Accurate Delivery Research Articles

Analysis of nonlinear landscape structure components accurate construction information delivery based on Rhino+Grasshopper parametric modeling

The development of digital construction technology has made the practical construction of nonlinear forms possible. In landscape architecture projects, Nonlinear Landscape Structures (NLS) have become the mainstream in design and aesthetics. However, the complex forms of NLS components make it challenging to deliver accurate construction information using traditional design methods. The application of Rhino+Grasshopper Parametric Modeling (RGPM) technology allows the construction of nonlinear geometric forms based on mathematical logic, facilitating precise engineering construction information delivery for NLS components. Nevertheless, there are existing gaps in current research on accurate construction information delivery for NLS components based on RGPM. Firstly, current research primarily focuses on large public buildings, lacking attention to the spatial scale of landscape structures. Secondly, there is a lack of systematic integration based on technical research contents. Thirdly, there is a lack of specific technical application analysis combining actual design, leading to weaker practical guidance for industry practitioners. Therefore, this study selects the precise engineering construction information delivery of perforated panel walls in the space under the Sanya Bridge and the landscape platform of the Beijing Jinding Mountain as research cases. Through the analysis of construction information delivery content and technical challenges in these cases, the necessity of RGPM application is clarified. By analyzing the application of RGPM technology and its outcomes in these cases, concrete examples are provided for the precise construction information delivery of NLS components to fill the research gaps and provide theoretical foundations and application examples for future research.

Analysis of nonlinear landscape structure components accurate construction information delivery based on Rhino+Grasshopper parametric modeling

The development of digital construction technology has made the practical construction of nonlinear forms possible. In landscape architecture projects, Nonlinear Landscape Structures (NLS) have become the mainstream in design and aesthetics. However, the complex forms of NLS components make it challenging to deliver accurate construction information using traditional design methods. The application of Rhino+Grasshopper Parametric Modeling (RGPM) technology allows the construction of nonlinear geometric forms based on mathematical logic, facilitating precise engineering construction information delivery for NLS components. Nevertheless, there are existing gaps in current research on accurate construction information delivery for NLS components based on RGPM. Firstly, current research primarily focuses on large public buildings, lacking attention to the spatial scale of landscape structures. Secondly, there is a lack of systematic integration based on technical research contents. Thirdly, there is a lack of specific technical application analysis combining actual design, leading to weaker practical guidance for industry practitioners. Therefore, this study selects the precise engineering construction information delivery of perforated panel walls in the space under the Sanya Bridge and the landscape platform of the Beijing Jinding Mountain as research cases. Through the analysis of construction information delivery content and technical challenges in these cases, the necessity of RGPM application is clarified. By analyzing the application of RGPM technology and its outcomes in these cases, concrete examples are provided for the precise construction information delivery of NLS components to fill the research gaps and provide theoretical foundations and application examples for future research.

Dual-drug controllable co-assembly nanosystem for targeted and synergistic treatment of hepatocellular carcinoma

The effectiveness of chemotherapeutic agents for hepatocellular carcinoma (HCC) is unsatisfactory because of tumor heterogeneity, multidrug resistance, and poor target accumulation. Therefore, multimodality-treatment with accurate drug delivery has become increasingly popular. Herein, a cell penetrating peptide-aptamer dual modified-nanocomposite (USILA NPs) was successfully constructed by coating a cell penetrating peptide and aptamer onto the surface of sorafenib (Sora), ursolic acid (UA) and indocyanine green (ICG) condensed nanodrug (USI NPs) via one-pot assembly for targeted and synergistic HCC treatment. USILA NPs showed higher cellular uptake and cytotoxicity in HepG2 and H22 cells, with a high expression of epithelial cell adhesion molecule (EpCAM). Furthermore, these NPs caused more significant mitochondrial membrane potential reduction and cell apoptosis. These NPs could selectively accumulate at the tumor site of H22 tumor-bearing mice and were detected with the help of ICG fluorescence; moreover, they retarded tumor growth better than monotherapy. Thus, USILA NPs can realize the targeted delivery of dual drugs and the integration of diagnosis and treatment. Moreover, the effects were more significant after co-administration of iRGD peptide, a tumor-penetrating peptide with better penetration promoting ability or programmed cell death ligand 1 (PD-L1) antibody for the reversal of the immunosuppressive state in the tumor microenvironment. The tumor inhibition rates of USILA NPs + iRGD peptide or USILA NPs + PD-L1 antibody with good therapeutic safety were 72.38 % and 67.91 % compared with control, respectively. Overall, this composite nanosystem could act as a promising targeted tool and provide an effective intervention strategy for enhanced HCC synergistic treatment.

In-situ coordination assembly of polyphenol with cage-like Prussian blue as an ecofriendly nanocarrier for site-specific pesticide delivery and sustained pest control

In sustainable agricultural production, an efficient and environmental-friendly nanoplatform for precise pesticide delivery is considerably desirable to enhance efficacy and minimize ecological side effects. In this study, a pH-responsive nanohybrid named EB@HMPB@TA was designed using hollow mesoporous Prussian blue (HMPB) coordinated with tannin (TA) for targeted delivery of emamectin benzoate (EB). Results demonstrated that the cage-like HMPB nanoparticles possessed a remarkable loading capacity for EB, reaching up to 63.7%. Through a coordination assembly process, an in-situ Fe3+-chelated TA coating was formed on the surface of EB@HMPB to obtain EB@HMPB@TA. Notably, EB@HMPB@TA appreciably improved the foliar affinity of EB. Moreover, under UV-light irradiation, the degradation rate of EB loaded in the HMPB@TA nanocarriers decreased by 47% compared to EB alone, thus reducing the loss of EB. Additionally, the release ratio of EB@HMPB@TA at pH = 8.5 was 9.47-fold higher than that at neutral pH over 48 h. This pH-dependent release feature held great potential for targeting lepidopteran pests, which own a unique alkaline gut environment. Importantly, compared to commercial EB suspension concentrate, EB@HMPB@TA exhibited potent insecticidal activity against three target pests. Safety evaluations conducted on both HK-2 cells in vitro and maize crops demonstrated the relative safety of EB@HMPB@TA. Consequently, EB@HMPB@TA offered a new approach for accurate pesticide delivery, facilitating efficient and eco-friendly pest control practices and holding tremendous potential for sustainable agricultural production, which aligns with the principles of cleaner production in agriculture.

Endoscopic Ultrasound-Guided Fiducial Placement for Stereotactic Body Radiation Therapy in Patients with Pancreatic Cancer.

Accurate delivery of stereotactic body radiotherapy (SBRT) to pancreatic tumors relies on successful EUS-guided placement of fiducial markers. The aim of this study is to report the technical feasibility and safety of EUS-guided fiducial placement and to evaluate the characteristics and technical benefit of SBRT in a cohort of patients with pancreatic cancer (PC). A retrospective chart review was performed for all (n = 82) PC patients referred for EUS-guided fiducial placement by a single endosonographer at a tertiary cancer center. Data regarding EUS-related technical details, SBRT characteristics, adverse events, and continuous visibility of fiducials were recorded and analyzed. Most patients included in the study had either locally advanced disease (32 patients, 39%) or borderline resectable disease (29 patients, 35%). Eighty-two PC patients underwent the placement of 230 fiducial markers under EUS guidance. The technical success rate of the fiducial placement was 98%. No immediate EUS-related adverse events were reported. The average time to the simulation CT after fiducial placement was 3.1 days. Of the 216 fiducial markers used for the SBRT delivery, 202 fiducial markers were visible on both the simulation CT and the cone beam CT scan. A median dose of 40cGY was given to all the patients in five fractions. Of these, 41% of the patients reported no SBRT-related toxicities during the follow-up. Fatigue and nausea were the most reported SBRT-related toxicities, which were seen in 35% of the patients post-SBRT. Our results demonstrate that EUS-guided fiducial placement is safe and effective in target volume delineation, facilitating SBRT delivery in PC patients. Further clinical trials are needed to determine the SBRT-related survival benefits in patients with pancreatic cancer.

Impact of Supply Chain Management on the Indian SME Operational Effectiveness

Supply Chain Management (SCM) operational effectiveness refers to the ability of an organization to efficiently and smoothly execute its supply chain processes to achieve its strategic goals. This involves streamlining processes, minimizing waste, and leveraging technology to enhance visibility and control across the entire supply chain network. The efficacy of a supply chain is a critical determinant of an organization's success and competitiveness in today's globalized business environment. When effectively managed, it can lead to numerous advantages, such as reduced costs through streamlined processes and minimized waste, improved customer satisfaction through timely and accurate deliveries, and enhanced responsiveness to market fluctuations. It also helps in optimizing inventory levels, reducing working capital requirements, and promoting sustainability by minimizing environmental impact. The study concluded that the efficacy of a supply chain is not just a cost-saving measure; it is a strategic asset that can drive growth, profitability, and long-term success for businesses in a highly interconnected and rapidly evolving world.

Improving Efficiency and Accuracy: Implementing Automation in King Hamad Hospital Outpatient Pharmacy

Pharmacy automation is an important tool for improving the safety, accuracy, and efficiency of medication delivery in healthcare settings. King Hamad University Hospital (KHUH) has implemented a comprehensive pharmacy automation system to improve the quality of care provided to its patients. The implementation of pharmacy automation at KHUH has resulted in improved patient safety and satisfaction. Automated dispensing cabinets have reduced medication errors by providing secure storage and access to medications. Automated medication packaging systems have improved accuracy by reducing the risk of errors associated with manual packaging. The CPOE system has improved communication between physicians and pharmacists by allowing physicians to electronically enter orders for medications directly into the EMR. Additionally, the implementation of pharmacy automation has improved patient satisfaction by reducing wait times for medications and increasing convenience for patients who need to pick up their prescriptions from the hospital pharmacy. Overall, pharmacy automation at KHUH has been successful in improving patient safety, accuracy, efficiency, and satisfaction. The implementation of this technology has allowed KHUH to provide better quality care for its patients while also reducing costs associated with manual processes.

FLASH radiotherapy and the associated dosimetric challenges

At Lund University and Skåne University Hospital in Lund, Sweden, we have, as the first clinic, modified a clinical Elekta Precise linear accelerator for convertible delivery of ultra-high dose rate (FLASH) irradiation. Whereas recently published reviews highlighted the need for standardised protocols for ultra-high dose rate beam dosimetry to be able to determine the true potential of FLASH irradiation, several dosimetry studies as well as in-vitro and in-vivo experiments have been carried out at our unit. Dosimetric procedures for verification of accurate dose delivery of FLASH irradiation to cell cultures, zebrafish embryos and small animals have been established using radiochromic films and thermo-luminescent dosimeters. Also, recently the first experience of electron FLASH radiotherapy (FLASH-RT) in canine patients in our clinical setting was published. Our research facilities also include a laboratory for 3D polymer gel manufacturing. Recently, we started investigating the feasibility of a NIPAM polymer gel dosimeter for ultra-high dose rate dosimetry. Furthermore, in the bunker of the modified Elekta linear accelerator, a Surface Guided Radiotherapy (SGRT) system is accessible. The Catalyst™ system (C-Rad Positioning, Uppsala, Sweden) provides optical surface imaging for patient setup, real-time motion monitoring and breathing adapted treatment. Aiming at treating patients using ultra-high dose rates, a real-time validation of the alignment between the beam and the target is crucial as the dose is delivered in a fraction of a second. Our research group has during the last decade investigated and developed SGRT workflows which improved patient setup and breathing adapted treatment for several cancer patient groups. Recently, we also started investigating the feasibility of a real-time motion monitoring system for surface guided FLASH-RT. Both FLASH related studies; 3D polymer gel dosimetry and surface guided FLASH-RT are to our knowledge the first of their kind. Following an introduction to the field of FLASH and the associated dosimetric challenges, we here aim to present the two ongoing studies including some preliminary results.

Improving ambulatory infusion drug delivery through alarm management using a quality improvement model and team learning.

472 Background: A quality outpatient cancer program depends on the accurate delivery of chemotherapy using a computerized ambulatory infusion pump to deliver a therapeutic dose of chemotherapy for patients. Between April and July 2021, our cancer center hotline reported an excessive rate of 60% of ambulatory pump were generating alarms. This resulted in interruptions in dose delivery, disruptions in clinical workflows, and negatively impacted patient satisfaction. Methods: A multidisciplinary team of frontline nurses, pharmacists, nurse leaders, and quality specialists was assembled to analyze six months of alarm data using a plan-do-study-act (PDSA) model. Quality tools were utilized to determine the root cause of the alarms and arrive at solutions to improve drug delivery by reducing alarms and calls to the infusion hotline. The team discovered 49% (n=22/45) of alarm could not be resolved, resulting in a dose interruption of the planned chemotherapy infusions. Patients returned to the infusion suite without receiving the total dose of chemotherapy as ordered. A full 70% of the hotline calls (n=16/22) were due to a “No Disposable” alarm code. Analysis of these returned units by both our group and the vendor led us to recommend a more advanced replacement model which was implemented in June/July of 2022. Results: Between July and December 2022, MCI outpatient ambulatory pump medication variances related to “No Disposable” improved by 100%. A total of 34 calls were received by the Hotline Nurse with 91% (31/34) of calls were successfully resolved. None of the ambulatory patients experienced an interruption in chemotherapy drug delivery. Conclusions: Forming a multidisciplinary working group resulted in a timely and significant improvement in chemotherapy safety using the PDSA model of quality improvement. Most importantly, confidence in chemotherapy drug delivery using ambulatory infusion pump was expressed by infusion nurses, pharmacists, and medical providers.

Cell migration-inspired stochastic steering strategy of magnetic particles in vascular networks

One primary challenge of magnetic drug targeting is to achieve the efficient and accurate delivery of drug particles to the desired sites in complex physiological conditions. Though a majority of drugs are delivered through intravenous administration, until now, the kinematics and dynamics of drug particles influenced by the magnetic field, vascular topology, and blood flows are still less understood. In this work, a multi-physics dynamical model, which captures transient particle motions inside the vascular networks manipulated by the external magnetic field, is developed. Based on the model, we studied the transport efficiency of particles in the two-dimensional (2D), three-dimensional (3D) artificial, and in vivo-relevant vascular networks. It is found that particles that perform a random walk with correlated speed and persistence, recapitulating some characteristics of migratory motion of immune and metastasis cells, have the largest mean square displacements in various vascular network topologies. Next, we designed a stochastic magnetic steering strategy, using a time-varying gradient magnetic field, to manipulate particles to perform the cell migration-inspired random motions in the vasculature. The capability of the proposed steering strategy to improve the particle spreading speed and reduce the consumed magnetic energy has been demonstrated using our multi-physics numerical model. Furthermore, the influence of heterogeneous flows in the vascular networks on the particle steering efficiency was investigated. Overall, the numerical model and the proposed stochastic magnetic steering strategy can be used to assist the development of drug delivery systems for precise medicine research.

A review of small animal dosimetry techniques: image-guided and spatially fractionated therapy

Research in small animal radiotherapy is a crucial step in clinical translation of novel radiotherapy techniques, either delivered as stand-alone treatment or in combination with other treatments, such as chemotherapy and immunotherapy. In order to efficiently translate preclinical findings to the clinical setting, preclinical radiotherapy must replicate clinical therapy in terms of mode of delivery as well as dose delivery accuracy as closely as possible. In this review article, we focused on the description of dosimetry tools for radiotherapy of small animals delivered with kilovoltage x-ray beams on image-guided irradiators and in a spatially-fractionated manner by means of microbeam therapy. The specifics of dosimetry of kilovoltage x-ray beam deliveries with small, often sub-millimeter, beams are highlighted, and suitable dosimeters, phantoms, and dose measurement and calculation techniques are reviewed. Future directions for accurate real-time high spatial resolution dosimetry of small animal irradiations are also discussed.

Obeticholic acid-loaded exosomes attenuate liver fibrosis through dual targeting of the FXR signaling pathway and ECM remodeling

End-stage of liver fibrosis as a precancerous state could lead to cirrhosis and hepatocellular carcinoma which liver transplantation is the only effective treatment. Previous studies have indicated that farnesoid X receptor (FXR) agonists, such as obeticholic acid (OCA) protect against hepatic injuries. However, free OCA administration results in side effects in clinical trials that could be alleviated by applying bio carriers such as MSC-derived exosomes (Exo) with the potential to mimic the biological regenerative effect of their parent cells, as proposed in this study. Loading OCA into the Exo was conducted via water bath sonication. Ex vivo bio distribution studies validated the Exo-loaded OCA more permanently accumulated in the liver. Using CCL4-induced liver fibrosis, we proposed whether Exo isolated from human Warton’s Jelly mesenchymal stem cells loaded with a minimal dosage of OCA can facilitate liver recovery. Notably, Exo-loaded OCA exerted additive anti-fibrotic efficacy on histopathological features in CCL4-induced fibrotic mice. Compared to baseline, Exo-mediated delivery OCA results in marked improvements in the fibrotic-related indicators as well as serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) concentrations. Accordingly, the synergistic impact of Exo-loaded OCA as a promising approach is associated with the inactivation of hepatic stellate cells (HSCs), extracellular matrix (ECM) remodeling, and Fxr-Cyp7a1 cascade on CCL4-induced liver fibrosis mice. In conclusion, our data confirmed the additive protective effects of Exo-loaded OCA in fibrotic mice, which suggests a valuable therapeutic strategy to combat liver fibrosis. Furthermore, the use of Exo for accurate drug delivery to the liver tissue can be inspiring.

Development of SCOR Database for Digitalisation of Supply Chain Customer Feedback Analysis

High-level customer service, with improved quality at a lower cost, is imperative in today's global supply chain, where customers have myriad options across borders. This is in line with the primary objective of supply chain management, which is to enable and deliver high-level customer service with lower costs, reduce lead time, and improve the quality of products/services. The Supply Chain Operations Reference (SCOR) model based on KPI metrics enables an increase in the quality of products/services by monitoring and digitalising involved processes. The current paper suggests the structure of the SCOR database for Supply Chain process improvement by applying the best practices of the SCOR for Business Processes improvement. We recommend the Bayesian Belief Network (BBN) and Case-Based Reasoning (CBR) methods to estimate the influence of these improvements on Supply Chain efficiency through key performance indicators before implementation. Integrating the methods proposed in this article focuses on an approach that minimises supply chain failures, decreases failure elimination time, understands consumer needs, and offers more accurate price proposals and lead times to improve customer satisfaction. Accordingly, the integrated SCOR-based Business Process Modelling (BPM) was not previously combined with BBN to identify the most efficient ways to improve the reliability of a Supply Chain by applying best practices, which impacts the entire supply chain. Our research is limited to SME companies in electronics manufacturing, but our ambition is to develop a universal framework suitable for broader areas. The study aims to analyse how the customers see the company by combining the CDA (Customer Delivery Accuracy) and Customer Complaints measures and find the optimal way to improve business processes by applying best practices. Still, it is limited to SCOR reliability performance metrics.

Optimization of Intelligent Transportation System using Biologically-Inspired Vehicular Ad hoc Networks for Achieve the Desired Performance

Many innovations made possible by the Intelligent Transportation System (ITS), such as media apps, encrypted financial transactions, and effective traffic management, rely heavily on vehicular ad hoc networks (VANETs). Using bio-inspired methodologies, This study looks back at the past and forward to the future to examine all of the routing challenges in VANETs, whether they are associated with a chain of related routing tasks or are aimed at a group of distinct approaches to routing. The high node mobility and unpredictable vehicle distribution (on the road) lead to major issues for VANETs, including the design of a network's physical architecture and unstable connections. VANET's provision of reliable and appropriate vehicular contact in situations requiring good service is crucial. As a result, effective means of navigation are desperately needed in VANET. Hence, in this paper, we examine the Bio-Inspired vehicular ad hoc networks (Bio-VANETs), wherein, should a suggested algorithmic network fail at any given node or vehicle, the remaining vehicles may be able to take over the task of relaying the data to the necessary nodes to achieve the desired performance. Route lifetime increases, and connection failures are decreased when the shortest way is selected using the fewest possible hops over highly connected links. In addition, the received signal intensity fluctuations due to vehicle density and speed are assessed. Packet Delivery Ratio, Optimal Performance, Accuracy and Efficiency of Bio-VANET are discussed and simulated against other methods that are existing models.

Tips and tricks in ultrasound-guided musculoskeletal interventional procedures.

Ultrasound visualization affords proceduralists versatile and accurate guidance for a variety of percutaneous, minimally invasive procedures in the musculoskeletal system including joint (intra-articular) injections or aspirations, intra-bursal injections, peritendinous, and perineural injections. A variety of percutaneous procedures are traditionally performed blindly, but may be more easily or more accurately performed with the real-time assistance of ultrasound guidance. Other procedures are only possible utilizing image-guidance, due to the required precision of the injection because of delicate local anatomy or depth of the injection; ultrasound is a safe, portable, and widespread modality that can be used to assist the proceduralist in localizing the needle tip in such cases, to ensure safe and accurate delivery of the medication, most frequently a solution of steroid and anesthetic. This review aims to provide a foundational approach to ultrasound-guided procedures in the musculoskeletal system, offering tips and tricks that can be employed in many different procedures including intra-articular, juxta-articular, and perineural injections for a multitude of clinical scenarios. Technical considerations regarding ultrasound transducer selection, sonographic technique, as well as common indications, contraindications, and complications of these procedures, are presented. Additionally, a variety of pharmacologic considerations for proceduralists contemplating ultrasound-guided injections are discussed.

Treatment of Central Nervous System Tumors on Combination MR-Linear Accelerators: Review of Current Practice and Future Directions.

Magnetic resonance imaging (MRI) provides excellent visualization of central nervous system (CNS) tumors due to its superior soft tissue contrast. Magnetic resonance-guided radiotherapy (MRgRT) has historically been limited to use in the initial treatment planning stage due to cost and feasibility. MRI-guided linear accelerators (MRLs) allow clinicians to visualize tumors and organs at risk (OARs) directly before and during treatment, a process known as online MRgRT. This novel system permits adaptive treatment planning based on anatomical changes to ensure accurate dose delivery to the tumor while minimizing unnecessary toxicity to healthy tissue. These advancements are critical to treatment adaptation in the brain and spinal cord, where both preliminary MRI and daily CT guidance have typically had limited benefit. In this narrative review, we investigate the application of online MRgRT in the treatment of various CNS malignancies and any relevant ongoing clinical trials. Imaging of glioblastoma patients has shown significant changes in the gross tumor volume over a standard course of chemoradiotherapy. The use of adaptive online MRgRT in these patients demonstrated reduced target volumes with cavity shrinkage and a resulting reduction in radiation dose to uninvolved tissue. Dosimetric feasibility studies have shown MRL-guided stereotactic radiotherapy (SRT) for intracranial and spine tumors to have potential dosimetric advantages and reduced morbidity compared with conventional linear accelerators. Similarly, dosimetric feasibility studies have shown promise in hippocampal avoidance whole brain radiotherapy (HA-WBRT). Next, we explore the potential of MRL-based multiparametric MRI (mpMRI) and genomically informed radiotherapy to treat CNS disease with cutting-edge precision. Lastly, we explore the challenges of treating CNS malignancies and special limitations MRL systems face.

Monte Carlo Simulation Study on the Depth-Dose Distribution of Thermoplastic Reinforced Composites for Potential Applications in External Beam Radiotherapy

External beam radiotherapy is a crucial method in treating cancer as it requires a high level of accuracy in patient positioning. Hence, commercial thermoplastic masks have a significant role during radiotherapy treatment as it is an efficient way of accurately positioning the patient without risking their safety and comfort. However, these commercial masks are expensive due to the use of costly compounds and additives, and several studies have concluded that commercial masks can significantly increase the surface dose. This study examined the effects of various thermoplastic reinforced composites for an alternative economic mask in terms of depth-dose distribution through Monte Carlo simulations in GEANT4 Application for Tomographic Emission (GATE). The simulations were varied by incident beams and their energies, material composition of the phantom, and varying thermoplastic reinforced composites. In general, the results indicated that PCL/PLA (polycaprolactone/polylactic acid), PLA/PU (polylactic acid/polyurethane), PCL/RH (polycaprolactone/rice husk), LDPE/PALF (low-density polyethylene/pineapple leaf fiber), and PP/PALF (polypropylene/pineapple leaf fiber) composites showed relatively accurate dose delivery in the target volume, which the slight difference will accumulate the 5% marginal error in treatment planning systems.

Script-based automatic radiotherapy planning for cervical cancer

Background This study aimed to develop fully automated script-based radiotherapy treatment plans for cervical cancer patients, and evaluate them against clinically accepted plans, as validation before clinical implementation. Material and methods In this retrospective planning study, treatment plans for 25 locally advanced cervical cancer (LACC) patients with up to three dose levels were included. Fully automated plans were created using an in-house developed Python script in RayStation, and compared to clinically accepted manually made plans. Quantitatively, relevant dose statistics were compared, and average dose volume histograms (DVHs) were analyzed. Qualitatively, a blinded plan comparison was conducted between the clinical and automatic plans. The accuracy of treatment plan delivery was verified with the Delta4 Phantom+. Results The quantitative evaluation showed that target coverage was acceptable for all the automatic and clinical plans. The automatic plans were significantly more conformal than the clinical plans; median of 1.03 vs. 1.12. Mean doses to almost all organs at risk (OARs) were reduced in the automatic plans, with a median reduction of between 0.6 Gy and 1.9 Gy. In the blinded plan comparison, the automatic plans were the preferred plans or of equal quality as the clinical plans in 99% of the cases. In addition, plan delivery was excellent, with a mean gamma passing rate of 99.8%. Complete script-based plans were generated in 30–45 min; about four to ten times faster than manually made plans. Conclusion The automatic plans had acceptable target coverage, lower doses to almost all OARs, more conformal dose distributions, and were predominantly preferred by the clinicians. Based on these results, our institution has implemented the script for clinical use.

Two novel stereotactic radiotherapy methods for locally advanced, previously irradiated head and neck cancers patients

To determine the feasibility and utility of conebeam CT-guided stereotactic radiotherapy for locally recurrent, previously irradiated head and neck cancer (HNC) patients on the Halcyon, a ring delivery system (RDS). This research aims to quantify plan quality, treatment delivery accuracy, and overall efficacy by comparing against novel clinical TrueBeam HyperArc method. Ten recurrent HNC patients who were treated at our institution on TrueBeam (6MV-FFF) for 30 to 40 Gy in 3 to 5 fractions with noncoplanar HyperArc plans were re-planned on Halcyon (6MV-FFF). These plans were re-planned with the same Acuros-based dose engine. Additionally, we used site-specific full/partial coplanar VMAT arcs. PTV coverage, mean dose to GTV, maximum dose to organs-at-risk (OAR), beam-on time (BOT), and quality assurance (QA) results were investigated and compared. Halcyon provided highly conformal HNC SRT plans with slightly superior mean PTVD99 coverage (96.7% vs 95.5%, p = 0.071), and slightly lower mean GTV dose (37.8 Gy vs 38.2 Gy, p = 0.241) when compared to the HyperArc plans. Differences in plan conformality and maximum dose to OARs were statistically insignificant. Due to Halcyon's coplanar geometry, D2cm was significantly higher (p = 0.001) but Halcyon did result in a reduced normal brain dose by 1 Gy on average and up to 5.2 Gy in some cases. Halcyon provided similar patient-specific QA pass rates with a 2%/2mm gamma criteria (98.2% vs 98.5%) and independent in-house Monte Carlo second check results (97.7% vs 98.2%), suggesting identical treatment delivery accuracy. Halcyon plans resulted in slightly longer beam-on time (3.16 vs 2.30 minutes, p = 0.010), however door-to-door patient time is expected to be <10 minutes. Compared to clinical TrueBeam HyperArc, Halcyon SRT plans provided similar plan quality and treatment delivery accuracy with a potentially faster overall treatment using fully automated patient setup and verification. Rapid delivery of recurrent HNC SRT may reduce intrafraction motion errors while also improving patient compliance and comfort. To provide high-quality of HNC SRT similar to HyperArc, we recommend Halcyon users consider commissioning this novel method. This method will be useful for remote and underserved patient cohorts including Halcyon-only clinics as well.

The first investigation of spot-scanning proton arc (SPArc) delivery time and accuracy with different delivery tolerance window settings

Objective. To investigate the impact of various delivery tolerance window settings on the treatment delivery time and dosimetric accuracy of spot-scanning proton arc (SPArc) therapy. Approach. SPArc plans were generated for three representative disease sites (brain, lung, and liver cancer) with an angle sampling frequency of 2.5°. An in-house dynamic arc controller was used to simulate the arc treatment delivery with various tolerance windows (±0.25, ±0.5, ±1, and ±1.25°). The controller generates virtual logfiles during the arc delivery simulation, such as gantry speed, acceleration and deceleration, spot position, and delivery sequence, similar to machine logfiles. The virtual logfile was then imported to the treatment planning system to reconstruct the delivered dose distribution and compare it to the initial SPArc nominal plan. A three-dimensional gamma index was used to quantitatively assess delivery accuracy. Total treatment delivery time and relative lost time (dynamic arc delivery time—fix beam delivery time)/fix beam delivery time) were reported. Main Results. The 3D gamma passing rate (GPR) was greater than 99% for all cases when using 3%/3 mm and 2%/2 mm criteria and the GPR (1%/1 mm criteria) degraded as the tolerance window opens. The total delivery time for dynamic arc delivery increased with the decreasing delivery tolerance window length. The average delivery time and the relative lost time (%) were 630 ± 212 s (253% ± 68%), 322 ± 101 s (81% ± 31%), 225 ± 60 s (27% ± 16%), 196 ± 41 s (11% ± 6%), 187 ± 29 s (6% ± 1%) for tolerance windows ±0.25, ±0.5, ±1, and ±1.25° respectively. Significance. The study quantitatively analyzed the dynamic SPArc delivery time and accuracy with different delivery tolerance window settings, which offer a critical reference in the future SPArc plan optimization and delivery controller design.