The potential impact of CT-MRI matching on tumor volume delineation in advanced head and neck cancer

To study the potential impact of the combined use of CT and MRI scans on the Gross Tumor Volume (GTV) estimation and interobserver variation. Four observers outlined the GTV in six patients with advanced head and neck cancer on CT, axial MRI, and coronal or sagittal MRI. The MRI scans were subsequently matched to the CT scan. The interobserver and interscan set variation were assessed in three dimensions. The mean CT derived volume was a factor of 1.3 larger than the mean axial MRI volume. The range in volumes was larger for the CT than for the axial MRI volumes in five of the six cases. The ratio of the scan set common (i.e., the volume common to all GTVs) and the scan set encompassing volume (i.e., the smallest volume encompassing all GTVs) was closer to one in MRI (0.3-0.6) than in CT (0.1-0.5). The rest volumes (i.e., the volume defined by one observer as GTV in one data set but not in the other data set) were never zero for CT vs. MRI nor for MRI vs. CT. In two cases the craniocaudal border was poorly recognized on the axial MRI but could be delineated with a good agreement between the observers in the coronal/sagittal MRI. MRI-derived GTVs are smaller and have less interobserver variation than CT-derived GTVs. CT and MRI are complementary in delineating the GTV. A coronal or sagittal MRI adds to a better GTV definition in the craniocaudal directio

The effect of magnetic dipolar interactions on the interchain spin wave dispersion in CsNiF_3

Inelastic neutron scattering measurements were performed on the ferromagnetic chain system CsNiF_3 in the collinear antiferromagnetic ordered state below T_N = 2.67K. The measured spin wave dispersion was found to be in good agreement with linear spin wave theory including dipolar interactions. The additional dipole tensor in the Hamiltonian was essential to explain some striking phenomena in the measured spin wave spectrum: a peculiar feature of the dispersion relation is a jump at the zone center, caused by strong dipolar interactions in this system. The interchain exchange coupling constant and the planar anisotropy energy were determined within the present model to be J'/k_B = -0.0247(12)K and A/k_B = 3.3(1)K. This gives a ratio J/J' \approx 500, using the previously determined intrachain coupling constant J/k_B = 11.8$. The small exchange energy J' is of the same order as the dipolar energy, which implies a strong competition between the both interactions.Comment: 18 pages, TeX type, 7 Postscript figures included. To be published in Phys. Rev.

High-precision prostate cancer irradiation by clinical application of an offline patient setup verification procedure, using portal imaging

Purpose: To investigate in three institutions, The Netherlands Cancer Institute (Antoni van Leeuwenhoek Huis [AvL]), Dr. Daniel den Hoed Cancer Center (DDHC), and Dr. Bernard Verbeeten Institute (BVI), how much the patient setup accuracy for irradiation of prostate cancer can be improved by an offline setup verification and correction procedure, using portal imaging. Methods and Materials: The verification procedure consisted of two stages. During the first stage, setup deviations were measured during a number (N(max)) of consecutive initial treatment sessions. The length of the average three dimensional (3D) setup deviation vector was compared with an action level for corrections, which shrunk with the number of setup measurements. After a correction was applied, N(max) measurements had to be performed again. Each institution chose different values for the initial action level (6, 9, and 10 mm) and N(max) (2 and 4). The choice of these parameters was based on a simulation of the procedure, using as input preestimated values of random and systematic deviations in each institution. During the second stage of the procedure, with weekly setup measurements, the AvL used a different criterion ('outlier detection') for corrective actions than the DDHC and the BVI ('sliding average'). After each correction the first stage of the procedure was restarted. The procedure was tested for 151 patients (62 in AvL, 47 in DDHC, and 42 in BVI) treated for prostate carcinoma. Treatment techniques and portal image acquisition and analysis were different in each institution. Results: The actual distributions of random and systematic deviations without corrections were estimated by eliminating the effect of the corrections. The percentage of mean (systematic) 3D deviations larger than 5 mm was 26% for the AvL and the DDHC, and 36% for the BVI. The setup accuracy after application of the procedure was considerably improved (percentage of mean 3D deviations larger than 5 mm was 1.6% in the AvL and 0% in the DDHC and BVI), in agreement with the results of the simulation. The number of corrections (about 0.7 on the average per patient) was not larger than predicted. Conclusion: The verification procedure appeared to be feasible in the three institutions and enabled a significant reduction of mean 3D setup deviations. The computer simulation of the procedure proved to be a useful tool, because it enabled an accurate prediction of the setup accuracy and the required number of corrections

Nonlinear excitations in CsNiF3 in magnetic fields perpendicular to the easy plane

Experimental and numerical studies of the magnetic field dependence of the specific heat and magnetization of single crystals of CsNiF3 have been performed at 2.4 K, 2.9 K, and 4.2 K in magnetic fields up to 9 T oriented perpendicular to the easy plane. The experimental results confirm the presence of the theoretically predicted double peak structure in the specific heat arising from the formation of nonlinear spin modes. The demagnetizing effects are found to be negligible, and the overall agreement between the data and numerical predictions is better than reported for the case when the magnetic field was oriented in the easy plane. Demagnetizing effects might play a role in generating the difference observed between theory and experiment in previous work analyzing the excess specific heat using the sine-Gordon model.Comment: 6 pages, 5 figures, submitted to Phys. Rev.

Intensity-modulated radiation therapy (IMRT) vs. 3D conformal radiotherapy (3DCRT) in locally advanced rectal cancer (LARC): dosimetric comparison and clinical implications

<p>Abstract</p> <p>Purpose</p> <p>To compare target dose distribution, comformality, normal tissue avoidance, and irradiated body volume (IBV) in 3DCRT using classic anatomical landmarks (c3DCRT), 3DCRT fitting the PTV (f3DCRT), and intensity-modulated radiation therapy (IMRT) in patients with locally advanced rectal cancer (LARC).</p> <p>Materials and methods</p> <p>Fifteen patients with LARC underwent c3DCRT, f3DCRT, and IMRT planning. Target definition followed the recommendations of the ICRU reports No. 50 and 62. OAR (SB and bladder) constraints were D5 ≤ 50 Gy and Dmax < 55 Gy. PTV dose prescription was defined as PTV95 ≥ 45 Gy and PTVmin ≥ 35 Gy. Target coverage was evaluated with the D95, Dmin, and Dmax. Target dose distribution and comformality was evaluated with the homogeneity indices (HI) and Conformity Index (CI). Normal tissue avoidance of OAR was evaluated with the D5 and V40. IBV at 5 Gy (V5), 10 Gy (V10), and 20 Gy (V20) were calculated.</p> <p>Results</p> <p>The mean GTV95, CTV95, and PTV95 doses were significantly lower for IMRT plans. Target dose distribution was more inhomogeneous after IMRT planning and 3DCRTplans had significantly lower CI. The V40 and D5 values for OAR were significantly reduced in the IMRT plans .V5 was greater for IMRT than for f3DCRT planning (p < 0.05) and V20 was smaller for IMRT plans(p < 0.05).</p> <p>Conclusions</p> <p>IMRT planning improves target conformity and decreases irradiation of the OAR at the expense of increased target heterogeneity. IMRT planning increases the IBV at 5 Gy or less but decreases the IBV at 20 Gy or more.</p

Radiation Dose–Volume Effects in the Lung

The three dimensional dose/volume/outcome data for lung are reviewed in detail. The rate of symptomatic pneumonitis is related to many dosimetric parameters, and there are no evident threshold “tolerance dose/volume” levels. There are strong volume and fractionation effects

Does Intensity Modulated Radiation Therapy (IMRT) prevent additional toxicity of treating the pelvic lymph nodes compared to treatment of the prostate only?

<p>Abstract</p> <p>Background</p> <p>To evaluate the risk of rectal, bladder and small bowel toxicity in intensity modulated radiation therapy (IMRT) of the prostate only compared to additional irradiation of the pelvic lymphatic region.</p> <p>Methods</p> <p>For ten patients with localized prostate cancer, IMRT plans with a simultaneous integrated boost (SIB) were generated for treatment of the prostate only (plan-PO) and for additional treatment of the pelvic lymph nodes (plan-WP). In plan-PO, doses of 60 Gy and 74 Gy (33 fractions) were prescribed to the seminal vesicles and to the prostate, respectively. Three plans-WP were generated with prescription doses of 46 Gy, 50.4 Gy and 54 Gy to the pelvic target volume; doses to the prostate and seminal vesicles were identical to plan-PO. The risk of rectal, bladder and small bowel toxicity was estimated based on NTCP calculations.</p> <p>Results</p> <p>Doses to the prostate were not significantly different between plan-PO and plan-WP and doses to the pelvic lymph nodes were as planned. Plan-WP resulted in increased doses to the rectum in the low-dose region ≤ 30 Gy, only, no difference was observed in the mid and high-dose region. Normal tissue complication probability (NTCP) for late rectal toxicity ranged between 5% and 8% with no significant difference between plan-PO and plan-WP. NTCP for late bladder toxicity was less than 1% for both plan-PO and plan-WP. The risk of small bowel toxicity was moderately increased for plan-WP.</p> <p>Discussion</p> <p>This retrospective planning study predicted similar risks of rectal, bladder and small bowel toxicity for IMRT treatment of the prostate only and for additional treatment of the pelvic lymph nodes.</p

Quantification de la fatigue neuromusculaire : production et maintien de la force maximale

The quantification of neuromuscular fatigability is of primary interest, whether to better evaluate the impact of particular conditioning on neuromuscular function, or in the context of pathologies leading to increased neuromuscular fatigability. This PhD project aims to investigate the relevance of quantifying neuromuscular fatigability through indexes from a maximal voluntary contraction sustained for 1 minute, compared to those obtained during a brief maximal voluntary contraction (i.e. few seconds long). The first study aims to determine the complementarity of the information provided by both maximal torque production and sustainability in quantifying neuromuscular fatigability induced by submaximal exercises. The second study allows us to further explore, through a sustained maximal voluntary contraction, the neuromuscular alterations induced by fatiguing contractions performed until exhaustion. Finally, the third study allowed us to investigate the influence of the mean torque produced during exercise on neuromuscular fatigability. These studies underline the importance of using a sustained maximal voluntary contraction to deepen knowledge of neuromuscular fatigability by providing a simultaneous evaluation of the maximal torque production and sustainability capacities.La quantification de la fatigue neuromusculaire revêt un intérêt primordial, que ce soit pour mieux évaluer l'impact d'un conditionnement particulier sur la fonction neuromusculaire, ou encore dans le cadre de pathologies entraînant une fatigue neuromusculaire accrue. L'objectif de ce projet de thèse est d’investiguer la pertinence de la quantification de la fatigue neuromusculaire au travers d'indices obtenus lors d'une contraction maximale volontaire d’une durée de 1 minute comparativement à une contraction maximale volontaire brève de quelques secondes. La première étude de ce projet a pour objectif de déterminer la complémentarité des informations fournies par la capacité de production et de maintien de la force maximale, dans l’évaluation de la fatigue neuromusculaire induite par des exercices sous-maximaux. La deuxième étude a permis d’explorer, grâce à une contraction maximale volontaire maintenue, les altérations neuromusculaires induites par des contractions fatigantes réalisées jusqu'à épuisement. Enfin, la troisième étude nous a permis d’appréhender l'influence de la force moyenne, développée pendant l'exercice, sur la fatigue neuromusculaire. L'ensemble de ces études souligne l'importance d'utiliser une contraction maximale volontaire, maintenue pendant une minute, pour une quantification plus détaillé et exhaustive de la fatigue neuromusculaire. La contraction maximale prolongée a alors l’avantage de pouvoir évaluer simultanément les deux caractéristiques distinctes de la fatigue neuromusculaire : la capacité de production et de maintien de la force maximale