy, R M

    1992-10-01

    Thirteen patients with HIV-related progressive multifocal leukoencephalopathy (PML), representing an institutional incidence of 4.2%, are reported. All cases were diagnosed by image guided stereotactic brain biopsy shortly after their presentation for neurologic complaints. All patients were males; risk factors included homosexual or bisexual activity or intravenous drug use. At the time of presentation with PML, the mean T4 count was 85 (range 9-240 cells/mm3). The most common neurologic symptoms were cognitive dysfunction and aphasia, whereas gait abnormalities and disordered cognition were the most common neurologic signs. Cerebrospinal fluid analysis was helpful only to rule out other causes of CNS disease. Magnetic resonance imaging, more sensitive than computed tomography (CT) scanning, typically revealed multiple areas of increased intensity on T2 weighted images although unifocal disease was seen in 23% of patients. Despite early stereotactic biopsy and aggressive symptomatic therapy, survival of these patients was poor with a mean of 2.6 months after the onset of neurological symptoms and 2.0 months after biopsy.

  16. Stereotactic radiosurgery with the linear accelerator: treatment of arteriovenous malformations.

    PubMed

    Betti, O O; Munari, C; Rosler, R

    1989-03-01

    An original stereotactic radiosurgical approach coupling a) Talairach's stereotactic methodology, b) a specially devised mechanical system, and c) a linear accelerator is detailed. The authors present their preliminary results on 66 patients with nonsurgical intracranial arteriovenous malformations. The doses delivered for treatment varied from 20 to 70 Gy. Doses of no more than 40 Gy were used in 80% of patients. An angiographic study was performed when the computed tomographic scan controls showed relevant modifications of the lesion volume. Total obliteration was obtained in 27 of the 41 patients (65.8%) who were followed up for at least 24 months. The percentage of the cured patients is significantly higher when a) the entire malformation is included in the 75% isodose (96%) and b) the maximum diameter of the lesion is less than 12 mm (81%). Two patients died of rebleeding at 18 and 29 months after treatment.

  17. Stereotactic body radiation therapy for metastasis to the adrenal glands.

    PubMed

    Shiue, Kevin; Song, Andrew; Teh, Bin S; Ellis, Rodney J; Yao, Min; Mayr, Nina A; Huang, Zhibin; Sohn, Jason; Machtay, Mitchell; Lo, Simon S

    2012-12-01

    Many primary cancers can metastasize to the adrenal glands. Adrenalectomy via an open or laparoscopic approach is the current definitive treatment, but not all patients are eligible or wish to undergo surgery. There are only limited studies on the use of conventional radiation therapy for palliation of symptoms from adrenal metastasis. However, the advent of stereotactic body radiation therapy (SBRT) - also named stereotactic ablative radiotherapy for primary lung cancer, metastases to the lung, and metastases to the liver - have prompted some investigators to consider the use of SBRT for metastases to the adrenal glands. This review focuses on the emerging data on SBRT of metastasis to the adrenal glands, while also providing a brief discussion of the overall management of adrenal metastasis.

  18. Multimodality stereotactic brain tissue identification: the NASA smart probe project

    NASA Technical Reports Server (NTRS)

    Andrews, R.; Mah, R.; Aghevli, A.; Freitas, K.; Galvagni, A.; Guerrero, M.; Papsin, R.; Reed, C.; Stassinopoulos, D.

    1999-01-01

    Real-time tissue identification can benefit procedures such as stereotactic brain biopsy, functional neurosurgery and brain tumor excision. Optical scattering spectroscopy has been shown to be effective at discriminating cancer from noncancerous conditions in the colon, bladder and breast. The NASA Smart Probe extends the concept of 'optical biopsy' by using neural network techniques to combine the output from 3 microsensors contained within a cannula 2. 7 mm in diameter (i.e. the diameter of a stereotactic brain biopsy needle). Experimental data from 5 rats show the clear differentiation between tissues such as brain, nerve, fat, artery and muscle that can be achieved with optical scattering spectroscopy alone. These data and previous findings with other modalities such as (1) analysis of the image from a fiberoptic neuroendoscope and (2) the output from a microstrain gauge suggest the Smart Probe multiple microsensor technique shows promise for real-time tissue identification in neurosurgical procedures. Copyright 2000 S. Karger AG, Basel.

  19. Guide design study for the high-resolution backscattering spectrometer FIRES

    NASA Astrophysics Data System (ADS)

    Pelley, C.; Kargl, F.; Garcia Sakai, V.; Telling, M. T. F.; Fernandez-Alonso, F.; Demmel, F.

    2010-11-01

    Different options are considered to transport cold neutrons along 90 m for the proposed new spectrometer FIRES at the ISIS facility. Monte Carlo simulations using the McStas programme package are used to assess the performance of various guide designs from the biological shield to the sample position. By employing a curved geometry, to avoid the direct line of sight, a hybrid design which combines a curved ballistic guide and an elliptic focusing section appears to be the best solution.

  20. Stereotactic body radiotherapy in lung cancer: an update *

    PubMed Central

    Abreu, Carlos Eduardo Cintra Vita; Ferreira, Paula Pratti Rodrigues; de Moraes, Fabio Ynoe; Neves, Wellington Furtado Pimenta; Gadia, Rafael; Carvalho, Heloisa de Andrade

    2015-01-01

    Abstract For early-stage lung cancer, the treatment of choice is surgery. In patients who are not surgical candidates or are unwilling to undergo surgery, radiotherapy is the principal treatment option. Here, we review stereotactic body radiotherapy, a technique that has produced quite promising results in such patients and should be the treatment of choice, if available. We also present the major indications, technical aspects, results, and special situations related to the technique. PMID:26398758

  1. High engagement, high quality: A guiding framework for developing empirically informed asynchronous e-learning programs for health professional educators.

    PubMed

    Sinclair, Peter M; Levett-Jones, Tracey; Morris, Amanda; Carter, Ben; Bennett, Paul N; Kable, Ashley

    2017-03-01

    E-learning involves the transfer of skills and knowledge via technology so that learners can access meaningful and authentic educational materials. While learner engagement is important, in the context of healthcare education, pedagogy must not be sacrificed for edu-tainment style instructional design. Consequently, health professional educators need to be competent in the use of current web-based educational technologies so that learners are able to access relevant and engaging e-learning materials without restriction. The increasing popularity of asynchronous e-learning programs developed for use outside of formal education institutions has made this need more relevant. In these contexts, educators must balance design and functionality to deliver relevant, cost-effective, sustainable, and accessible programs that overcome scheduling and geographic barriers for learners. This paper presents 10 guiding design principles and their application in the development of an e-learning program for general practice nurses focused on behavior change. Consideration of these principles will assist educators to develop high quality, pedagogically sound, engaging, and interactive e-learning resources.

  2. High-performance iron oxide nanoparticles for magnetic particle imaging - guided hyperthermia (hMPI)

    NASA Astrophysics Data System (ADS)

    Bauer, Lisa M.; Situ, Shu F.; Griswold, Mark A.; Samia, Anna Cristina S.

    2016-06-01

    Magnetic particle imaging (MPI) is an emerging imaging modality that allows the direct and quantitative mapping of iron oxide nanoparticles. In MPI, the development of tailored iron oxide nanoparticle tracers is paramount to achieving high sensitivity and good spatial resolution. To date, most MPI tracers being developed for potential clinical applications are based on spherical undoped magnetite nanoparticles. For the first time, we report on the systematic investigation of the effects of changes in chemical composition and shape anisotropy on the MPI performance of iron oxide nanoparticle tracers. We observed a 2-fold enhancement in MPI signal through selective doping of magnetite nanoparticles with zinc. Moreover, we demonstrated focused magnetic hyperthermia heating by adapting the field gradient used in MPI. By saturating the iron oxide nanoparticles outside of a field free region (FFR) with an external static field, we can selectively heat a target region in our test sample. By comparing zinc-doped magnetite cubic nanoparticles with undoped spherical nanoparticles, we could show a 5-fold improvement in the specific absorption rate (SAR) in magnetic hyperthermia while providing good MPI signal, thereby demonstrating the potential for high-performance focused hyperthermia therapy through an MPI-guided approach (hMPI).Magnetic particle imaging (MPI) is an emerging imaging modality that allows the direct and quantitative mapping of iron oxide nanoparticles. In MPI, the development of tailored iron oxide nanoparticle tracers is paramount to achieving high sensitivity and good spatial resolution. To date, most MPI tracers being developed for potential clinical applications are based on spherical undoped magnetite nanoparticles. For the first time, we report on the systematic investigation of the effects of changes in chemical composition and shape anisotropy on the MPI performance of iron oxide nanoparticle tracers. We observed a 2-fold enhancement in MPI signal

  3. Highly directional transurethral ultrasound applicators with rotational control for MRI-guided prostatic thermal therapy

    NASA Astrophysics Data System (ADS)

    Ross, Anthony B.; Diederich, Chris J.; Nau, William H.; Gill, Harcharan; Bouley, Donna M.; Daniel, Bruce; Rieke, Viola; Butts, R. Kim; Sommer, Graham

    2004-01-01

    Transurethral ultrasound applicators with highly directional energy deposition and rotational control were investigated for precise treatment of benign prostatic hyperplasia (BPH) and adenocarcinoma of the prostate (CaP). Two types of catheter-based applicators were fabricated, using either 90° sectored tubular (3.5 mm OD × 10 mm) or planar transducers (3.5 mm × 10 mm). They were constructed to be MRI compatible, minimally invasive and allow for manual rotation of the transducer array within a 10 mm cooling balloon. In vivo evaluations of the applicators were performed in canine prostates (n = 3) using MRI guidance (0.5 T interventional magnet). MR temperature imaging (MRTI) utilizing the proton resonance frequency shift method was used to acquire multiple-slice temperature overlays in real time for monitoring and guiding the thermal treatments. Post-treatment T1-weighted contrast-enhanced imaging and triphenyl tetrazolium chloride stained tissue sections were used to define regions of tissue coagulation. Single sonications with the 90° tubular applicator (9-15 W, 12 min, 8 MHz) produced coagulated zones covering an 80° wedge of the prostate extending from 1-2 mm outside the urethra to the outer boundary of the gland (16 mm radial coagulation). Single sonications with the planar applicator (15-20 W, 10 min, ~8 MHz) generated thermal lesions of ~30° extending to the prostate boundary. Multiple sequential sonications (sweeping) of a planar applicator (12 W with eight rotations of 30° each) demonstrated controllable coagulation of a 270° contiguous section of the prostate extending to the capsule boundary. The feasibility of using highly directional transurethral ultrasound applicators with rotational capabilities to selectively coagulate regions of the prostate while monitoring and controlling the treatments with MRTI was demonstrated in this study.

  4. Highly directional transurethral ultrasound applicators with rotational control for MRI-guided prostatic thermal therapy.

    PubMed

    Ross, Anthony B; Diederich, Chris J; Nau, William H; Gill, Harcharan; Bouley, Donna M; Daniel, Bruce; Rieke, Viola; Butts, R Kim; Sommer, Graham

    2004-01-21

    Transurethral ultrasound applicators with highly directional energy deposition and rotational control were investigated for precise treatment of benign prostatic hyperplasia (BPH) and adenocarcinoma of the prostate (CaP). Two types of catheter-based applicators were fabricated, using either 90 degrees sectored tubular (3.5 mm OD x 10 mm) or planar transducers (3.5 mm x 10 mm). They were constructed to be MRI compatible, minimally invasive and allow for manual rotation of the transducer array within a 10 mm cooling balloon. In vivo evaluations of the applicators were performed in canine prostates (n = 3) using MRI guidance (0.5 T interventional magnet). MR temperature imaging (MRTI) utilizing the proton resonance frequency shift method was used to acquire multiple-slice temperature overlays in real time for monitoring and guiding the thermal treatments. Post-treatment T1-weighted contrast-enhanced imaging and triphenyl tetrazolium chloride stained tissue sections were used to define regions of tissue coagulation. Single sonications with the 90 degrees tubular applicator (9-15 W, 12 min, 8 MHz) produced coagulated zones covering an 80 degrees wedge of the prostate extending from 1-2 mm outside the urethra to the outer boundary of the gland (16 mm radial coagulation). Single sonications with the planar applicator (15-20 W, 10 min, approximately 8 MHz) generated thermal lesions of approximately 30 degrees extending to the prostate boundary. Multiple sequential sonications (sweeping) of a planar applicator (12 W with eight rotations of 30 degrees each) demonstrated controllable coagulation of a 270 degrees contiguous section of the prostate extending to the capsule boundary. The feasibility of using highly directional transurethral ultrasound applicators with rotational capabilities to selectively coagulate regions of the prostate while monitoring and controlling the treatments with MRTI was demonstrated in this study.

  5. Stereotactic fractionated radiotherapy for the treatment of benign meningiomas

    SciTech Connect

    Candish, Charles; McKenzie, Michael . E-mail: mmckenzi@bccancer.bc.edu; Clark, Brenda G.; Ma, Roy; Lee, Richard; Vollans, Emily; Robar, James; Gete, Ermias; Martin, Monty

    2006-11-15

    Purpose: To assess the use of stereotactic fractionated radiotherapy (SRT) for the treatment of meningiomas. Methods and Materials: Between April 1999 and October 2004, 38 patients underwent SRT. Of 34 patients (36 tumors) assessed, the median age was 53 years. The indication was primary treatment in 26 cases (no histology) and postoperative in 10 cases. The most common sites were cavernous sinus (17), optic nerve (6), and cerebellopontine angle (5). The median gross target volume and planning target volume were 8.9 cm{sup 3} and 18.9 cm{sup 3}, respectively. Stereotactic treatment was delivered with 6-MV photons with static conformal fields (custom-made blocks, 9 patients, and micromultileaf collimator, 25 patients). Median number of fields was six. The median dose prescribed was 50 Gy (range, 45-50.4 Gy) in 28 fractions. The median homogeneity and conformality indices were 1.1 and 1.79, respectively. Results: Treatment was well tolerated. Median follow-up was 26 months with 100% progression-free survival. One patient developed an area of possible radionecrosis related to previous radiotherapy, and 2 men developed mild hypogonadism necessitating testosterone replacement. The vision of 5 of 6 patients with optic pathway meningiomas improved or remained static. Conclusions: Stereotactic fractionated radiotherapy for the treatment of meningiomas is practical, and with early follow-up, seems to be effective.

  6. Stereotactic Radiotherapy for Adrenal Gland Metastases: University of Florence Experience

    SciTech Connect

    Casamassima, Franco; Livi, Lorenzo; Masciullo, Stefano; Menichelli, Claudia; Masi, Laura; Meattini, Icro; Bonucci, Ivano; Agresti, Benedetta; Simontacchi, Gabriele; Doro, Raffaela

    2012-02-01

    Purpose: To evaluate a retrospective single-institution outcome after hypofractionated stereotactic body radiotherapy (SBRT) for adrenal metastases. Methods and Materials: Between February 2002 and December 2009, we treated 48 patients with SBRT for adrenal metastases. The median age of the patient population was 62.7 years (range, 43-77 years). In the majority of patients, the prescription dose was 36 Gy in 3 fractions (70% isodose, 17.14 Gy per fraction at the isocenter). Eight patients were treated with single-fraction stereotactic radiosurgery and forty patients with multi-fraction stereotactic radiotherapy. Results: Overall, the series of patients was followed up for a median of 16.2 months (range, 3-63 months). At the time of analysis, 20 patients were alive and 28 patients were dead. The 1- and 2-year actuarial overall survival rates were 39.7% and 14.5%, respectively. We recorded 48 distant failures and 2 local failures, with a median interval to local failure of 4.9 months. The actuarial 1-year disease control rate was 9%; the actuarial 1- and 2-year local control rate was 90%. Conclusion: Our retrospective study indicated that SBRT for the treatment of adrenal metastases represents a safe and effective option with a control rate of 90% at 2 years.

  7. CT Imaging Findings after Stereotactic Radiotherapy for Liver Tumors

    PubMed Central

    Brook, Olga R.; Thornton, Eavan; Mendiratta-Lala, Mishal; Mahadevan, Anand; Raptopoulos, Vassilious; Brook, Alexander; Najarian, Robert; Sheiman, Robert; Siewert, Bettina

    2015-01-01

    Purpose. To study radiological response to stereotactic radiotherapy for focal liver tumors. Materials and Methods. In this IRB-approved, HIPAA-compliant study CTs of 68 consecutive patients who underwent stereotactic radiotherapy for liver tumors between 01/2006 and 01/2010 were retrospectively reviewed. Two independent reviewers evaluated lesion volume and enhancement pattern of the lesion and of juxtaposed liver parenchyma. Results. 36 subjects with hepatocellular carcinoma (HCC), 25 with liver metastases, and seven with cholangiocarcinoma (CCC) were included in study. Mean follow-up time was 5.6 ± 7.1 months for HCC, 6.4 ± 5.1 months for metastases, and 10.1 ± 4.8 months for the CCC. Complete response was seen in 4/36 (11.1%) HCCs and 1/25 (4%) metastases. Partial response (>30% decrease in long diameter) was seen in 25/36 (69%) HCCs, 14/25 (58%) metastases, and 7/7 (100%) of CCCs. Partial response followed by local recurrence (>20% increase in long diameter from nadir) occurred in 2/36 (6%) HCCs and 4/25 (17%) metastases. Liver parenchyma adjacent to the lesion demonstrated a prominent halo of delayed enhancement in 27/36 (78%) of HCCs, 19/21 (91%) of metastases, and 7/7 (100%) of CCCs. Conclusion. Sustainable radiological partial response to stereotactic radiotherapy is most frequent outcome seen in liver lesions. Prominent halo of delayed enhancement of the adjacent liver is frequent finding. PMID:26221135

  8. Early Warning System Implementation Guide: For Use with the National High School Center's Early Warning System Tool v2.0

    ERIC Educational Resources Information Center

    Therriault, Susan Bowles; Heppen, Jessica; O'Cummings, Mindee; Fryer, Lindsay; Johnson, Amy

    2010-01-01

    This Early Warning System (EWS) Implementation Guide is a supporting document for schools and districts that are implementing the National High School Center's Early Warning System (EWS) Tool v2.0. Developed by the National High School Center at the American Institutes for Research (AIR), the guide and tool support the establishment and…

  9. Monitoring of hidden fatigue crack growth in multi-layer aircraft structures using high frequency guided waves

    NASA Astrophysics Data System (ADS)

    Chan, H.; Masserey, B.; Fromme, P.

    2015-03-01

    Varying loading conditions of aircraft structures result in stress concentration at fastener holes, where multi-layered components are connected, potentially leading to the development of hidden fatigue cracks in inaccessible layers. High frequency guided waves propagating along the structure allow for the structural health monitoring (SHM) of such components, e.g., aircraft wings. Experimentally the required guided wave modes can be easily excited using standard ultrasonic wedge transducers. However, the sensitivity for the detection of small, potentially hidden, fatigue cracks has to be ascertained. The type of multi-layered model structure investigated consists of two adhesively bonded aluminum plate-strips with a sealant layer. Fatigue experiments were carried out and the growth of fatigue cracks at the fastener hole in one of the metallic layers was monitored optically during cyclic loading. The influence of the fatigue cracks of increasing size on the scattered guided wave field was evaluated. The sensitivity and repeatability of the high frequency guided wave modes to detect and monitor the fatigue crack growth was investigated, using both standard pulse-echo equipment and a laser interferometer. The potential for hidden fatigue crack growth monitoring at critical and difficult to access fastener locations from a stand-off distance was ascertained. The robustness of the methodology for practical in situ ultrasonic monitoring of fatigue crack growth is discussed.

  10. Relevance of Biologically Equivalent Dose Values in Outcome Evaluation of Stereotactic Radiotherapy for Lung Nodules

    SciTech Connect

    Casamassima, Franco Masi, Laura; Bonucci, Ivano; Polli, Caterina; Menichelli, Claudia; Gulisano, Massimo; Pacini, Stefania; Aterini, Stefano; Cavedon, Carlo

    2008-05-01

    Purpose: Different biologically equivalent dose (BED) values associated with stereotactic radiotherapy (SRT) of patients with primary and metastatic pulmonary nodules were studied. The BED values were calculated for tumoral tissue and low {alpha}/{beta} ratio, assuming that better local response could be obtained by using stereotactic high-BED treatment. Methods and Materials: Fifty-eight patients with T1-T3 N0 non-small-cell lung cancer and 46 patients with metastatic lung nodules were treated with SRT. The BED was calculated for {alpha}/{beta} ratios of 3 and 10. Overall survival (OS) was assessed according to Kaplan-Meier and appraised as a function of three BED levels: low (30-50 Gy), medium (50-70 Gy), and high (70-98 Gy; {alpha}/{beta} = 10). Results: The OS rates for all 104 patients at 12, 24, and 36 months were 73%, 48.3%, and 35.8%, respectively. Local response greater than 50% for low, medium, and high BED values was observed in 54%, 47%, and 73%, respectively. In the high-BED treated group, OS rates at 12, 24, and 36 months (80.9%, 70%, and 53.6%, respectively) were significantly improved compared with low- (69%, 46.1%, and 30.7%, respectively) and medium-BED (67%, 28%, and 21%, respectively) treated patients. Results are also discussed in terms of BED calculated on {alpha}/{beta} 3 Gy characteristic of the microcapillary bed. No acute toxicity higher than Grade 1 was observed. Conclusions: Radioablation of pulmonary neoplastic nodules may be achieved with SRT delivered by using a high-dose fraction with high BED value.

  11. A cost effective and high fidelity fluoroscopy simulator using the Image-Guided Surgery Toolkit (IGSTK)

    NASA Astrophysics Data System (ADS)

    Gong, Ren Hui; Jenkins, Brad; Sze, Raymond W.; Yaniv, Ziv

    2014-03-01

    The skills required for obtaining informative x-ray fluoroscopy images are currently acquired while trainees provide clinical care. As a consequence, trainees and patients are exposed to higher doses of radiation. Use of simulation has the potential to reduce this radiation exposure by enabling trainees to improve their skills in a safe environment prior to treating patients. We describe a low cost, high fidelity, fluoroscopy simulation system. Our system enables operators to practice their skills using the clinical device and simulated x-rays of a virtual patient. The patient is represented using a set of temporal Computed Tomography (CT) images, corresponding to the underlying dynamic processes. Simulated x-ray images, digitally reconstructed radiographs (DRRs), are generated from the CTs using ray-casting with customizable machine specific imaging parameters. To establish the spatial relationship between the CT and the fluoroscopy device, the CT is virtually attached to a patient phantom and a web camera is used to track the phantom's pose. The camera is mounted on the fluoroscope's intensifier and the relationship between it and the x-ray source is obtained via calibration. To control image acquisition the operator moves the fluoroscope as in normal operation mode. Control of zoom, collimation and image save is done using a keypad mounted alongside the device's control panel. Implementation is based on the Image-Guided Surgery Toolkit (IGSTK), and the use of the graphics processing unit (GPU) for accelerated image generation. Our system was evaluated by 11 clinicians and was found to be sufficiently realistic for training purposes.

  12. [Stereotactic Body Radiotherapy with CyberKnife®for Liver Metastases from Colorectal Cancer].

    PubMed

    Mihara, Koki; Kaihara, Masaki; Sunahori, Sayaka; Yamashiro, Naotsugu; Nishiya, Shin; Ito, Yasuhiro; Funakoshi, Kazuto; Egawa, Tomohisa; Tsukamoto, Nobuhiro; Nagashima, Atsushi

    2015-10-01

    For treatment of colorectal liver metastases, liver resection is recommended for resectable cases in the clinical guidelines for colorectal cancer. On the other hand, there are currently no data supporting the efficacy of radiation therapy as a topical treatment, and this treatment can therefore not presently be recommended. With CyberKnife®, it is possible to perform stereotactic radiation therapy using a linear accelerator with high accuracy, even for lesions in the trunk area such as liver metastases. Between December 2009 and September 2014 in our hospital, we performed radiation treatment using CyberKnife® for 14 cases with 22 colorectal liver metastases. As a result, we obtained response and local control rates of 76.2%and 81.0%, respectively. Moreover, no advanced adverse events were observed. Thus, we consider that CyberKnife® treatment for colorectal liver metastases is effective as a topical treatment, with low invasiveness and high safety.

  13. 10 CFR 35.645 - Periodic spot-checks for gamma stereotactic radiosurgery units.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 1 2012-01-01 2012-01-01 false Periodic spot-checks for gamma stereotactic radiosurgery... § 35.645 Periodic spot-checks for gamma stereotactic radiosurgery units. (a) A licensee authorized to... minimum— (1) Assure proper operation of— (i) Treatment table retraction mechanism, using backup...

  14. 10 CFR 35.645 - Periodic spot-checks for gamma stereotactic radiosurgery units.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Periodic spot-checks for gamma stereotactic radiosurgery units. 35.645 Section 35.645 Energy NUCLEAR REGULATORY COMMISSION MEDICAL USE OF BYPRODUCT MATERIAL Photon Emitting Remote Afterloader Units, Teletherapy Units, and Gamma Stereotactic Radiosurgery...

  15. 10 CFR 35.2632 - Records of teletherapy, remote afterloader, and gamma stereotactic radiosurgery full calibrations.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Records of teletherapy, remote afterloader, and gamma stereotactic radiosurgery full calibrations. 35.2632 Section 35.2632 Energy NUCLEAR REGULATORY COMMISSION... stereotactic radiosurgery unit(s), the source(s), and the instruments used to calibrate the unit(s); (3)...

  16. 10 CFR 35.2632 - Records of teletherapy, remote afterloader, and gamma stereotactic radiosurgery full calibrations.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... stereotactic radiosurgery full calibrations. (a) A licensee shall maintain a record of the teletherapy unit... 10 Energy 1 2014-01-01 2014-01-01 false Records of teletherapy, remote afterloader, and gamma stereotactic radiosurgery full calibrations. 35.2632 Section 35.2632 Energy NUCLEAR REGULATORY...

  17. 10 CFR 35.2632 - Records of teletherapy, remote afterloader, and gamma stereotactic radiosurgery full calibrations.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... stereotactic radiosurgery full calibrations. (a) A licensee shall maintain a record of the teletherapy unit... 10 Energy 1 2011-01-01 2011-01-01 false Records of teletherapy, remote afterloader, and gamma stereotactic radiosurgery full calibrations. 35.2632 Section 35.2632 Energy NUCLEAR REGULATORY...

  18. 10 CFR 35.2632 - Records of teletherapy, remote afterloader, and gamma stereotactic radiosurgery full calibrations.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... stereotactic radiosurgery full calibrations. (a) A licensee shall maintain a record of the teletherapy unit... 10 Energy 1 2012-01-01 2012-01-01 false Records of teletherapy, remote afterloader, and gamma stereotactic radiosurgery full calibrations. 35.2632 Section 35.2632 Energy NUCLEAR REGULATORY...

  19. 10 CFR 35.2632 - Records of teletherapy, remote afterloader, and gamma stereotactic radiosurgery full calibrations.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... stereotactic radiosurgery full calibrations. (a) A licensee shall maintain a record of the teletherapy unit... 10 Energy 1 2013-01-01 2013-01-01 false Records of teletherapy, remote afterloader, and gamma stereotactic radiosurgery full calibrations. 35.2632 Section 35.2632 Energy NUCLEAR REGULATORY...

  20. Vemurafenib and concomitant stereotactic radiation for the treatment of melanoma with spinal metastases: A case report

    PubMed Central

    Stefan, Dinu; Popotte, Hosni; Stefan, Andreea Raluca; Tesniere, Audrey; Tomaszewski, Aurélie; Lesueur, Paul; Habrand, Jean-Louis; Verneuil, Laurence

    2016-01-01

    A 56-year-old man with BRAFV600E melanoma and spinal metastases treated with vemurafenib and stereotactic radiation showed a partial response without neurological, skin or mucosal toxicity, 8 months after completion of this combination. This case suggests that stereotactic radiation spares normal tissues and might be safer than conventional fractionated radiation with vemurafenib. PMID:26900362

  1. Vemurafenib and concomitant stereotactic radiation for the treatment of melanoma with spinal metastases: A case report.

    PubMed

    Stefan, Dinu; Popotte, Hosni; Stefan, Andreea Raluca; Tesniere, Audrey; Tomaszewski, Aurélie; Lesueur, Paul; Habrand, Jean-Louis; Verneuil, Laurence

    2016-01-01

    A 56-year-old man with BRAFV600E melanoma and spinal metastases treated with vemurafenib and stereotactic radiation showed a partial response without neurological, skin or mucosal toxicity, 8 months after completion of this combination. This case suggests that stereotactic radiation spares normal tissues and might be safer than conventional fractionated radiation with vemurafenib.

  2. High frequency guided ultrasonic waves for hidden fatigue crack growth monitoring in multi-layer model aerospace structures

    NASA Astrophysics Data System (ADS)

    Chan, Henry; Masserey, Bernard; Fromme, Paul

    2015-02-01

    Especially for ageing aircraft the development of fatigue cracks at fastener holes due to stress concentration and varying loading conditions constitutes a significant maintenance problem. High frequency guided waves offer a potential compromise between the capabilities of local bulk ultrasonic measurements with proven defect detection sensitivity and the large area coverage of lower frequency guided ultrasonic waves. High frequency guided waves have energy distributed through all layers of the specimen thickness, allowing in principle hidden (2nd layer) fatigue damage monitoring. For the integration into structural health monitoring systems the sensitivity for the detection of hidden fatigue damage in inaccessible locations of the multi-layered components from a stand-off distance has to be ascertained. The multi-layered model structure investigated consists of two aluminium plate-strips with an epoxy sealant layer. During cyclic loading fatigue crack growth at a fastener hole was monitored. Specific guided wave modes (combination of fundamental A0 and S0 Lamb modes) were selectively excited above the cut-off frequencies of higher modes using a standard ultrasonic wedge transducer. Non-contact laser measurements close to the defect were performed to qualify the influence of a fatigue crack in one aluminium layer on the guided wave scattering. Fatigue crack growth monitoring using laser interferometry showed good sensitivity and repeatability for the reliable detection of small, quarter-elliptical cracks. Standard ultrasonic pulse-echo equipment was employed to monitor hidden fatigue damage from a stand-off distance without access to the damaged specimen layer. Sufficient sensitivity for the detection of fatigue cracks located in the inaccessible aluminium layer was verified, allowing in principle practical in situ ultrasonic monitoring of fatigue crack growth.

  3. Dosimetric measurements of Onyx embolization material for stereotactic radiosurgery

    SciTech Connect

    Roberts, Donald A.; Balter, James M.; Chaudhary, Neeraj; Gemmete, Joseph J.; Pandey, Aditya S.

    2012-11-15

    Purpose: Arteriovenous malformations are often treated with a combination of embolization and stereotactic radiosurgery. Concern has been expressed in the past regarding the dosimetric properties of materials used in embolization and the effects that the introduction of these materials into the brain may have on the quality of the radiosurgery plan. To quantify these effects, the authors have taken large volumes of Onyx 34 and Onyx 18 (ethylene-vinyl alcohol copolymer doped with tantalum) and measured the attenuation and interface effects of these embolization materials. Methods: The manufacturer provided large cured volumes ({approx}28 cc) of both Onyx materials. These samples were 8.5 cm in diameter with a nominal thickness of 5 mm. The samples were placed on a block tray above a stack of solid water with an Attix chamber at a depth of 5 cm within the stack. The Attix chamber was used to measure the attenuation. These measurements were made for both 6 and 16 MV beams. Placing the sample directly on the solid water stack and varying the thickness of solid water between the sample and the Attix chamber measured the interface effects. The computed tomography (CT) numbers for bulk material were measured in a phantom using a wide bore CT scanner. Results: The transmission through the Onyx materials relative to solid water was approximately 98% and 97% for 16 and 6 MV beams, respectively. The interface effect shows an enhancement of approximately 2% and 1% downstream for 16 and 6 MV beams. CT numbers of approximately 2600-3000 were measured for both materials, which corresponded to an apparent relative electron density (RED) {rho}{sub e}{sup w} to water of approximately 2.7-2.9 if calculated from the commissioning data of the CT scanner. Conclusions: We performed direct measurements of attenuation and interface effects of Onyx 34 and Onyx 18 embolization materials with large samples. The introduction of embolization materials affects the dose distribution of a MV

  4. Hypofractionated stereotactic radiotherapy combined with topotecan in recurrent malignant glioma

    SciTech Connect

    Wurm, Reinhard E. . E-mail: Reinhard.Wurm@charite.de; Kuczer, David A.; Schlenger, Lorenz; Matnjani, Gesa; Scheffler, Dirk; Cosgrove, Vivian P.; Ahlswede, Julia; Woiciechowsky, Christian; Budach, Volker

    2006-11-15

    Purpose: To assess hypofractionated stereotactic radiotherapy (H-SRT) with concurrent topotecan in patients with recurrent malignant glioma. Methods and Materials: Between February 1998 and December 2001, 25 patients with recurrent malignant glioma were treated in a phase I-II study (8 females and 17 males; median age, 45 years; range, 11-66 years; median Karnofsky performance status, 80%, range, 50-100%; median Mini Mental Standard Examination score, 25 points; range, 10-30 points). Of the 25 patients, 20% had World Health Organization Grade III and 80% World Health Organization Grade IV glioma. All patients had been treated previously by external beam radiotherapy with 54.4 Gy in 34 fractions twice daily, at least 6 h apart, within 3.5 weeks or 60 Gy in 30 fractions within 6 weeks. In addition, 84% had already received at least one chemotherapy regimen for recurrence. The median H-SRT dose at the 80% isodose was 25 Gy, and the maximal dose was 30 Gy delivered in five to six fractions on consecutive days. Topotecan (1.1 mg/m{sup 2}/d) was given as a continuous i.v. infusion during H-SRT. Depending on the toxicity and compliance, patients received an additional 48 topotecan courses. Results: For all patients, the actuarial median progression-free survival was 10.5 months (range, 1.4-47.8 months), the median functional survival was 12.6 months (range, 1.6-49.5 months), and the median overall survival was 14.5 months (range, 3-56.4 months). Twelve percent of patients developed presumed adverse radiation effects (Radiation Therapy Oncology Group Grade 2). According to the Common Toxicity Criteria, version 2.0, no topotecan-related Grade 4 toxicity was noted. Grade 3 neutropenia was documented after 14 and Grade 3 thrombopenia after 12 courses. Conclusion: H-SRT with topotecan is feasible and well-tolerated in patients with recurrent high-grade glioma and results in similar survival compared with other repeat treatment modalities.

  5. High-contrast, large optical bandwidth field-induced guide/antiguide modulator

    NASA Technical Reports Server (NTRS)

    Huang, T. C.; Chung, Y.; Dagli, N.; Coldren, L. A.

    1991-01-01

    An electric field induced-guide/antiguide optical intensity modulator which has a very wide optical bandwidth from 1 to 1.55/micron which is the largest ever reported before for an intensity modulator. A TE mode ON/OFF ratio larger than 21 dB at 1.15 micron, and a propagation loss about 1 dB at 1.3 micron has been measured. The electrooptic effects, along with carrier effects have been exploited to increase the refractive index under the guide and adjacent antiguide electrodes by applying reverse biases to them.

  6. Preliminary experimental investigation of an X-band Cerenkov-type high power microwave oscillator without guiding magnetic field

    NASA Astrophysics Data System (ADS)

    Guo, Liming; Shu, Ting; Li, Zhiqiang; Ju, Jinchuan; Fang, Xiaoting

    2017-02-01

    Among high power microwave (HPM) generators without guiding magnetic field, Cerenkov-type oscillator is expected to achieve a relatively high efficiency, which has already been realized in X-band in our previous simulation work. This paper presents the preliminary experimental investigations into an X-band Cerenkov-type HPM oscillator without guiding magnetic field. Based on the previous simulation structure, some modifications regarding diode structure were made. Different cathode structures and materials were tested in the experiments. By using a ring-shaped graphite cathode, microwave of about one hundred megawatt level was generated with a pure center frequency of 9.14 GHz, and an efficiency of about 1.3%. As analyzed in the paper, some practical issues reduce the efficiency in experiments, such as real features of the electron beam, probable breakdown regions on the cathode surface which can damage the diode, and so forth.

  7. Treatment time reduction through parameter optimization in magnetic resonance guided high intensity focused ultrasound treatments

    NASA Astrophysics Data System (ADS)

    Coon, Joshua

    Magnetic Resonance guided High Intensity Focused Ultrasound (MRgHIFU) treatments are a promising modality for cancer treatments in which a focused beam of ultrasound energy is used to kill tumor tissue. However, obstacles still exist to its widespread clinical implementation, including long treatment times. This research demonstrates reductions in treatment times through intelligent selection of the user-controllable parameters, including: the focal zone treatment path, focal zone size, focal zone spacing, and whether to treat one or several focal zone locations at any given time. Several treatments using various combinations of these parameters were simulated using a finite difference method to solve the Pennes bio-heat transfer equation for an ultrasonically heated tissue region with a wide range of acoustic, thermal, geometric, and tumor properties. The total treatment time was iteratively optimized using either a heuristic method or routines included in the Matlab software package, with constraints imposed for patient safety and treatment efficacy. The results demonstrate that large reductions in treatment time are possible through the intelligent selection of user-controllable treatment parameters. For the treatment path, treatment times are reduced by as much as an order of magnitude if the focal zones are arranged into stacks along the axial direction and a middle-front-back ordering is followed. For situations where normal tissue heating constraints are less stringent, these focal zones should have high levels of adjacency to further decrease treatment times; however, adjacency should be reduced in some cases where normal tissue constraints are more stringent. Also, the use of smaller, more concentrated focal zones produces shorter treatment times than larger, more diluted focal zones, a result verified in an agar phantom model. Further, focal zones should be packed using only a small amount of overlap in the axial direction and with a small gap in the

  8. AEROX: Computer program for transonic aircraft aerodynamics to high angles of attack. Volume 1: Aerodynamic methods and program users' guide

    NASA Technical Reports Server (NTRS)

    Axelson, J. A.

    1977-01-01

    The AEROX program estimates lift, induced-drag and pitching moments to high angles (typ. 60 deg) for wings and for wingbody combinations with or without an aft horizontal tail. Minimum drag coefficients are not estimated, but may be input for inclusion in the total aerodynamic parameters which are output in listed and plotted formats. The theory, users' guide, test cases, and program listing are presented.

  9. DENTAL HYGIENE MANUAL, GUIDE FOR A TWO-YEAR POST HIGH SCHOOL CURRICULUM.

    ERIC Educational Resources Information Center

    North Carolina State Board of Education, Raleigh. Div. of Vocational-Technical Programs.

    DEVELOPED BY TEACHERS IN DENTAL HYGIENE PROGRAMS, THE STATE ADVISORY COMMITTEE FOR DENTAL AUXILIARY EDUCATION, AND REPRESENTATIVES OF THE DENTAL ORGANIZATIONS AND BASED UPON THE EXPERIENCE OF THREE OPERATING DENTAL HYGIENE PROGRAMS OVER A 3-YEAR PERIOD, THIS GUIDE IS FOR ADMINISTRATOR AND TEACHER USE IN DEVELOPING CURRICULUMS IN DENTAL HYGIENE IN…

  10. Insurance Curriculum Guide for High School Consumer Education and Various Other Courses.

    ERIC Educational Resources Information Center

    Mason, Kathy

    The Insurance Department and the Department of Education of the Commonwealth of Pennsylvania collaborated on the insurance guide intending to present basic information about the insurance industry and its regulations in Pennsylvania. Presented in a format appropriate to existing curriculum needs and students' skills at the secondary level, the…

  11. Coastal Awareness: A Resource Guide for Teachers in Senior High Science. Preprint.

    ERIC Educational Resources Information Center

    Rasmussen, Frederick A.

    The stated purpose of this resource guide is to entice teachers to explore ecological aspects of coastal awareness. Discussions describe different characteristics of the coast such as: (1) waves, currents, and tides; (2) sandy beaches; (3) rocky shores; (4) estuaries; and (5) marshes. These discussions present some of the physical processes that…

  12. The First Amendment: Free Speech & a Free Press. A Curriculum Guide for High School Teachers.

    ERIC Educational Resources Information Center

    Eveslage, Thomas

    This curriculum guide is intended to encourage students to learn how everyone benefits when young people, other citizens, and the media exercise the constitutional rights of free speech and free press. Background information on free speech issues is provided, along with classroom activities, discussion questions, and student worksheets. There are…

  13. Ocean Prospects: A High School Teacher's Guide to Ocean-Related Topics.

    ERIC Educational Resources Information Center

    Plummer, C. M.

    Provided in this guide are resources for these 11 topics: the physical/geological ocean; the chemical/biological ocean; the ocean's coasts; fishing and aquaculture; tourism, recreation, and development; mining and drilling; research and exploration; maritime and military; ocean technology; pollution; and resource management. These resources…

  14. WAVAI Curriculum Guide for Instruction in Wisconsin High Schools. 1975 Revision. Bulletin No. 5011.

    ERIC Educational Resources Information Center

    Wisconsin State Dept. of Public Instruction, Madison. Bureau for Career and Manpower Development.

    This guide is designed to aid the development of vocational education programs in agriculture in local school districts. Major program objectives, good learning conditions, program evaluation, suggested teaching methods, and Wisconsin's philosophy and procedures in developing occupational experience programs in vocational agriculture/agribusiness…

  15. Curriculum Guide for General Education Development or High School Equivalency Examination in Spanish.

    ERIC Educational Resources Information Center

    Sharma, Shobha; Escalona, Margaret Boyter

    This curriculum guide was developed as part of the Worker Education Program for workers in the garment industry. The program was jointly developed by the workers, their employer, their union, and Northeastern Illinois University. It contains the materials required to teach a course to help Spanish-speaking individuals pass the General Educational…

  16. Peopling the High Plains: Wyoming's European Heritage. Curriculum Ideas and Guides for Teachers.

    ERIC Educational Resources Information Center

    Willems, Arnold L.

    The teacher's guide contains 25 K-12 lessons which illustrate the activities of all ethnic groups in Wyoming. The Basque, British, Eastern European, German-speaking, Greek, and Italian immigrants are highlighted. Titles include "Costumes by Flannelboard,""National Basque Week,""Dolls From Our Heritage,""Cook-In/Dance-In Ethnic…

  17. Elective English: Curriculum Guide and Course of Study at Silverton Union High School.

    ERIC Educational Resources Information Center

    Silverton Public Schools, OR.

    The secondary English curriculum outlined in this guide consists of a required course during the freshman year followed by three years in the elective program, during which each student is expected to complete a one semester course in each of the three basic areas of language, literature, and writing plus three more courses from any one area. This…

  18. INSTRUCTIONAL GUIDE FOR THE TEACHING OF HEALTH AND PHYSICAL EDUCATION. PRIMARY THROUGH SENIOR HIGH SCHOOL.

    ERIC Educational Resources Information Center

    BROCKMEYER, W.

    AN INSTRUCTIONAL GUIDE FOR THE TEACHING OF HEALTH AND PHYSICAL EDUCATION, EMPHASIZING EDUCATION BY EXPERIENCE IN ACTIVITY, WAS PRESENTED. THE GOALS WERE TO DEVELOP GOOD HUMAN RELATIONSHIPS, GOOD SELF-REALIZATION, CIVIC RESPONSIBILITY, AND ECONOMIC EFFICIENCY. THE PROGRAM FOR BOYS, GRADES SEVEN THROUGH NINE, INCLUDED CALISTHENICS APPARATUS (SUCH AS…

  19. Human Sexuality. A Resource Guide for Parents and Teachers on Teaching...High School Level.

    ERIC Educational Resources Information Center

    Utah State Office of Education, Salt Lake City.

    This guide provides information and resources that will facilitate parents' ability to help adolescents understand human sexuality within the context of home and family values and ideals. It provides teachers with resources to facilitate the decision making process. Contents are organized within a framework of objectives and guidelines for both…

  20. School Health Index: A Self-Assessment and Planning Guide. Middle School/High School.

    ERIC Educational Resources Information Center

    Barrios, Lisa C.; Burgeson, Charlene R.; Crossett, Linda; Harrykissoon, Samantha D.; Pritzl, Jane; Wechsler, Howell; Kuester, Sarah A.; Pederson, Linda; Graffunder, Corinne; Rainford, Neil; Sleet, David

    2004-01-01

    The "School Health Index" is a self-assessment and planning guide that will enable schools to: (1) identify the strengths and weaknesses of school policies and programs for promoting health and safety; (2) develop an action plan for improving student health and safety, and (3) involve teachers, parents, students, and the community in improving…

  1. Teaching Human Rights: A Teaching Guide for Middle and High School Educators.

    ERIC Educational Resources Information Center

    Shiman, David A.

    This curriculum guide incorporates three dimensions of human rights education: teaching about human rights, teaching against human rights violations, and teaching for the creation of a world in which all human beings are treated with justice and dignity. The book is based upon the United Nations' Universal Declaration of Human Rights (UDHR).…

  2. How High Is It? An Educator's Guide with Activities Focused on Scale Models of Distances.

    ERIC Educational Resources Information Center

    Rosenberg, Carla B.; Rogers, Melissa J. B.

    This guide focuses on scale models of distances. Activities also incorporate mathematics but can be used in science and technology grades 5-8 classes. The content of the book is divided into three sections: (1) Introductory Activities; (2) Core Activities; and (3) Activity/Assessment. Activities include: (1) KWL Chart; (2) Ball and String…

  3. The Student Guide: High School Seniors/College Students, 2004-2005.

    ERIC Educational Resources Information Center

    Department of Education, Washington, DC.

    This guide explains student financial aid programs the U.S. Department of Education's Federal Student Aid (FSA) office administers. The first three pages are a quick reference; the rest of the publication provides more of what you need to know about the financial aid programs offered. (AMT)

  4. Survey of the Mass Media: Curriculum Guide for Stow Senior High School 1971-1972.

    ERIC Educational Resources Information Center

    Hackman, Judith; And Others

    An outline guide for a survey of major mass media--newspapers, magazines, radio, television, movies, books, and advertising--is presented. The course intends to help students develop critical judgement of the media by improving viewing, reading, and listening skills. The objectives include: (1) presentation of the characteristics of each major…

  5. The Librarian's Internet Survival Guide: Strategies for the High-Tech Reference Desk.

    ERIC Educational Resources Information Center

    McDermott, Irene E.; Quint, Barbara, Ed.

    This guide discusses the use of the World Wide Web for library reference service. Part 1, "Ready Reference on the Web: Resources for Patrons," contains chapters on searching and meta-searching the Internet, using the Web to find people, news on the Internet, quality reference resources on the Web, Internet sites for kids, free full-text…

  6. An MRS- and PET-guided biopsy tool for intraoperative neuronavigational systems.

    PubMed

    Grech-Sollars, Matthew; Vaqas, Babar; Thompson, Gerard; Barwick, Tara; Honeyfield, Lesley; O'Neill, Kevin; Waldman, Adam D

    2017-03-17

    OBJECTIVE Glioma heterogeneity and the limitations of conventional structural MRI for identifying aggressive tumor components can limit the reliability of stereotactic biopsy and, hence, tumor characterization, which is a hurdle for developing and selecting effective treatment strategies. In vivo MR spectroscopy (MRS) and PET enable noninvasive imaging of cellular metabolism relevant to proliferation and can detect regions of more highly active tumor. Here, the authors integrated presurgical PET and MRS with intraoperative neuronavigation to guide surgical biopsy and tumor sampling of brain gliomas with the aim of improving intraoperative tumor-tissue characterization and imaging biomarker validation. METHODS A novel intraoperative neuronavigation tool was developed as part of a study that aimed to sample high-choline tumor components identified by multivoxel MRS and (18)F-methylcholine PET-CT. Spatially coregistered PET and MRS data were integrated into structural data sets and loaded onto an intraoperative neuronavigation system. High and low choline uptake/metabolite regions were represented as color-coded hollow spheres for targeted stereotactic biopsy and tumor sampling. RESULTS The neurosurgeons found the 3D spherical targets readily identifiable on the interactive neuronavigation system. In one case, areas of high mitotic activity were identified on the basis of high (18)F-methylcholine uptake and elevated choline ratios found with MRS in an otherwise low-grade tumor, which revealed the possible use of this technique for tumor characterization. CONCLUSIONS These PET and MRI data can be combined and represented usefully for the surgeon in neuronavigation systems. This method enables neurosurgeons to sample tumor regions based on physiological and molecular imaging markers. The technique was applied for characterizing choline metabolism using MRS and (18)F PET; however, this approach provides proof of principle for using different radionuclide tracers and

  7. An MRS- and PET-guided biopsy tool for intraoperative neuronavigational systems.

    PubMed

    Grech-Sollars, Matthew; Vaqas, Babar; Thompson, Gerard; Barwick, Tara; Honeyfield, Lesley; O'Neill, Kevin; Waldman, Adam D

    2016-11-11

    OBJECTIVE Glioma heterogeneity and the limitations of conventional structural MRI for identifying aggressive tumor components can limit the reliability of stereotactic biopsy and, hence, tumor characterization, which is a hurdle for developing and selecting effective treatment strategies. In vivo MR spectroscopy (MRS) and PET enable noninvasive imaging of cellular metabolism relevant to proliferation and can detect regions of more highly active tumor. Here, the authors integrated presurgical PET and MRS with intraoperative neuronavigation to guide surgical biopsy and tumor sampling of brain gliomas with the aim of improving intraoperative tumor-tissue characterization and imaging biomarker validation. METHODS A novel intraoperative neuronavigation tool was developed as part of a study that aimed to sample high-choline tumor components identified by multivoxel MRS and (18)F-methylcholine PET-CT. Spatially coregistered PET and MRS data were integrated into structural data sets and loaded onto an intraoperative neuronavigation system. High and low choline uptake/metabolite regions were represented as color-coded hollow spheres for targeted stereotactic biopsy and tumor sampling. RESULTS The neurosurgeons found the 3D spherical targets readily identifiable on the interactive neuronavigation system. In one case, areas of high mitotic activity were identified on the basis of high (18)F-methylcholine uptake and elevated choline ratios found with MRS in an otherwise low-grade tumor, which revealed the possible use of this technique for tumor characterization. CONCLUSIONS These PET and MRI data can be combined and represented usefully for the surgeon in neuronavigation systems. This method enables neurosurgeons to sample tumor regions based on physiological and molecular imaging markers. The technique was applied for characterizing choline metabolism using MRS and (18)F PET; however, this approach provides proof of principle for using different radionuclide tracers and

  8. Verification of the linac isocenter for stereotactic radiosurgery using cine-EPID imaging and arc delivery

    SciTech Connect

    Rowshanfarzad, Pejman; Sabet, Mahsheed; O' Connor, Daryl J.; Greer, Peter B.

    2011-07-15

    Purpose:Verification of the mechanical isocenter position is required as part of comprehensive quality assurance programs for stereotactic radiosurgery/radiotherapy (SRS/SRT) treatments. Several techniques have been proposed for this purpose but each of them has certain drawbacks. In this paper, a new efficient and more comprehensive method using cine-EPID images has been introduced for automatic verification of the isocenter with sufficient accuracy for stereotactic applications. Methods: Using a circular collimator fixed to the gantry head to define the field, EPID images of a Winston-Lutz phantom were acquired in cine-imaging mode during 360 deg. gantry rotations. A robust matlab code was developed to analyze the data by finding the center of the field and the center of the ball bearing shadow in each image with sub-pixel accuracy. The distance between these two centers was determined for every image. The method was evaluated by comparison to results of a mechanical pointer and also by detection of a manual shift applied to the phantom position. The repeatability and reproducibility of the method were tested and it was also applied to detect couch and collimator wobble during rotation. Results:The accuracy of the algorithm was 0.03 {+-} 0.02 mm. The repeatability was less than 3 {mu}m and the reproducibility was less than 86 {mu}m. The time elapsed for the analysis of more than 100 cine images of Varian aS1000 and aS500 EPIDs were {approx}65 and 20 s, respectively. Processing of images taken in integrated mode took 0.1 s. The output of the analysis software is printable and shows the isocenter shifts as a function of angle in both in-plane and cross-plane directions. It gives warning messages where the shifts exceed the criteria for SRS/SRT and provides useful data for the necessary adjustments in the system including bearing system and/or room lasers. Conclusions: The comprehensive method introduced in this study uses cine-images, is highly accurate, fast, and

  9. Cooperative Marketing and Distributive Education I and II (Junior and Senior High School Students). Vocational Education Teacher-Coordinators Curriculum Guide. Bulletin 1702.

    ERIC Educational Resources Information Center

    Louisiana State Dept. of Education, Baton Rouge. Div. of Vocational Education.

    Developed by experienced vocational teacher-coordinators and teacher-educators, this guide is intended to be used as a resource by cooperative distributive education and marketing teachers in Louisiana junior and senior high schools. The guide contains suggested curriculum for both beginning and advanced courses. Course I consists of 19 units in…

  10. Stereotactic body radiotherapy for the pancreas: a critical review for the medical oncologist

    PubMed Central

    Kim, Samuel K.; Wu, Cheng-Chia

    2016-01-01

    With recent advances in imaging modalities and radiation therapy, stereotactic body radiotherapy (SBRT) has allowed for the delivery of high doses of radiation with accuracy and precision. As such, SBRT has generated favorable results in the treatment of several cancers. Although the role of radiation has been controversial for the treatment of pancreatic ductal adenocarcinoma (PDAC) due to rather lackluster results in clinical trials, SBRT may offer improved outcomes, enhance the quality of life, and aid in palliative care settings for PDAC patients. This review delineates the role of SBRT in the treatment of PDAC, presents the defining principles of radiation biology and the radiation oncology work flow, and discusses the prospects of new treatment regimens involving tumor immunology and radiation therapy. PMID:27284482

  11. Feasibility evaluation of a motion detection system with face images for stereotactic radiosurgery.

    PubMed

    Yamakawa, Takuya; Ogawa, Koichi; Iyatomi, Hitoshi; Kunieda, Etsuo

    2011-01-01

    In stereotactic radiosurgery we can irradiate a targeted volume precisely with a narrow high-energy x-ray beam, and thus the motion of a targeted area may cause side effects to normal organs. This paper describes our motion detection system with three USB cameras. To reduce the effect of change in illuminance in a tracking area we used an infrared light and USB cameras that were sensitive to the infrared light. The motion detection of a patient was performed by tracking his/her ears and nose with three USB cameras, where pattern matching between a predefined template image for each view and acquired images was done by an exhaustive search method with a general-purpose computing on a graphics processing unit (GPGPU). The results of the experiments showed that the measurement accuracy of our system was less than 0.7 mm, amounting to less than half of that of our previous system.

  12. Retreatment for prostate cancer with stereotactic body radiation therapy (SBRT): Feasible or foolhardy?

    PubMed

    Arcangeli, Stefano; Agolli, Linda; Donato, Vittorio

    2015-01-01

    The most popular therapeutic option in the management of radio-recurrent prostatic carcinoma is represented by the androgen deprivation therapy, that however should be considered only palliative and hampered by potential adverse effects of testosterone suppression. Local therapies such as surgery, cryoablation or brachytherapy might be curative choices for patients in good conditions and with a long-life expectancy, but at cost of significant risk of failure and severe toxicity. The administration of stereotactic body radiation therapy (SBRT) in this setting have come about because of tremendous technologic advances in image guidance and treatment delivery techniques that enable the delivery of large doses to tumor with reduced margins and high gradients outside the target, thereby reducing the volume of rectum which already received significant doses from primary radiotherapy. So far, very modest data are available to support its employment. Rationale, clinical experience, and challenges are herein reviewed and discussed.

  13. Clinical results of stereotactic heavy-charged-particle radiosurgery for intracranial angiographically occult vascular malformations

    SciTech Connect

    Levy, R.P.; Fabrikant, J.I.; Phillips, M.H.; Frankel, K.A.; Steinberg, G.K.; Marks, M.P.; DeLaPaz, R.L.; Chuang, F.Y.S.; Lyman, J.T.

    1989-12-01

    Angiographically occult vascular malformations (AOVMs) of the brain have been recognized for many years to cause neurologic morbidity and mortality. They generally become symptomatic due to intracranial hemorrhage, focal mass effect, seizures or headaches. The true incidence of AOVMs is unknown, but autopsy studies suggest that they are more common than high-flow angiographically demonstrable arteriovenous malformations (AVMs). We have developed stereotactic heavy-charged-particle Bragg peak radiosurgery for the treatment of inoperable intracranial vascular malformations, using the helium ion beams at the Lawrence Berkeley Laboratory 184-inch Synchrocyclotron and Bevatron. This report describes the protocol for patient selection, radiosurgical treatment planning method, clinical and neuroradiologic results and complications encountered, and discusses the strengths and limitations of the method. 10 refs., 1 fig.

  14. WE-G-BRD-07: Investigation of Distal Lung Atelectasis Following Stereotactic Body Radiation Therapy Using Regional Lung Volume Changes Between Pre- and Post- Treatment CT Scans

    SciTech Connect

    Diot, Q; Kavanagh, B; Miften, M

    2014-06-15

    Purpose: To propose a quantitative method using lung deformations to differentiate between radiation-induced fibrosis and potential airway stenosis with distal atelectasis in patients treated with stereotactic body radiation therapy (SBRT) for lung tumors. Methods: Twenty-four lung patients with large radiation-induced density increases outside the high dose region had their pre- and post-treatment CT scans manually registered. They received SBRT treatments at our institution between 2002 and 2009 in 3 or 5 fractions, to a median total dose of 54Gy (range, 30–60). At least 50 anatomical landmarks inside the lung (airway branches) were paired for the pre- and post-treatment scans to guide the deformable registration of the lung structure, which was then interpolated to the whole lung using splines. Local volume changes between the planning and follow-up scans were calculated using the deformation field Jacobian. Hyperdense regions were classified as atelectatic or fibrotic based on correlations between regional density increases and significant volume contractions compared to the surrounding tissues. Results: Out of 24 patients, only 7 demonstrated a volume contraction that was at least one σ larger than the remaining lung average. Because they did not receive high doses, these shrunk hyperdense regions were likely showing distal atelectasis resulting from radiation-induced airway stenosis rather than conventional fibrosis. On average, the hyperdense regions extended 9.2 cm farther than the GTV contours but not significantly more than 8.6 cm for the other patients (p>0.05), indicating that a large offset between the radiation and hyperdense region centers is not a good surrogate for atelectasis. Conclusion: A method based on the relative comparison of volume changes between different dates was developed to identify potential lung regions experiencing distal atelectasis. Such a tool is essential to study which lung structures need to be avoided to prevent

  15. Analysis of high frequency guided wave scattering at a fastener hole with a view to fatigue crack detection.

    PubMed

    Masserey, Bernard; Fromme, Paul

    2017-04-01

    The scattering of high frequency guided ultrasonic waves by a fatigue crack at the side of a fastener hole has been studied. The guided wave pulse consists of the superposition of the two fundamental Lamb modes A0 and S0 above the cut-off frequencies of the higher modes. The scattered field was simulated using a three-dimensional finite difference algorithm with a staggered, Cartesian grid for the limited area of interest around the hole and an analytical phase angle correction for the additional, variable propagation distance. Experimentally, the modes were selectively excited using a standard ultrasonic wedge transducer and measured using a laser interferometer, resulting in good spatial resolution. The scattered field was measured and simulated for an undamaged hole, a small, part-thickness quarter-elliptical fatigue crack, and a through-thickness fatigue crack. Good agreement was found and a significant influence of the fatigue cracks on the scattered field was observed. The complex difference of the scattered field due to additional scattered waves at the fatigue cracks of variable depth and length was evaluated. This allows for the prediction of high frequency guided wave sensitivity for fatigue crack detection at fastener holes, a significant maintenance problem for ageing aircraft.

  16. High-resolution mini gamma camera for diagnosis and radio-guided surgery in diabetic foot infection

    NASA Astrophysics Data System (ADS)

    Scopinaro, F.; Capriotti, G.; Di Santo, G.; Capotondi, C.; Micarelli, A.; Massari, R.; Trotta, C.; Soluri, A.

    2006-12-01

    The diagnosis of diabetic foot osteomyelitis is often difficult. 99mTc-WBC (White Blood Cell) scintigraphy plays a key role in the diagnosis of bone infections. Spatial resolution of Anger camera is not always able to differentiate soft tissue from bone infection. Aim of present study is to verify if HRD (High-Resolution Detector) is able to improve diagnosis and to help surgery. Patients were studied by HRD showing 25.7×25.7 mm 2 FOV, 2 mm spatial resolution and 18% energy resolution. The patients were underwent to surgery and, when necessary, bone biopsy, both guided by HRD. Four patients were positive at Anger camera without specific signs of osteomyelitis. HRS (High-Resolution Scintigraphy) showed hot spots in the same patients. In two of them the hot spot was bar-shaped and it was localized in correspondence of the small phalanx. The presence of bone infection was confirmed at surgery, which was successfully guided by HRS. 99mTc-WBC HRS was able to diagnose pedal infection and to guide the surgery of diabetic foot, opening a new way in the treatment of infected diabetic foot.

  17. [Intensity-modulated radiation therapy and stereotactic body radiation therapy for head and neck tumors: evidence-based medicine].

    PubMed

    Lapierre, A; Martin, F; Lapeyre, M

    2014-10-01

    Over the last decade, there have been many technical advances in radiation therapy, such as the spread of intensity-modulated conformal radiotherapy, and the rise of stereotactic body radiation therapy. By allowing better dose-to-target conformation and thus better organs at risk-sparing, these techniques seem very promising, particularly in the field of head and neck tumors. The present work aims at analyzing the level of evidence and recommendation supporting the use of high-technology radiotherapy in head and neck neoplasms, by reviewing the available literature.

  18. Developing and implementing a high precision setup system

    NASA Astrophysics Data System (ADS)

    Peng, Lee-Cheng

    The demand for high-precision radiotherapy (HPRT) was first implemented in stereotactic radiosurgery using a rigid, invasive stereotactic head frame. Fractionated stereotactic radiotherapy (SRT) with a frameless device was developed along a growing interest in sophisticated treatment with a tight margin and high-dose gradient. This dissertation establishes the complete management for HPRT in the process of frameless SRT, including image-guided localization, immobilization, and dose evaluation. The most ideal and precise positioning system can allow for ease of relocation, real-time patient movement assessment, high accuracy, and no additional dose in daily use. A new image-guided stereotactic positioning system (IGSPS), the Align RT3C 3D surface camera system (ART, VisionRT), which combines 3D surface images and uses a real-time tracking technique, was developed to ensure accurate positioning at the first place. The uncertainties of current optical tracking system, which causes patient discomfort due to additional bite plates using the dental impression technique and external markers, are found. The accuracy and feasibility of ART is validated by comparisons with the optical tracking and cone-beam computed tomography (CBCT) systems. Additionally, an effective daily quality assurance (QA) program for the linear accelerator and multiple IGSPSs is the most important factor to ensure system performance in daily use. Currently, systematic errors from the phantom variety and long measurement time caused by switching phantoms were discovered. We investigated the use of a commercially available daily QA device to improve the efficiency and thoroughness. Reasonable action level has been established by considering dosimetric relevance and clinic flow. As for intricate treatments, the effect of dose deviation caused by setup errors remains uncertain on tumor coverage and toxicity on OARs. The lack of adequate dosimetric simulations based on the true treatment coordinates from

  19. [Neuroprotective subthalamotomy in Parkinson's disease. The role of magnetic resonance-guided focused ultrasound in early surgery].

    PubMed

    Guridi, Jorge; Marigil, Miguel; Becerra, Victoria; Parras, Olga

    Subthalamic nucleus hyperactivity in Parkinson's disease may be a very early phenomenon. Its start is not well known, and it may occur during the pre-symptomatic disease stage. Glutamatergic hyperactivity may be neurotoxic over the substantia nigra compacta dopaminergic neurons. If this occurred, the excitatory neurotransmitter, glutamate, should affect the neurons that maintain a high turnover as a compensatory mechanism. Would a subthalamic nucleus lesion decrease this hyperactivity and thus be considered as a neuroprotective mechanism for dopaminergic neurons? The authors hypothesise about the possibility to perform surgery on a subthalamic nucleus lesion at a very early stage in order to avoid the neurotoxic glutamatergic effect over the dopaminergic neurons, and therefore be considered as a neuroprotective surgery able to alter the progress of the disease during early motor symptoms. In this regard, magnetic resonance-guided focused ultrasound techniques open a new window in the stereotactic armamentarium.

  20. The treatment of recurrent brain metastases with stereotactic radiosurgery.

    PubMed

    Loeffler, J S; Kooy, H M; Wen, P Y; Fine, H A; Cheng, C W; Mannarino, E G; Tsai, J S; Alexander, E

    1990-04-01

    Between May 1986 and August 1989, we treated 18 patients with 21 recurrent or persistent brain metastases with stereotactic radiosurgery using a modified linear accelerator. To be eligible for radiosurgery, patients had to have a performance status of greater than or equal to 70% and have no evidence of (or stable) systemic disease. All but one patient had received prior radiotherapy, and were treated with stereotactic radiosurgery at the time of recurrence. Polar lesions were treated only if the patient had undergone and failed previous complete surgical resection (10 patients). Single doses of radiation (900 to 2,500 cGy) were delivered to limited volumes (less than 27 cm3) using a modified 6MV linear accelerator. The most common histology of the metastatic lesion was carcinoma of the lung (seven patients), followed by carcinoma of the breast (four patients), and melanoma (four patients). With median follow-up of 9 months (range, 1 to 39), all tumors have been controlled in the radiosurgery field. Two patients failed in the immediate margin of the treated volume and were subsequently treated with surgery and implantation of 125I to control the disease. Radiographic response was dramatic and rapid in the patients with adenocarcinoma, while slight reduction and stabilization occurred in those patients with melanoma, renal cell carcinoma, and sarcoma. The majority of patients improved neurologically following treatment, and were able to be withdrawn from corticosteroid therapy. Complications were limited and transient in nature and no cases of symptomatic radiation necrosis occurred in any patient despite previous exposure to radiotherapy. Stereotactic radiosurgery is an effective and relatively safe treatment for recurrent solitary metastases and is an appealing technique for the initial management of deep-seated lesions as a boost to whole brain radiotherapy.

  1. Guided visualization interventions on perceived stress, dyadic satisfaction and psychological symptoms in highly stressed couples.

    PubMed

    Rogers, Kim R; Hertlein, Katherine; Rogers, Donna; Cross, Chad L

    2012-05-01

    This study focused on the effect of a brief CBT-based relaxation/guided visualization intervention on perceived stress, dyadic satisfaction and psychological symptoms. This study also tested the hypothesis that indicators of global orientation including Sense of Coherence and Differentiation of Self would mediate between perceived stress and symptoms of physical, psychological and relational distress. A three session intervention used guided visualization scripts which incorporated relaxation and controlled breathing techniques as well as a CBT approach that focused on stress management and internal locus of control. Results indicated that after the intervention, participants showed lower levels of perceived stress and lower levels of dyadic distress, as well as lower psychological and physical complaints as reported with the Symptom Checklist-90-R. Both Sense of Coherence and Differentiation of Self were mediators for the effect of perceived stress on the number of endorsed symptoms.

  2. A high transmission wave-guide wire network made by self-assembly

    NASA Astrophysics Data System (ADS)

    Salvatore, Stefano; Vignolini, Silvia; Philpott, Julian; Stefik, Morgan; Wiesner, Ulrich; Baumberg, Jeremy J.; Steiner, Ullrich

    2014-12-01

    Polymer self-assembly of a 3D continuous gyroid morphology was replicated into a network consisting of hollow gold struts. This was achieved by first replicating a gyroid structured film into nickel. The Ni network was employed as an electrode for electrochemical Au deposition, followed by the removal of Ni. The resulting hollow network of plasmonic gold exhibited a substantial optical transmission enhancement by a factor of nearly 3, compared to a network of full Au struts. The overall transmission across the hollow wave-guide morphology depends sensitively on the wall-thickness of the hollow struts down to 1 nm. The dramatic transmission increase arises from an interplay of three mechanisms: (1) the additional number of modes propagating through the wave-guide structure, (2) the increased efficiency of light in-coupling, and (3) a reduction of dissipation by decreasing the Au-volume experienced in plasmon mode propagation.

  3. Glass light guides for color mixing of high-power LEDs

    NASA Astrophysics Data System (ADS)

    Paßlick, C.; Geyer, U.; Heßling, T.; Hellwig, A.; Hübner, M. C.

    2016-09-01

    Constant LED developments show increasing levels of luminous flux and power densities. In particular, automotive and entertainment industries are requesting mechanically and optically stable light guides for their new mid to highest-power lighting solutions. The switch from polymer to glass optics comes with improved temperature resistance, higher optical performance and better longevity of the systems [1, 2]. Even highest-power LEDs can be driven at maximum current obtaining best light output. The option of directly implementing micro structures on the output aperture of glass light guides gives the opportunity to customize final color mixing and light scattering over a wide range. This reduces the amount of required components and subsequently the total system costs.

  4. Novalis Stereotactic Radiosurgery for Spinal Dural Arteriovenous Fistula.

    PubMed

    Sung, Kyoung-Su; Song, Young-Jin; Kim, Ki-Uk

    2016-07-01

    The spinal dural arteriovenous fistula (SDAVF) is rare, presenting with progressive, insidious symptoms, and inducing spinal cord ischemia and myelopathy, resulting in severe neurological deficits. If physicians have accurate and enough information about vascular anatomy and hemodynamics, they achieve the good results though the surgery or endovascular embolization. However, when selective spinal angiography is unsuccessful due to neurological deficits, surgery and endovascular embolization might be failed because of inadequate information. We describe a patient with a history of vasospasm during spinal angiography, who was successfully treated by spinal stereotactic radiosurgery using Novalis system.

  5. Novalis Stereotactic Radiosurgery for Spinal Dural Arteriovenous Fistula

    PubMed Central

    Sung, Kyoung-Su; Song, Young-Jin

    2016-01-01

    The spinal dural arteriovenous fistula (SDAVF) is rare, presenting with progressive, insidious symptoms, and inducing spinal cord ischemia and myelopathy, resulting in severe neurological deficits. If physicians have accurate and enough information about vascular anatomy and hemodynamics, they achieve the good results though the surgery or endovascular embolization. However, when selective spinal angiography is unsuccessful due to neurological deficits, surgery and endovascular embolization might be failed because of inadequate information. We describe a patient with a history of vasospasm during spinal angiography, who was successfully treated by spinal stereotactic radiosurgery using Novalis system. PMID:27446527

  6. Development of a new microsurgical robot for stereotactic neurosurgery.

    PubMed

    Koyama, H; Uchida, T; Funakubo, H; Takakura, K; Fankhauser, H

    1990-01-01

    The robot technology was introduced into a new stereotactic neurosurgery system for applications to biopsy, blind surgery, and functional neurosurgery. The authors have developed a newly designed prototype microsurgical robot, designed to allow a biopsy needle to reach the target such as a cerebral tumor within a brain automatically on the basis of the X, Y, and Z coordinates obtained by CT scanner. This robot is so small that it can be driven in a CT scanner gantry. It consists mainly of the link mechanism and the insertion mechanism. We constructed the link mechanism and investigated its working space.

  7. Technique for Robotic Stereotactic Irradiation of Choroidal Melanoma.

    PubMed

    Béliveau-Nadeau, Dominic; Callejo, Sonia; Roberge, David

    2016-04-21

    Radiotherapy has a long history in the organ-sparing management of choroidal melanoma. Joining plaque radiotherapy and proton irradiation, stereotactic robotic photon irradiation is a new tool in the radiation oncologist's armamentarium for ocular tumors. The non-coplanar fields with steep dose gradients are well suited to spare uninvolved retina, anterior chamber, and the optic nerve. In our practice, it is the preferred treatment for melanomas that are non-amenable to standard plaque brachytherapy. Since late 2010, we have treated more than 40 patients with our robotic linear accelerator. This case-based technical note outlines the technique used at the University of Montreal, Montreal, Canada.

  8. Technique for Robotic Stereotactic Irradiation of Choroidal Melanoma

    PubMed Central

    Béliveau-Nadeau, Dominic; Callejo, Sonia

    2016-01-01

    Radiotherapy has a long history in the organ-sparing management of choroidal melanoma. Joining plaque radiotherapy and proton irradiation, stereotactic robotic photon irradiation is a new tool in the radiation oncologist’s armamentarium for ocular tumors. The non-coplanar fields with steep dose gradients are well suited to spare uninvolved retina, anterior chamber, and the optic nerve. In our practice, it is the preferred treatment for melanomas that are non-amenable to standard plaque brachytherapy. Since late 2010, we have treated more than 40 patients with our robotic linear accelerator. This case-based technical note outlines the technique used at the University of Montreal, Montreal, Canada. PMID:27226942

  9. Experiments on Self-Guiding Mechanisms of High Power Laser Pulses in a Plasma

    NASA Astrophysics Data System (ADS)

    Ralph, Joseph; Pak, Arthur; Marsh, Kenneth; Clayton, Christopher; Fang, Fang; Joshi, Chandrashekhar

    2007-11-01

    Recent 3D theory and PIC simulations in the blowout regime, wherein the pondermotive force of laser with a pulse length on the order of a plasma wavelength expels all electrons, has predicted a range of parameter space where stable laser propagation can occur [1]. In this theory, the density depression caused by electron blow out is the dominant mechism responsible for self-guiding. In this paper we examine experimentally and with PIC simulations laser beam guiding of a multi terwatt TiSapphire laser in a supersonic Helium gas jet. Gas jet density was varied from 2*E18 to to 2*E19 and the length of the plasma was varied from 2 to 5 mm using several gas jets with different diameters. Pondermotive and relativistic effects are considerd by varying laser and plasma parameters. Diagnostics include interferometric and Schlieren techniques. Images of the guided mode are taken at the exit of the gas jet. In addition, the forward images were sent to an imaging spectragraph to observe photon deceleration and deceleration [2]. [1] W. Lu, C. Huang, M. Zhou, and M. Tzoufras, F. S. Tsung, W. B. Mori, and T. Katsouleas, Phys. Plasmas 13, 056709 (2006) [2] A. E. Pak, J. E. Ralph, K. A. Marsh , C. E. Clayton, F. Fang and C. Joshi, These Procedings

  10. Neuronavigation-guided focused ultrasound-induced blood-brain barrier opening: A preliminary study in swine

    NASA Astrophysics Data System (ADS)

    Liu, Hao-Li; Tsai, Hong-Chieh; Lu, Yu-Jen; Wei, Kuo-Chen

    2012-11-01

    FUS-induced BBB opening is a promising technique for noninvasive and local delivery of drugs into the brain. Here we propose the novel use of a neuronavigation system to guide the FUS-induced BBB opening procedure, and investigate its feasibility in vivo in large animals. We developed an interface between the neuronavigator and FUS to allow guidance of the focal energy produced by the FUS transducer. The system was tested in 29 pigs by more than 40 sonication procedures and evaluated by MRI. Gd-DTPA concentration was quantitated in vivo by MRI R1 relaxometry and compared by ICP-OES assay. Brain histology after FUS exposure was investigated by HE and TUNEL staining. Neuronavigation could successfully guide the focal beam with comparable precision to neurosurgical stereotactic procedures (2.3 ± 0.9 mm). FUS pressure of 0.43 MPa resulted in consistent BBB-opening. Neuronavigation-guided BBB-opening increased Gd-DTPA deposition by up to 1.83 mM (140% increase). MR relaxometry demonstrated high correlation to ICP-OES measurements (r2 = 0.822), suggesting that Gd-DTPA deposition can be directly measured by imaging. Neuronavigation could provide sufficient precision for guiding FUS to temporally and locally open the BBB. Gd-DTPA deposition in the brain could be quantified by MR relaxometry, providing a potential tool for the in vivo quantification of therapeutic agents in CNS disease treatment.

  11. Stereotactic Body Radiotherapy as Primary Treatment for Elderly Patients with Medically Inoperable Head and Neck Cancer

    PubMed Central

    Vargo, John A.; Ferris, Robert L.; Clump, David A.; Heron, Dwight E.

    2014-01-01

    Purpose: With a growing elderly population, elderly patients with head and neck cancers represent an increasing challenge with limited prospective data to guide management. The complex interplay between advanced age, associated co-morbidities, and conventional local therapies, such as surgery and external beam radiotherapy ± chemotherapy, can significantly impact elderly patients’ quality of life (QoL). Stereotactic body radiotherapy (SBRT) is a well-established curative strategy for medical-inoperable early-stage lung cancers even in elderly populations; however, there is limited data examining SBRT as primary therapy in head and neck cancer. Material/methods: Twelve patients with medically inoperable head and neck cancer treated with SBRT ± cetuximab from 2002 to 2013 were retrospectively reviewed. SBRT consisted of primarily 44 Gy in five fractions delivered on alternating days over 1–2 weeks. Concurrent cetuximab was administered at a dose of 400 mg/m2 on day −7 followed by 250 mg/m2 on day 0 and +7 in n = 3 (25%). Patient-reported quality of life (PRQoL) was prospectively recorded using the previously validated University of Washington quality of life revised (UW-QoL-R). Results: Median clinical follow-up was 6 months (range: 0.5–29 months). The 1-year actuarial local progression-free survival, distant progression-free survival, progression-free survival, and overall survival for definitively treated patients were 69, 100, 69, and 64%, respectively. One patient (8%) experienced acute grade 3 dysphagia and one patient (8%) experienced late grade 3 mucositis; there were no grade 4–5 toxicities. Prospective collection of PRQoL as assessed by UW-QoL-R was preserved across domains. Conclusion: Stereotactic body radiotherapy shows encouraging survival and relatively low toxicity in elderly patients with unresectable head and neck cancer, which may provide an aggressive potentially curative local therapy while maintaining QoL. PMID

  12. Stereotactic Radiotherapy of Central Nervous System and Head and Neck Lesions, Using a Conformal Intensity-Modulated Radiotherapy System (Peacock™ System)

    PubMed Central

    Ammirati, Mario; Bernardo, Antonio; Ramsinghani, Nilam; Yakoob, Richard; Al-Ghazi, Matthew; Kuo, Jeffrey; Ammirati, Giuseppe

    2001-01-01

    The objective of this article is to evaluate single-fraction or fractionated stereotactic radiotherapy of central nervous system (CNS) and head and neck lesions using intensity-modulated radiotherapy (IMRT) with a commercially available system (Peacock™, Nomos Corporation, Sewickley, PA). This system allows tomotherapeutic delivery of intensity-modulated radiation, that is, the slice-by-slice treatment of the volume of interest with an intensity-modulated beam, making the delivery of highly conformal radiation to the target possible in both single or multiple fractions mode. During an 18-month period, 43 (21 males and 22 females) patients were treated, using a removable cranial screw-fixation device. Ages ranged from 10 to 77 years (mean, 52.2; median, 53.5). Intra- and extra-axial lesions, including head and neck malignancies and spine metastases, were treated. Clinical target volume ranged from 0.77 to 195 cm3 (mean, 47.8; median, 29.90). The dose distribution was normalized to the maximum and was prescribed, in most cases, at the 80% or 90% isodose line (range, 65 to 96%; median, 85%; mean, 83.4%) and ranged from 14 to 80 Gy (mean, 48; median, 50). The number of fractions ranged from 1 to 40 (mean, 23; median, 25). In all but one patient, 90% of the prescription isodose line covered 100% of the clinical target volume. The heterogeneity index (the ratio between the maximum radiation dose and the prescribed dose) ranged between 1.0 and 1.50, whereas the conformity index (the ratio between the volume encompassed by the prescription isodose line and the clinical target volume) ranged between 1.0 and 4.5. There were no complications related to the radiation treatment. With a median follow-up of 6 months, more than 70% of our patients showed decreased lesion size. Stereotactic IMRT of CNS and head and neck lesions can be delivered safely and accurately. The Peacock system delivers stereotactic radiation in single or multiple fractions and has no volume limitations

  13. Anniversary Paper: The role of medical physicists in developing stereotactic radiosurgery

    SciTech Connect

    Benedict, Stanley H.; Bova, Frank J.; Clark, Brenda; Goetsch, Steven J.; Hinson, William H.; Leavitt, Dennis D.; Schlesinger, David J.; Yenice, Kamil M.

    2008-09-15

    This article is a tribute to the pioneering medical physicists over the last 50 years who have participated in the research, development, and commercialization of stereotactic radiosurgery (SRS) and stereotactic radiotherapy utilizing a wide range of technology. The authors have described the evolution of SRS through the eyes of physicists from its beginnings with the Gamma Knife in 1951 to proton and charged particle therapy; modification of commercial linacs to accommodate high precision SRS setups; the multitude of accessories that have enabled fine tuning patients for relocalization, immobilization, and repositioning with submillimeter accuracy; and finally the emerging technology of SBRT. A major theme of the article is the expanding role of the medical physicist from that of advisor to the neurosurgeon to the current role as a primary driver of new technology that has already led to an adaptation of cranial SRS to other sites in the body, including, spine, liver, and lung. SRS continues to be at the forefront of the impetus to provide technological precision for radiation therapy and has demonstrated a host of downstream benefits in improving delivery strategies for conventional therapy as well. While this is not intended to be a comprehensive history, and the authors could not delineate every contribution by all of those working in the pursuit of SRS development, including physicians, engineers, radiobiologists, and the rest of the therapy and dosimetry staff in this important and dynamic radiation therapy modality, it is clear that physicists have had a substantial role in the development of SRS and theyincreasingly play a leading role in furthering SRS technology.

  14. Adjuvant Stereotactic Radiosurgery and Radiation Therapy for the Treatment of Intracranial Chordomas

    PubMed Central

    Choy, Winward; Terterov, Sergei; Ung, Nolan; Kaprealian, Tania; Trang, Andy; DeSalles, Antonio; Chung, Lawrance K.; Martin, Neil; Selch, Michael; Bergsneider, Marvin; Yong, William; Yang, Isaac

    2015-01-01

    Objective Chordomas are locally aggressive, highly recurrent tumors requiring adjuvant radiotherapy following resection for successful management. We retrospectively reviewed patients treated for intracranial chordomas with adjuvant stereotactic radiosurgery (SRS) and stereotactic radiation therapy (SRT). Methods A total of 57 patients underwent 83 treatments at the UCLA Medical Center between February 1990 and August 2011. Mean follow-up was 57.8 months. Mean tumor diameter was 3.36 cm. Overall, 8 and 34 patients received adjuvant SRS and SRT, and the mean maximal dose of radiation therapy was 1783.3 cGy and 6339 cGy, respectively. Results Overall rate of recurrence was 51.8%, and 1- and 5-year progression-free survival (PFS) was 88.2% and 35.2%, respectively. Gross total resection was achieved in 30.9% of patients. Adjuvant radiotherapy improved outcomes following subtotal resection (5-year PFS 62.5% versus 20.1%; p = 0.036). SRS and SRT produced comparable rates of tumor control (p = 0.28). Higher dose SRT (> 6,000 cGy) (p = 0.013) and younger age (< 45 years) (p = 0.03) was associated with improved rates of tumor control. Conclusion Adjuvant radiotherapy is critical following subtotal resection of intracranial chordomas. Adjuvant SRT and SRS were safe and improved PFS following subtotal resection. Higher total doses of SRT and younger patient age were associated with improved rates of tumor control. PMID:26949587

  15. Stereotactic brachytherapy of low-grade cerebral glioma after tumor resection.

    PubMed

    Suchorska, Bogdana; Ruge, Maximilian; Treuer, Harald; Sturm, Volker; Voges, Jürgen

    2011-10-01

    The purpose of this study was to assess the impact of stereotactic brachytherapy (SBT) on survival time and outcome when applied after resection of low-grade glioma (LGG) of World Health Organization grade II. From January 1982 through December 2006 we treated 1024 patients who had glioma with stereotactic implantation of iodine-125 seeds and SBT in accordance with a prospective protocol. For the present analysis, we selected 95 of 277 patients with LGG, in whom SBT was applied to treat progressive (43 patients) or recurrent (52 patients) tumor after resection. At 24 months after seed implantation, the tumor response rate was 35.9%, and the tumor control rate was 97.3%. The median progression-free-survival (PFS) duration after SBT was 52.7 ± 7.1 months. Five-year and 10-year PFS probabilities were 43.4% and 10.7%, respectively. Malignant tumor transformation, the diagnosis "astrocytoma," and tumor volume >20 mL were significantly associated with reduced PFS. Tumor progression or relapse after SBT (53 of 95 patients) was treated with tumor resection, a second SBT, chemotherapy, and/or radiotherapy. The median overall survival duration (from the first diagnosis of LGG until the patient's last contact) was 245.0 ± 4.9 months. Patients still under observation after seed implantation had a median follow-up time of 156.4 ± 55.7 months. Perioperative transient morbidity was 1.1%, and the frequency of permanent morbidity caused by SBT was 3.3%. In conclusion, SBT of recurrent or progressive LGG after resection located in functionally critical brain areas has high local efficacy and comparably low morbidity. Referred to individually adopted glioma treatment concepts SBT provides a reasonably long PFS, thus improving overall survival. In selected patients, SBT can lead to delays in the application of chemotherapy and/or radiotherapy.

  16. [Stereotactic radiotherapy and radiosurgery in treatment of patients with intracranial schwannomas].

    PubMed

    Zolotova, S V; Golanov, A V; Kotel'nikova, T M; Soboleva, O I; Gorlachev, G E; Fil'chenkova, N A; Nikonova, N G; Kapitanov, D N; Makhmudov, U B; Shimanskiĭ, V N; Arutiunov, N V; Pronin, I N

    2010-01-01

    Aim of this study is to assess the role of stereotactic radiosurgery (SRS) and radiotherapy (SRT) in management of cranial nerves schwannomas by analysis of tumor control, clinical response and variables affecting treatment outcomes. Between April 2005 and January 2009 patients with schwannomas of VIII (63), V (14) and caudal nerves (2) were treated in Burdenko Moscow Neurosurgical Institute using linear accelerator. Mean age was 49 years (13-82). In 42 cases radiation treatment was preceded by surgical resection. 13 patients had type I or II neurofibromatosis. Mean volume of the tumor was 3.9 cm3 (0.5-14.4 cm3) and 13.4 cm3 (2.8-41.3 cm3) for SRS and SRT, respectively. Mean SRS dose was 12 Gy (10.8-14.4 Gy) for vestibular schwannomas and 15 Gy (13.2-18 Gy) for schwannomas of other nerves. In hypofractionated SRT the dose of 35 Gy was delivered in 7 fractions or 30 Gy in 6 fractions. In cases of classical fractioning total dose of 50-60 Gy was divided into daily fractions of 1.8-2.0 Gy. Radiographic tumor control rate reached 97.5% at the last follow-up. 5 patients experienced trigeminal dysfunction, it was transient in 3 cases and persistent in 2. Permanent decline in House-Brackmann facial nerve scale developed in 2 of 79 patients. After treatment effective hearing (class I-II) was preserved in 7 of 9 patients (67%) who had same level of hearing before SRS. Linear accelerator-based stereotactic radiation treatment provides long-term tumor control associated with high rates of preservation of neurological functions. No further tumor surgery was necessary in 100% of cases with solitary tumors with a minimal follow-up of 5 years.

  17. Multipurpose high-pressure high-temperature diamond-anvil cell with a novel high-precision guiding system and a dual-mode pressurization device.

    PubMed

    Pippinger, Thomas; Miletich, Ronald; Burchard, Michael

    2011-09-01

    A novel diamond-anvil cell (DAC) design has been constructed and tested for in situ applications at high-pressure (HP) operations and has proved to be suitable even for HP sample environments at non-ambient temperature conditions. The innovative high-precision guiding mechanism, comparable to a dog clutch, consists of perpendicular planar sliding-plane elements and is integrated directly into the base body of the cylindrically shaped DAC. The combination of two force-generating devices, i.e., mechanical screws and an inflatable gas membrane, allows the user to choose independently between, and to apply individually, two different forcing mechanisms for pressure generation. Both mechanisms are basically independent of each other, but can also be operated simultaneously. The modularity of the DAC design allows for an easy exchange of functional core-element groups optimized not only for various analytical in situ methods but also for HP operation with or without high-temperature (HT) application. For HP-HT experiments a liquid cooling circuit inside the specific inner modular groups has been implemented to obtain a controlled and limited heat distribution within the outer DAC body.

  18. Guiding of high intensity ultrashort laser pulses in plasma channels produced with the dual laser pulse ignitor-heater technique

    SciTech Connect

    Volfbeyn, P.; Leemans, W.P.

    1998-07-01

    The authors present results of experimental investigations of laser guiding in plasma channels. A new technique for plasma channel creation, the Ignitor-Heater scheme is proposed and experimentally tested in hydrogen and nitrogen. It makes use of two laser pulses. The Ignitor, an ultrashort (< 100 fs) laser pulse, is brought to a line focus using a cylindrical lens to ionize the gas. The Heater pulse (160 ps long) is used subsequently to heat the existing spark via inverse Bremsstrahlung. The hydrodynamic shock expansion creates a partially evacuated plasma channel with a density minimum on axis. Such a channel has properties of an optical waveguide. This technique allows creation of plasma channels in low atomic number gases, such as hydrogen, which is of importance for guiding of highly intense laser pulses. The channel density was diagnosed with time resolved longitudinal interferometry. From these measurements the plasma temperature was inferred. The guiding properties of the channels were tested by injecting a > 5 {times} 10{sup 17} W/cm{sup 2}, 75 fs laser pulse.

  19. Modeling-based design and assessment of an acousto-optic guided high-intensity focused ultrasound system

    NASA Astrophysics Data System (ADS)

    Adams, Matthew T.; Cleveland, Robin O.; Roy, Ronald A.

    2017-01-01

    Real-time acousto-optic (AO) sensing has been shown to noninvasively detect changes in ex vivo tissue optical properties during high-intensity focused ultrasound (HIFU) exposures. The technique is particularly appropriate for monitoring noncavitating lesions that offer minimal acoustic contrast. A numerical model is presented for an AO-guided HIFU system with an illumination wavelength of 1064 nm and an acoustic frequency of 1.1 MHz. To confirm the model's accuracy, it is compared to previously published experimental data gathered during AO-guided HIFU in chicken breast. The model is used to determine an optimal design for an AO-guided HIFU system, to assess its robustness, and to predict its efficacy for the ablation of large volumes. It was found that a through transmission geometry results in the best performance, and an optical wavelength around 800 nm was optimal as it provided sufficient contrast with low absorption. Finally, it was shown that the strategy employed while treating large volumes with AO guidance has a major impact on the resulting necrotic volume and symmetry.

  20. Triggering and guiding high-voltage large-scale leader discharges with sub-joule ultrashort laser pulses

    NASA Astrophysics Data System (ADS)

    Pépin, Henri

    2000-10-01

    Lasers are promising tools for triggering and guiding lightning strikes. In this context, Hydro-Québec and INRS have undertaken a feasibility study of laser triggered lightning using ultrashort laser pulses in Megavolt electrode configurations (3-7 m rod-plane air gap). A sub-Joule sub-picosecond laser beam focussed close to the rod electrode has been found to be able to trigger and guide leader discharges over distances of 3-4 m, lower the leader inception voltage by 50%, increase the leader velocity by a factor of 10. It has also been found that highly ionized filaments generated by the propagation of an ultrashort pulse in air have the ability to guide electric discharges over large distances. The basic physical processes involved in the formation of streamers and in the leader propagation have been observed using time-resolved optical diagnostics, as well as electric field and current probes. The discharge process triggered by the laser pulse has been successfully described using a leader propagation model in presence of the laser plasma channel. Numerical simulations have successfully reproduced the experimental results obtained with and without the ultrashort laser pulse.

  1. High Power, Computer-Controlled, LED-Based Light Sources for Fluorescence Imaging and Image-Guided Surgery

    PubMed Central

    Gioux, Sylvain; Kianzad, Vida; Ciocan, Razvan; Gupta, Sunil; Oketokoun, Rafiou; Frangioni, John V.

    2009-01-01

    Optical imaging requires appropriate light sources. For image-guided surgery, and in particular fluorescence-guided surgery, high fluence rate, long working distance, computer control, and precise control of wavelength are required. In this study, we describe the development of light emitting diode (LED)-based light sources that meet these criteria. These light sources are enabled by a compact LED module that includes an integrated linear driver, heat-dissipation technology, and real-time temperature monitoring. Measuring only 27 mm W by 29 mm H, and weighing only 14.7 g, each module provides up to 6500 lx of white (400-650 nm) light and up to 157 mW of filtered fluorescence excitation light, while maintaining an operating temperature ≤ 50°C. We also describe software that can be used to design multi-module light housings, and an embedded processor that permits computer control and temperature monitoring. With these tools, we constructed a 76-module, sterilizable, 3-wavelength surgical light source capable of providing up to 40,000 lx of white light, 4.0 mW/cm2 of 670 nm near-infrared (NIR) fluorescence excitation light, and 14.0 mW/cm2 of 760 nm NIR fluorescence excitation light over a 15-cm diameter field-of-view. Using this light source, we demonstrate NIR fluorescence-guided surgery in a large animal model. PMID:19723473

  2. Outcomes After Stereotactic Body Radiotherapy or Radiofrequency Ablation for Hepatocellular Carcinoma

    PubMed Central

    Wahl, Daniel R.; Stenmark, Matthew H.; Tao, Yebin; Pollom, Erqi L.; Caoili, Elaine M.; Lawrence, Theodore S.; Schipper, Matthew J.

    2016-01-01

    Purpose Data guiding selection of nonsurgical treatment of hepatocellular carcinoma (HCC) are lacking. We therefore compared outcomes between stereotactic body radiotherapy (SBRT) and radiofrequency ablation (RFA) for HCC. Patients and Methods From 2004 to 2012, 224 patients with inoperable, nonmetastatic HCC underwent RFA (n = 161) to 249 tumors or image-guided SBRT (n = 63) to 83 tumors. We applied inverse probability of treatment weighting to adjust for imbalances in treatment assignment. Freedom from local progression (FFLP) and toxicity were retrospectively analyzed. Results RFA and SBRT groups were similar with respect to number of lesions treated per patient, type of underlying liver disease, and tumor size (median, 1.8 v 2.2 cm in maximum diameter; P = .14). However, the SBRT group had lower pretreatment Child-Pugh scores (P = .003), higher pretreatment alpha-fetoprotein levels (P = .04), and a greater number of prior liver-directed treatments (P < .001). One- and 2-year FFLP for tumors treated with RFA were 83.6% and 80.2% v 97.4% and 83.8% for SBRT. Increasing tumor size predicted for FFLP in patients treated with RFA (hazard ratio [HR], 1.54 per cm; P = .006), but not with SBRT (HR, 1.21 per cm; P = .617). For tumors ≥ 2 cm, there was decreased FFLP for RFA compared with SBRT (HR, 3.35; P = .025). Acute grade 3+ complications occurred after 11% and 5% of RFA and SBRT treatments, respectively (P = .31). Overall survival 1 and 2 years after treatment was 70% and 53% after RFA and 74% and 46% after SBRT. Conclusion Both RFA and SBRT are effective local treatment options for inoperable HCC. Although these data are retrospective, SBRT appears to be a reasonable first-line treatment of inoperable, larger HCC. PMID:26628466

  3. Sampling strategies for subsampled segmented EPI PRF thermometry in MR guided high intensity focused ultrasound

    SciTech Connect

    Odéen, Henrik Diakite, Mahamadou; Todd, Nick; Minalga, Emilee; Payne, Allison; Parker, Dennis L.

    2014-09-15

    Purpose: To investigate k-space subsampling strategies to achieve fast, large field-of-view (FOV) temperature monitoring using segmented echo planar imaging (EPI) proton resonance frequency shift thermometry for MR guided high intensity focused ultrasound (MRgHIFU) applications. Methods: Five different k-space sampling approaches were investigated, varying sample spacing (equally vs nonequally spaced within the echo train), sampling density (variable sampling density in zero, one, and two dimensions), and utilizing sequential or centric sampling. Three of the schemes utilized sequential sampling with the sampling density varied in zero, one, and two dimensions, to investigate sampling the k-space center more frequently. Two of the schemes utilized centric sampling to acquire the k-space center with a longer echo time for improved phase measurements, and vary the sampling density in zero and two dimensions, respectively. Phantom experiments and a theoretical point spread function analysis were performed to investigate their performance. Variable density sampling in zero and two dimensions was also implemented in a non-EPI GRE pulse sequence for comparison. All subsampled data were reconstructed with a previously described temporally constrained reconstruction (TCR) algorithm. Results: The accuracy of each sampling strategy in measuring the temperature rise in the HIFU focal spot was measured in terms of the root-mean-square-error (RMSE) compared to fully sampled “truth.” For the schemes utilizing sequential sampling, the accuracy was found to improve with the dimensionality of the variable density sampling, giving values of 0.65 °C, 0.49 °C, and 0.35 °C for density variation in zero, one, and two dimensions, respectively. The schemes utilizing centric sampling were found to underestimate the temperature rise, with RMSE values of 1.05 °C and 1.31 °C, for variable density sampling in zero and two dimensions, respectively. Similar subsampling schemes

  4. Novel approach to lung stereotactic body radiation therapy plan evaluation and delivery

    NASA Astrophysics Data System (ADS)

    Jurkovic, Ines-Ana

    Stereotactic body radiation therapy is currently being used as an efficient treatment for Stage I/II medically inoperable and surgically unrespectable non small cell and metastatic lung cancer. Hypofractional dose and dose escalation used in stereotactic body radiation therapy have the potential of increasing the likelihood of the tumor control and the long term progression free survival. Currently available commercial treatment planning systems are capable of calculating accurate dose distributions for static case, where the tumor and surrounding healthy tissues are not moving during the dose delivery. However, respiratory induced organ motion can result in significant movement of the lesion leading to the discrepancies between the dose delivered and the dose planned. The precision and conformity of the stereotactic body radiation therapy makes it very susceptible to motion, i.e. patient respiration can lead to significant dose delivery errors. Conventional stereotactic body radiation therapy treatment plans use free breathing three-dimensional computed tomography images where margins are added to delineated gross tumor volume to create planning tumor volume and avoid geometrical misses of the target. The specific hypothesis of the study is that the true four-dimensional delivery of the four-dimensional plans will allow for more accurate radiation therapy treatment and critical organ sparing along with radiobiological evaluation of the dose distributions. The specific aims are designed to provide in depth understanding of the radiation therapy treatments and influence of the four-dimensional planning and delivery, heterogeneity corrections and various radiobiological factors on the outcome. The primary focus of the Specific Aim 1 was the evaluation of the tumor volume based on the four-dimensional computed tomography scan data through its motion, volume and computed tomography number. The results indicated that tumor motion parameters will exceed the typical

  5. High-Dose, Single-Fraction Image-Guided Intensity-Modulated Radiotherapy for Metastatic Spinal Lesions

    SciTech Connect

    Yamada, Yoshiya Bilsky, Mark H.; Lovelock, D. Michael; Venkatraman, Ennapadam S.; Toner, Sean; Johnson, Jared; Zatcky, Joan N.P.; Zelefsky, Michael J.; Fuks, Zvi

    2008-06-01

    Purpose: To report tumor control and toxicity for patients treated with image-guided intensity-modulated radiotherapy (RT) for spinal metastases with high-dose single-fraction RT. Methods and Materials: A total of 103 consecutive spinal metastases in 93 patients without high-grade epidural spinal cord compression were treated with image-guided intensity-modulated RT to doses of 18-24 Gy (median, 24 Gy) in a single fraction between 2003 and 2006. The spinal cord dose was limited to a 14-Gy maximal dose. The patients were prospectively examined every 3-4 months with clinical assessment and cross-sectional imaging. Results: The overall actuarial local control rate was 90% (local failure developed in 7 patients) at a median follow-up of 15 months (range, 2-45 months). The median time to local failure was 9 months (range, 2-15 months) from the time of treatment. Of the 93 patients, 37 died. The median overall survival was 15 months. In all cases, death was from progression of systemic disease and not local failure. The histologic type was not a statistically significant predictor of survival or local control. The radiation dose was a significant predictor of local control (p = 0.03). All patients without local failure also reported durable symptom palliation. Acute toxicity was mild (Grade 1-2). No case of radiculopathy or myelopathy has developed. Conclusion: High-dose, single-fraction image-guided intensity-modulated RT is a noninvasive intervention that appears to be safe and very effective palliation for patients with spinal metastases, with minimal negative effects on quality of life and a high probability of tumor control.

  6. Stereotactic radiosurgery planning based on time-resolved CTA for arteriovenous malformation: a case report and review of the literature.

    PubMed

    Turner, Ryan C; Lucke-Wold, Brandon P; Josiah, Darnell; Gonzalez, Javier; Schmidt, Matthew; Tarabishy, Abdul Rahman; Bhatia, Sanjay

    2016-08-01

    Stereotactic radiosurgery has long been recognized as the optimal form of management for high-grade arteriovenous malformations not amenable to surgical resection. Radiosurgical plans have generally relied upon the integration of stereotactic magnetic resonance angiography (MRA), standard contrast-enhanced magnetic resonance imaging (MRI), or computed tomography angiography (CTA) with biplane digital subtraction angiography (DSA). Current options are disadvantageous in that catheter-based biplane DSA is an invasive test associated with a small risk of complications and perhaps more importantly, the two-dimensional nature of DSA is an inherent limitation in creating radiosurgical contours. The necessity of multiple scans to create DSA contours for radiosurgical planning puts patients at increased risk. Furthermore, the inability to import two-dimensional plans into some radiosurgery programs, such as Cyberknife TPS, limits treatment options for patients. Defining the nidus itself is sometimes difficult in any of the traditional modalities as all draining veins and feeding arteries are included in the images. This sometimes necessitates targeting a larger volume, than strictly necessary, with stereotactic radiosurgery for treatment of the AVM. In this case report, we show the ability to use a less-invasive and three-dimensional form of angiography based on time-lapsed CTA (4D-CTA) rather than traditional DSA for radiosurgical planning. 4D-CTA may allow generation of a series of images, which can show the flow of contrast through the AVM. A review of these series may allow the surgeon to pick and use a volume set that best outlines the nidus with least interference from feeding arteries or draining veins. In addition, 4D-CTA scans can be uploaded into radiosurgery programs and allow three-dimensional targeting. This is the first reported case demonstrating the use of a 4D CTA and an MRI to delineate the AVM nidus for Gamma Knife radiosurgery, with complete

  7. SU-E-T-282: Dose Measurements with An End-To-End Audit Phantom for Stereotactic Radiotherapy

    SciTech Connect

    Jones, R; Artschan, R; Thwaites, D; Lehmann, J

    2015-06-15

    Purpose: Report on dose measurements as part of an end-to-end test for stereotactic radiotherapy, using a new audit tool, which allows audits to be performed efficiently either by an onsite team or as a postal audit. Methods: Film measurements have been performed with a new Stereotactic Cube Phantom. The phantom has been designed to perform Winston Lutz type position verification measurements and dose measurements in one setup. It comprises a plastic cube with a high density ball in its centre (used for MV imaging with film or EPID) and low density markers in the periphery (used for Cone Beam Computed Tomography, CBCT imaging). It also features strategically placed gold markers near the posterior and right surfaces, which can be used to calculate phantom rotations on MV images. Slit-like openings allow insertion of film or other detectors.The phantom was scanned and small field treatment plans were created. The fields do not traverse any inhomogeneities of the phantom on their paths to the measurement location. The phantom was setup at the delivery system using CBCT imaging. The calculated treatment fields were delivered, each with a piece of radiochromic film (EBT3) placed in the anterior film holder of the phantom. MU had been selected in planning to achieve similar exposures on all films. Calibration films were exposed in solid water for dose levels around the expected doses. Films were scanned and analysed following established procedures. Results: Setup of the cube showed excellent suitability for CBCT 3D alignment. MV imaging with EPID allowed for clear identification of all markers. Film based dose measurements showed good agreement for MLC created fields down to 0.5 mm × 0.5 mm. Conclusion: An end-to-end audit phantom for stereotactic radiotherapy has been developed and tested.

  8. 75 FR 76019 - Compliance Policy Guide Sec. 390.500 Definition of “High-Voltage Vacuum Switch”-21 CFR 1002.61(a...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-07

    ...-Voltage Vacuum Switch''--21 CFR 1002.61(a)(3) and (b)(2); Withdrawal of Guidance AGENCY: Food and Drug... the withdrawal of Compliance Policy Guide Sec. 390.500 Definition of ``High-Voltage Vacuum...

  9. Verification of dose volume histograms in stereotactic radiosurgery and radiotherapy using polymer gel and MRI

    NASA Astrophysics Data System (ADS)

    Šemnická, Jitka; Novotný, Josef, Jr.; Spěváček, Václav; Garčic, Jirí; Steiner, Martin; Judas, Libor

    2006-12-01

    In this work we focus on dose volume histograms (DVHs) measurement in stereotactic radiosurgery (SR) performed with the Leksell gamma knife (ELEKTA Instrument AB, Stockholm, Sweden) and stereotactic radiotherapy (SRT) performed with linear accelerator 6 MV Varian Clinac 2100 C/D (Varian Medical Systems, Palo Alto, USA) in conjunction with BrainLAB stereotactic system (BrainLAB, Germany) using modified BANG gel and magnetic resonance imaging (MRI). The aim of the experiments was to investigate a method for acquiring entire dose volume information from irradiated gel dosimeter and calculate DVHs.

  10. Stereotactic radiotherapy in neovascular age-related macular degeneration

    PubMed Central

    Ranjbar, Mahdy; Kurz, Maximilian; Holzhey, Annekatrin; Melchert, Corinna; Rades, Dirk; Grisanti, Salvatore

    2016-01-01

    Abstract Stereotactic radiotherapy (SRT) is a new approach to treat neovascular age-related macular degeneration (nAMD). The INTREPID trial suggested that SRT could reduce the frequency of regular intravitreal injections (IVIs) with antivascular endothelial growth factor drugs, which are necessary to control disease activity. However, the efficacy of SRT in nAMD and resulting morphological changes have not been validated under real-life circumstances, an issue, which we would like to address in this retrospective analysis. Patients who met the INTREPID criteria for best responders were eligible for SRT. A total of 32 eyes of 32 patients were treated. Thereafter, patients were examined monthly for 12 months and received pro re nata IVI of aflibercept or ranibizumab. Outcome measures were: mean number of injections, best-corrected visual acuity, and morphological changes of the outer retina-choroid complex as well as patient safety. Mean number of IVI decreased by almost 50% during the 12 months after SRT compared to the year before, whereas visual acuity increased by one line (logMAR). Morphological evaluation showed that most changes affect outer retinal layers. Stereotactic radiotherapy significantly reduced IVI retreatment in nAMD patients under real-life circumstances. Therefore, SRT might be the first step to stop visual loss as a result of IVI undertreatment, which is a major risk. PMID:28033280

  11. Effectiveness of fractionated stereotactic radiotherapy for uveal melanoma

    SciTech Connect

    Muller, Karin; Nowak, Peter; Pan, Connie de; Marijnissen, Johannes P.; Paridaens, Dion A.; Levendag, Peter; Luyten, Gre P.M. . E-mail: g.p.m.luyten@erasmusmc.nl

    2005-09-01

    Purpose: To study the effectiveness and acute side effects of fractionated stereotactic radiation therapy (fSRT) for uveal melanoma. Methods and Materials: Between 1999 and 2003, 38 patients (21 male, 17 female) were included in a prospective, nonrandomized clinical trial (mean follow-up of 25 months). A total dose of 50 Gy was given in 5 consecutive days. A blinking light and a camera (to monitor the position of the diseased eye) were fixed to a noninvasive relocatable stereotactic frame. Primary end points were local control, best corrected visual acuity, and toxicity at 3, 6, 12, and 24 months, respectively. Results: After 3 months (38 patients), the local control was 100%; after 12 months (32 patients) and 24 months (15 patients), no recurrences were seen. The best corrected visual acuity declined from a mean of 0.21 at diagnosis to 0.06 2 years after therapy. The acute side effects after 3 months were as follows: conjunctival symptoms (10), loss of lashes or hair (6), visual symptoms (5), fatigue (5), dry eye (1), cataract (1), and pain (4). One eye was enucleated at 2 months after fSRT. Conclusions: Preliminary results demonstrate that fSRT is an effective and safe treatment modality for uveal melanoma with an excellent local control and mild acute side effects. The follow-up should be prolonged to study both long-term local control and late toxicity.

  12. Current status of cranial stereotactic radiosurgery in the UK

    PubMed Central

    Kirkby, Karen J; Nisbet, Andrew; Clark, Catharine H

    2016-01-01

    Objective: To investigate and benchmark the current clinical and dosimetric practices in stereotactic radiosurgery (SRS) in the UK. Methods: A detailed questionnaire was sent to 70 radiotherapy centres in the UK. 97% (68/70) of centres replied between June and December 2014. Results: 21 centres stated that they are practising SRS, and a further 12 centres plan to start SRS by the end of 2016. The most commonly treated indications are brain metastases and acoustic neuromas. A large range of prescription isodoses that range from 45% to 100% between different radiotherapy centres was seen. Ionization chambers and solid-water phantoms are used by the majority of centres for patient-specific quality assurance, and thermoplastic masks for patient immobilization are more commonly used than fixed stereotactic frames. The majority of centres perform orthogonal kilovoltage X-rays for localization before and during delivery. The acceptable setup accuracy reported ranges from 0.1 to 2 mm with a mean of 0.8 mm. Conclusion: SRS has been increasing in use in the UK and will continue to increase in the next 2 years. There is no current consensus between SRS centres as a whole, or even between SRS centres with the same equipment, on the practices followed. This indicates the need for benchmarking and standardization in SRS practices within the UK. Advances in knowledge: This article outlines the current practices in SRS and provides a benchmark for reference and comparison with future research in this technique. PMID:26689091

  13. Temporal compartmental dosing effects for robotic prostate stereotactic body radiotherapy

    NASA Astrophysics Data System (ADS)

    Shiao, Stephen L.; Sahgal, Arjun; Hu, Weigang; Jabbari, Siavash; Chuang, Cynthia; Descovich, Martina; Hsu, I.-Chow; Gottschalk, Alexander R.; Roach, Mack, III; Ma, Lijun

    2011-12-01

    The rate of dose accumulation within a given area of a target volume tends to vary significantly for non-isocentric delivery systems such as Cyberknife stereotactic body radiotherapy. In this study, we investigated whether intra-target temporal dose distributions produce significant variations in the biological equivalent dose. For the study, time courses of ten patients were reconstructed and calculation of a biologically equivalent uniform dose (EUD) was performed using a formula derived from the linear quadratic model (α/β = 3 for prostate cancer cells). The calculated EUD values obtained for the actual patient treatments were then compared with theoretical EUD values for delivering the same physical dose distribution except that the whole target being irradiated continuously (e.g. large-field ‘dose-bathing’ type of delivery). For all the case, the EUDs for the actual treatment delivery were found to correlate strongly with the EUDs for the large-field delivery: a linear correlation coefficient of R2 = 0.98 was obtained and the average EUD for the actual Cyberknife delivery was somewhat higher (5.0 ± 4.7%) than that for the large-field delivery. However, no statistical significance was detected between the two types of delivery (p = 0.21). We concluded that non-isocentric small-field Cyberknife delivery produced consistent biological dosing that tracked well with the constant-dose-rate, large-field-type delivery for prostate stereotactic body radiotherapy.

  14. High contrast optical imaging methods for image guided laser ablation of dental caries lesions

    NASA Astrophysics Data System (ADS)

    LaMantia, Nicole R.; Tom, Henry; Chan, Kenneth H.; Simon, Jacob C.; Darling, Cynthia L.; Fried, Daniel

    2014-02-01

    Laser based methods are well suited for automation and can be used to selectively remove dental caries to minimize the loss of healthy tissues and render the underlying enamel more resistant to acid dissolution. The purpose of this study was to determine which imaging methods are best suited for image-guided ablation of natural non-cavitated carious lesions on occlusal surfaces. Multiple caries imaging methods were compared including near-IR and visible reflectance and quantitative light fluorescence (QLF). In order for image-guided laser ablation to be feasible, chemical and physical modification of tooth surfaces due to laser irradiation cannot greatly reduce the contrast between sound and demineralized dental hard tissues. Sound and demineralized surfaces of 48 extracted human molar teeth with non-cavitated lesions were examined. Images were acquired before and after laser irradiation using visible and near-IR reflectance and QLF at several wavelengths. Polarization sensitive-optical coherence tomography was used to confirm that lesions were present. The highest contrast was attained at 1460-nm and 1500-1700-nm, wavelengths coincident with higher water absorption. The reflectance did not decrease significantly after laser irradiation for those wavelengths.

  15. TU-G-BRA-01: Assessing Radiation-Induced Reductions in Regional Lung Perfusion Following Stereotactic Radiotherapy for Lung Cancer

    SciTech Connect

    McGurk, R; Green, R; Lawrence, M; Schreiber, E; Das, S; Zagar, T; Marks, L; Sheikh, A; McCartney, W; Rivera, P

    2015-06-15

    Purpose: The dose-dependent nature of radiation therapy (RT)-induced lung injury following hypo-fractionated stereotactic RT is unclear. We herein report preliminary results of a prospective study assessing the magnitude of RT-induced reductions in regional lung perfusion following hypo-fractionated stereotactic RT. Methods: Four patients undergoing hypo-fractionated stereotactic lung RT (SBRT: 12 Gy x 4 fractions or 10 Gy x 5 fractions) had a pre-treatment SPECT (single-photon emission computed tomography) perfusion scan providing a 3D map of regional lung perfusion. Scans were repeated 3–6 months post-treatment. Pre- and post SPECT scans were registered to the planning CT scan (and hence the 3D dose data). Changes in regional perfusion (counts per cc on the pre-post scans) were computed in regions of the lung exposed to different doses of radiation (in 5 Gy intervals), thus defining a dose-response function. SPECT scans were internally normalized to the regions receiving <5 Gy. Results: At 3 months post-RT, the changes in perfusion are highly variable. At 6 months, there is a consistent dose-dependent reduction in regional perfusion. The average percent decline in regional perfusion was 10% at 15–20 Gy, 20% at 20–25 Gy, and 30% at 25–30 Gy representing a relatively linear dose response with an approximate 2% reduction per Gray for doses in excess of 10 Gy. There was a subtle increase in perfusion in the lung receiving <10 Gy. Conclusion: Hypo-fractionated stereotactic RT appears to cause a dose-dependent reduction in regional lung perfusion. There appears to be a threshold effect with no apparent perfusion loss at doses <10 Gy, though this might be in part due to the normalization technique used. Additional data is needed from a larger number of patients to better assess this issue. This sort of data can be used to assist optimizing RT treatment plans that minimize the risk of lung injury. Partly supported by the NIH (CA69579) and the Lance Armstrong

  16. Behaviour of a two rows of holes coolant film along the pressure side of a high pressure nozzle guide vane

    NASA Astrophysics Data System (ADS)

    Arts, T.; Bourguignon, A. E.

    1989-06-01

    The purpose of this paper is to quantify the influence on external convective heat transfer of a coolant film whose position varies along the pressure side of a high pressure turbine nozzle guide vane. The measurements were performed in the short duration Isentropic Light Piston Compression Tube facility of the von Karman Institute. The effects of external and internal flow are considered in terms of Mach number, Reynolds number, freestream turbulence intensity, blowing rate and coolant to freestream temperature ratio. The way to evaluate these results in terms of film cooling efficiency and heat transfer coefficient is finally discussed.

  17. A Droplet-Based High-Throughput SERS Platform on a Droplet-Guiding-Track-Engraved Superhydrophobic Substrate.

    PubMed

    Shin, Sera; Lee, Jaehong; Lee, Sanggeun; Kim, Hyunchul; Seo, Jungmok; Kim, Dayeong; Hong, Juree; Lee, Soonil; Lee, Taeyoon

    2017-02-01

    A novel droplet-based surface-enhanced Raman scattering (SERS) sensor for high-throughput real-time SERS monitoring is presented. The developed sensors are based on a droplet-guiding-track-engraved superhydrophobic substrate covered with hierarchical SERS-active Ag dendrites. The droplet-guiding track with a droplet stopper is designed to manipulate the movement of a droplet on the superhydrophobic substrate. The superhydrophobic Ag dendritic substrates are fabricated through a galvanic displacement reaction and subsequent self-assembled monolayer coating. The optimal galvanic reaction time to fabricate a SERS-active Ag dendritic substrate for effective SERS detection is determined, with the optimized substrate exhibiting an enhancement factor of 6.3 × 10(5) . The height of the droplet stopper is optimized to control droplet motion, including moving and stopping. Based on the manipulation of individual droplets, the optimized droplet-based real-time SERS sensor shows high resistance to surface contaminants, and droplets containing rhodamine 6G, Nile blue A, and malachite green are successively controlled and detected without spectral interference. This noble droplet-based SERS sensor reduces sample preparation time to a few seconds and increased detection rate to 0.5 µL s(-1) through the simple operation mechanism of the sensor. Accordingly, our sensor enables high-throughput real-time molecular detection of various target analytes for real-time chemical and biological monitoring.

  18. Computed Tomography-Guided High-Dose-Rate Brachytherapy in Hepatocellular Carcinoma: Safety, Efficacy, and Effect on Survival

    SciTech Connect

    Mohnike, Konrad; Wieners, Gero; Schwartz, Franziska; Seidensticker, Max; Pech, Maciej; Ruehl, Ricarda; Wust, Peter; Lopez-Haenninen, Enrique; Gademann, Guenther; Peters, Nils; Berg, Thomas; Malfertheiner, Peter; Ricke, Jens

    2010-09-01

    Purpose: To determine the saftety and efficacy of computed tomography (CT)-guided brachytherapy in hepatocellular carcinoma (HCC). Methods and Materials: A total of 83 patients were recruited, presenting with 140 HCC- lesions. Treatment was performed by CT-guided high-dose-rate (HDR) brachytherapy with an iridium-192 source. The primary endpoint was time to progression; secondary endpoints included local tumor control and overall survival (OS). A matched-pair analysis with patients not receiving brachytherapy was performed. Match criteria included the Cancer of the Liver Italian Program (CLIP) score, alpha-fetoprotein, presence, and extent of multifocal disease. For statistical analysis, Kaplan-Meier and Cox regression were performed. Results: Mean and median cumulative TTP for all patients (n = 75) were 17.7 and 10.4 months. Five local recurrences were observed. The OS after inclusion reached median times of 19.4 months (all patients), 46.3 months (CLIP score, 0), 20.6 months (CLIP score, 1) 12.7 months, (CLIP score, 2), and 8.3 months (CLIP score, {>=}3). The 1- and 3-year OS were 94% and 65% (CLIP score, 0), 69% and 12% (CLIP score, 1), and 48% and 19% (CLIP score, 2), respectively. Nine complications requiring intervention were encountered in 124 interventions. Matched-pair analysis revealed a significantly longer OS for patients undergoing CT-guided brachytherapy. Conclusion: Based on our results the study treatment could be safely performed. The study treatment had a beneficial effect on OS in patients with advanced HCC, with respect to (and depending on) the CLIP score and compared with OS in a historical control group. A high rate of local control was also observed, regardless of applied dose in a range of 15 to 25 Gy.

  19. Image-guided high-dose-rate brachytherapy of head and neck – a case series study

    PubMed Central

    Kieszko, Dariusz; Brzozowska, Anna; Kordzin’ska-Cisek, Izabela; Mazurkiewicz, Maria

    2016-01-01

    Purpose The aim of the study was the evaluation of image guided transdermal application of interstitial brachytherapy in patients undergoing repeated irradiation for relapsed local tumor of the head and neck area. Material and methods The article describes transdermal application of interstitial high-dose-rate (HDR) brachytherapy in 4 patients treated due to relapsed local tumor in soft palate, submandibular area, laryngopharynx, as well as pterygoid muscles and maxillary sinus. The application was conducted under continuous computed tomography (CT)-image guidance (CT fluoroscopy). Patients qualified for this type of treatment had neoplastic lesions located deep under the skin surface. Because of their location, access to the lesions was limited, and the risk of damaging the adjacent tissues such as vessels and nerves was high. The following parameters have been evaluated: clinical response using RECIST 1.1, incidence of perisurgical complications using CTCAE 4.0 and the frequency of occurrence of radiotherapy related early morbidity using RTOG. Results Various radiation schemes were used, from 3 to 5 fractions of 3.5-5 Gy. The median total dose (D90) was 20.6 Gy. Biologic effective dose (BED) and equivalent 2 Gy (DEQ2) median doses were 30.4 Gy and 25.3 Gy, respectively. In the follow-up period of 3-7 months (the median value of 3.5 months), 2 patients had partial regression of the disease and in 2 others the neoplastic process was stabilized. None of the patients had serious complications of treatment (of 3rd degree or higher). Conclusions Computed tomography-image guided brachytherapy proved to be a safe method of treatment in patients with local relapse in sites, in which traditional visually controlled application was impossible due to risk of complications. Despite short observation period and small study group, it seems justified to conduct prospective studies for the evaluation of efficacy and safety of CT-image guided brachytherapy. PMID:28115962

  20. Comprehensive approach to image-guided surgery

    NASA Astrophysics Data System (ADS)

    Peters, Terence M.; Comeau, Roch M.; Kasrai, Reza; St. Jean, Philippe; Clonda, Diego; Sinasac, M.; Audette, Michel A.; Fenster, Aaron

    1998-06-01

    Image-guided surgery has evolved over the past 15 years from stereotactic planning, where the surgeon planned approaches to intracranial targets on the basis of 2D images presented on a simple workstation, to the use of sophisticated multi- modality 3D image integration in the operating room, with guidance being provided by mechanically, optically or electro-magnetically tracked probes or microscopes. In addition, sophisticated procedures such as thalamotomies and pallidotomies to relieve the symptoms of Parkinson's disease, are performed with the aid of volumetric atlases integrated with the 3D image data. Operations that are performed stereotactically, that is to say via a small burr- hole in the skull, are able to assume that the information contained in the pre-operative imaging study, accurately represents the brain morphology during the surgical procedure. On the other hand, preforming a procedure via an open craniotomy presents a problem. Not only does tissue shift when the operation begins, even the act of opening the skull can cause significant shift of the brain tissue due to the relief of intra-cranial pressure, or the effect of drugs. Means of tracking and correcting such shifts from an important part of the work in the field of image-guided surgery today. One approach has ben through the development of intra-operative MRI imaging systems. We describe an alternative approach which integrates intra-operative ultrasound with pre-operative MRI to track such changes in tissue morphology.