Med Phys
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In Gamma Knife radiosurgery, an efficient plan is one that achieves dosimetric quality while minimizing treatment time. Although minimization of treatment time to improve throughput and benefit patient comfort is a common and important goal of radiosurgery planning, to date no studies have attempted to specifically quantify efficiency. The aim of this study was to define simple index to score efficiency, and by quantifying time savings achieved by replanning those cases identified as least efficient, so demonstrate the efficacy of the index. ⋯ The PEI is a viable metric for identifying those plans that benefit from a more efficient planning strategy.
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Molecular breast imaging (MBI) is a dedicated nuclear medicine breast imaging modality that employs dual-head cadmium zinc telluride (CZT) gamma cameras to functionally detect breast cancer. MBI has been shown to detect breast cancers otherwise occult on mammography and ultrasound. Currently, a MBI-guided biopsy system does not exist to biopsy such lesions. Our objective was to consider the utility of a novel conical slant-hole (CSH) collimator for rapid (<1 min) and accurate monitoring of lesion position to serve as part of a MBI-guided biopsy system. ⋯ A Monte Carlo model was used to demonstrate the feasibility of a CSH collimator design for rapid biopsy application in molecular breast imaging. Specifically, lesion depth of a 1-cm diameter lesion positioned in the center of a typical breast can be estimated with error of less than 2 mm using circumferential count profiles of images acquired in 1 min.
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Comparative Study
Comparison of beam angle selection strategies for intracranial IMRT.
Various strategies to select beneficial beam ensembles for intensity-modulated radiation therapy (IMRT) have been suggested over the years. These beam angle selection (BAS) strategies are usually evaluated against reference configurations applying equispaced coplanar beams but they are not compared to one another. Here, the authors present a meta analysis of four BAS strategies that incorporates fluence optimization (FO) into BAS by combinatorial optimization (CO) and one BAS strategy that decouples FO from BAS, i.e., spherical cluster analysis (SCA). The underlying parameters of the BAS process are investigated and the dosimetric benefits of the BAS strategies are quantified. ⋯ Both BAS strategies incorporating FO by CO and independent BAS strategies excluding FO provide dose savings in OARs for optimized coplanar and especially noncoplanar beam ensembles; they should not be neglected in the clinic.
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Ablative hyperthermia (>55 °C) has been used as a definitive treatment for accessible solid tumors not amenable to surgery, whereas mild hyperthermia (40-45 °C) has been shown effective as an adjuvant for both radiotherapy and chemotherapy. An optimal mild hyperthermia treatment is spatially accurate, with precise and homogeneous heating limited to the target region while also limiting the likelihood of unwanted thermal or mechanical bioeffects (tissue damage, vascular shutoff). Magnetic resonance imaging-guided high-intensity focused ultrasound (MR-HIFU) can noninvasively heat solid tumors under image-guidance. In a mild hyperthermia setting, a sonication approach utilizing multiple concurrent foci may provide the benefit of reducing acoustic pressure in the focal region (leading to reduced or no mechanical effects), while providing better control over the heating. The objective of this study was to design, implement, and characterize a multifoci sonication approach in combination with a mild hyperthermia heating algorithm, and compare it to the more conventional method of electronically sweeping a single focus. ⋯ A multifoci sonication approach was combined with a mild hyperthermia heating algorithm, and implemented on a clinical MR-HIFU platform. This approach resulted in accurate and precise heating within the targeted region with significantly lower acoustic pressures and spatially more confined heating in the beam path direction compared to the single focus sonication method.The reduction in acoustic pressure and improvement in spatial control suggest that multifoci heating is a useful tool in mild hyperthermia applications for clinical oncology.
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Accurate patient registration is crucial for effective image-guidance in open cranial surgery. Typically, it is accomplished by matching skin-affixed fiducials manually identified in the operating room (OR) with their counterparts in the preoperative images, which not only consumes OR time and personnel resources but also relies on the presence (and subsequent fixation) of the fiducials during the preoperative scans (until the procedure begins). In this study, the authors present a completely automatic, volumetric image-based patient registration technique that does not rely on fiducials by registering tracked (true) 3D ultrasound (3DUS) directly with preoperative magnetic resonance (MR) images. ⋯ Because common features deep in the brain and throughout the surgical volume of interest are used, intraoperative fiducial-less patient registration is possible on-demand, which is attractive in cases where preoperative patient registration is compromised (e.g., from loss∕movement of skin-affixed fiducials) or not possible (e.g., in cases of emergency when external fiducials were not placed in time). CR registration was more robust than MI (capture range about twice as big) and appears to be more accurate, although both methods are comparable to or better than fiducial-based registration in the patient cases evaluated. The results presented here suggest that 3DUS image-based patient registration holds promise for clinical application in the future.