Superior Coverage Research Articles

Comparing the performance variability of different eDNA primers in fish monitoring

Environmental DNA technology develops rapidly in the field of biodiversity detection. Selecting appropriate primers may be one of the key questions. However, there is currently a lack of systematic studies on differences in primer detection efficiencies. This research investigates the efficiency of six universal primers (12S, 16S, 18S, MiFish, Cytb, and COI) in detecting fish species across diverse aquatic ecosystems using an environmental DNA approach. The research spans five study areas, representing marine, river, wetland, lake, and reservoir ecosystems. Illumina MiSeq sequencing and bioinformatics tools were employed for primer performance evaluation. Results indicate that MiFish consistently outperforms other primers, detecting the highest number of fish species across all ecosystems and exhibiting superior taxonomic coverage. Furthermore, marine ecosystems consistently show higher detection numbers across all primers. The absence of commonly identified species detected by all primers emphasizes the necessity of using multiple primers for a comprehensive assessment. This study provides valuable insights into the strengths and limitations of universal primers, highlighting the importance of primer selection for accurate eDNA-based fish monitoring. The findings contribute to the scientific basis for the comprehensive management of aquatic ecosystems, assisting researchers and ecosystem managers in screening suitable fish universal primers for eDNA methods. The study also calls for further research into factors influencing primer performance and encourages the refinement of primers to enhance biodiversity monitoring precision in various ecosystems.

Whole-brain radiotherapy with hippocampus sparing and simultaneous integrated boost to metastases: A plan quality comparison study between Ethos, HyperArc, VMAT and Tomotherapy

This study provides a concise and structured overview of a dosimetric comparison study conducted to assess the feasibility and effectiveness of 4 advanced radiotherapy techniques in treating brain metastases with hippocampus sparing and simultaneous integrated boost (HS-WBRT+SIB). Eleven patients with brain metastases previously treated with radiotherapy were included in the study. Planning CT scans with 2 mm slice thickness and MR imaging were used for contouring and dose prescription. The bilateral hippocampus and other organs at risk (OARs) were automatically contoured, and hippocampal avoidance regions (HAR) were defined as a 7 mm 3D expansion around the hippocampus. Gross tumor volume for each metastasis (GTVmet) and planning target volume for metastases (PTVmet) were delineated. The whole-brain CTV (CTVWB) and planning target volume for whole brain (PTVWB) were defined accordingly. Treatment planning and optimization were conducted using state-of-the-art radiotherapy techniques: Ethos, HyperArc, VMAT, and Tomotherapy. Tomotherapy achieved the highest D98% for PTVmet, indicating the best metastasis coverage. HyperArc plans showed the highest D98% for PTVWB, suggesting superior whole-brain coverage. Tomotherapy demonstrated significantly lower D98%, D2%, and Dmean values for the hippocampus, indicating its superiority in sparing the hippocampus. VMAT resulted in the lowest D2% values for the eyes, optic nerves, brainstem, and hypophysis, showing the best sparing of these critical structures. Tomotherapy consistently achieved lower Dmean values for parotids, oral cavity, and lips compared to the other techniques. The dosimetric comparison revealed distinct strengths and weaknesses for each radiotherapy technique. Tomotherapy excelled in sparing the hippocampus, while VMAT showed promise in sparing OARs. HyperArc plans demonstrated the best overall whole-brain coverage. These findings should guide clinicians in selecting the most suitable technique based on patient characteristics and institutional resources.

Stereotactic body radiotherapy with volumetric intensity-modulated arc therapy and flattening filter-free beams: dosimetric considerations.

The present study comparatively evaluates the impact of energy-matched flattening filter-free (FFF) photon beams with different energy levels on the physical-dosimetric quality of lung and liver stereotactic body radiotherapy (SBRT) treatment plans. For this purpose, 54different lung and liver lesions from 44patients who had already received SBRT combined with volumetric modulated arc therapy (VMAT) were included in this retrospective planning study. Planning computed tomography scans already available were used for the renewed planning with 6MV, 6MV-FFF, 10MV, and 10MV-FFF under constant planning objectives. The treatment delivery data, dosimetric distributions, and dose-volume histograms as well as parameters such as the conformity index and gradient indices were the basis for the evaluation and comparison of treatment plans. Asignificant reduction of beam-on time (BOT) was achieved due to the high dose rates of FFF beams. In addition, we showed that for FFF beams compared to flattened beams of the same energy level, smaller planning target volumes (PTV) require fewer monitor units (MU) than larger PTVs. An equal to slightly superior target volume coverage and sparing of healthy tissue as well as organs at risk in both lung and liver lesions were found. Significant differences were seen mainly in the medium to lower dose range. We found that FFF beams together with VMAT represent an excellent combination for SBRT of lung or liver lesions with shortest BOT for 10MV-FFF but significant dose savings for 6MV-FFF in lung lesions.

Dosimetric Comparison of Conventional Radiotherapy, Volumetric Modulated Arc Therapy, and Proton Beam Therapy for Palliation of Thoracic Spine Metastases Secondary to Breast or Prostate Cancer.

The aim of this planning study was to compare the dosimetric outcomes of Volumetric Modulated Arc Therapy (VMAT), Proton Beam Therapy (PBT), and conventional External Beam Radiation Therapy (cEBRT) in the treatment of thoracic spinal metastases originating from breast or prostate cancer. Our study utilized data from 30 different treatment plans and evaluated target coverage and doses to vital organs at risk (OARs), such as the spinal cord, heart, esophagus, and lungs. The results showed that VMAT and PBT achieved superior target coverage and significantly lower doses to the spinal cord compared to cEBRT (target: median PTVD95%: 75.2 for cEBRT vs. 92.9 and 91.7 for VMAT (p < 0.001) and PBT (p < 0.001), respectively; spinal cord: median Dmax%: 105.1 for cEBRT vs. 100.4 and 103.6 for VMAT (p < 0.001) and PBT (p = 0.002), respectively). Specifically, VMAT was notable for its superior target coverage and PBT for significantly lower doses to heart, lungs, and esophagus. However, VMAT resulted in higher lung doses, indicating potential trade-offs among different techniques. The study demonstrated the relative advantages of VMAT and PBT over traditional RT in the palliative treatment of spinal metastases using conventional fractionation. These findings underscore the potential of VMAT and PBT to improve dosimetric outcomes, suggesting that they may be more suitable for certain patient groups for whom the sparing of specific OARs is especially important.

Analysis ofsurvivorship following periacetabular osteotomy forhip dysplasia based onthree-dimensional acetabular coverage.

Periacetabular osteotomy (PAO) is an established procedure for correcting acetabular coverage and preventing osteoarthritis progression in hip dysplasia. However, it is unclear how acetabular coverage changes three-dimensionally after PAO and how it affects survival. Therefore, this study aimed to investigate the change in three-dimensional acetabular coverage preoperatively and postoperatively and identify demographic, clinical and radiographic factors associated with conversion to total hip arthroplasty (THA) and radiographic osteoarthritis progression after PAO. We retrospectively reviewed 46 consecutive patients (66 hips) who underwent PAO, using preoperative and postoperative radiographs and pelvic computed tomography (CT). Three-dimensional acetabular coverage based on CT data was investigated. Kaplan-Meier survival analysis was performed, and hazard ratios were calculated using univariate Cox regression models to identify the risk factors associated with conversion to THA and radiographic osteoarthritis progression after PAO as the endpoints. Radiographic osteoarthritis progression was defined as a minimum joint space of <2.0 mm. The mean follow-up was 10.7 years. Post-PAO, acetabular coverage gradually increased from the anterosuperior to the superior to the posterosuperior direction. The survival rate after PAO was 98.0% at 10 years. Less postoperative superior acetabular coverage, with a hazard ratio of 0.93, was significantly associated with conversion to THA and radiographic osteoarthritis progression after PAO (P = 0.03). In this study, poor superior acetabular coverage after PAO was a significant risk factor for conversion to THA and radiographic progression of osteoarthritis. Therefore, surgeons should attempt to prioritize the correction of the superior acetabular coverage when performing PAO.

Design and preparation of a novel nano-composite coating for desensitization of CL-20

Although 2,4,6,8,10,12-hexanitro-2,4,6,8,10,12-hexaazaisowurtzitane (CL-20) is one of the best high-energy explosives, its application is severely limited by its high sensitivity. Herein, a composite wax-film with interfacial crosslinking anti-falling was designed and fabricated to desensitize CL-20. It was filled with nano-silica powder (n-Si), nano-graphenes (n-GPNs) and multi-walled carbon nanotubes (MWCNTs) as insensitive enhancers. A unique and stable core-shell composite explosive was prepared, and characterized by DSC, SEM, TEM, XRD, XPS as well as mechanical sensitivity tests. The results suggested that the functional group interaction and structural strengthening between enhancers and microcrystalline wax (MW) further enhanced the desensitization ability of the composite film for CL-20. Because of the hydrogen bonding and thickening enhancement, the CL-20 crystal was uniformly coated with a nano-composite film. Three enhancers were demonstrated to be highly compatible with CL-20. In comparison with MW@CL-20, The Ea, Tp0 and Tb of the composites containing n-GPNs increased by >375.27 kJ·mol−1, 21.04 °C and 18.27 °C, respectively. The SEM and XPS results showed that the composite performed a complete core-shell structure with thermal softening resistance and superior coverage (98.20 %). The insensitive enhancer was also distributed and embedded in the MW-film matrix. Besides, the anti-fall and cross-linking properties of the film enable the mechanical sensitivity of the composite explosive to reach to a level better than that of WO3/Al nanothermite with 5 wt% polyaniline and polymer-bonded explosive (PBX) with 95 wt% LLM-105 and 5 wt% ternary composite. The heterogeneous composites demonstrated excellent mechanical safety and high energy performance. These findings can provide a reference for the efficient desensitization of CL-20.

Associated Factors and Prevention of Upper Pole Rippling in Prepectoral Direct-to-Implant Breast Reconstruction.

Background Despite its many advantages, prepectoral breast reconstruction also carries the risk of implant rippling. The recent introduction of partial superior implant coverage using a pectoralis muscle slip in prepectoral direct-to-implant (DTI) breast reconstruction has shown the potential to minimize upper pole rippling. The purpose of this study was to identify factors associated with rippling and the effectiveness of our surgical technique. Methods In total, 156 patients (186 breasts) who underwent prepectoral DTI breast reconstruction between August 2019 and March 2021 were identified retrospectively. Patient data were analyzed from medical records. Univariable and multivariable logistic analyses were performed to contextualize the risks associated with rippling deformity relative to demographic characteristics and other clinical factors. Retrospective propensity-matched analysis was performed to identify the relationship between rippling deformity and the reconstruction method. Results Patients with body mass index (BMI; odds ratio [OR], 0.736; p < 0.001), those with a postoperative chemotherapy history (OR, 0.324; p = 0.027) and those who received breast reconstruction via the superior coverage technique (OR, 0.2; p = 0.004), were less likely to develop rippling deformity. The median follow-up period was 64.9 weeks, and there were no significant differences between patients in types of mastectomy, implant, or acellular dermal matrix. Patients who underwent superior coverage technique-based reconstruction showed significantly reduced rippling (OR, 0.083; p = 0.017) Conclusion Patients with higher BMI and prior postoperative chemotherapy were less likely to develop rippling deformity. The superior coverage technique can be effective in minimizing upper pole rippling.

Assessment of Two Distinct Anatomical Landmarks for Suprascapular Nerve Injection: A Cadaveric Study.

The suprascapular nerve block (SSNB) is a commonly used procedure for the management of pain in various shoulder pathologies. Both image-guided and landmark-based techniques have been utilized successfully for SSNB, though more consensus is needed regarding the optimal method of administration. This study aims to evaluate the theoretical effectiveness of a SSNB at two distinct anatomic landmarks and propose a simple, reliable way of administration for future clinical use. 14 upper extremity cadaveric specimens were randomly assigned to either receive an injection 1cm medial to the posterior acromioclavicular (AC) joint vertex or 3cm medial to the posterior AC joint vertex. Each shoulder was injected with a 10ml Methylene Blue solution at the assigned location, and gross dissection was performed to evaluate the anatomic diffusion of the dye. The presence of dye was specifically assessed at the suprascapular notch, supraspinatus fossa, and spinoglenoid notch to determine the theoretic analgesic effectiveness of a SSNB at these two injection sites. Methylene Blue diffused to the suprascapular notch in 57.1% of the 1 cm group and 100% of the 3 cm group, the supraspinatus fossa in 71.4% of the 1 cm group and 100% of the 3 cm group, and the spinoglenoid notch in 100% of the 1 cm group and 42.9% of the 3 cm group. Given its superior coverage at the more proximal sensory branches of the suprascapular nerve, a SSNB injection performed 3 cm medial to the posterior AC joint vertex provides more clinically adequate analgesia than an injection site 1cm medial to the AC junction. Performing a SSNB injection at this location allows for an effective method of anesthetizing the suprascapular nerve.

Improving the quality of service indices of task allocation in mobile crowd sensing with fuzzy-based inverse stackelberg game theory

This paper introduces a comprehensive strategy for heterogeneously allocating tasks, aiming to optimize mobile crowd sensing through the use of fuzzy logic and thus achieving superior coverage quality. We employed a deep learning method to address the diverse range of requests. Recognizing the instability during the learning process, we utilized an approximation function for the Q-values, thereby preventing divergence during the training phase of the model. A prominent challenge is ensuring robust user participation in mobile crowd sensing initiatives. Essentially, a higher number of monitoring nodes within an area correlates with improved coverage quality. We employed fuzzy logic to estimate participation density, taking into account both the duration of users' presence in the study region and the geographical density. Our results are compelling: the proposed method boosts coverage levels by over 17% compared to standard techniques. Additionally, with an accuracy spanning 91.5% to 95.3% for the correct allocation of resources using a dataset from Google, the efficacy of our approach is further underscored.

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.

Hierarchical Area-Based and Path-Based Heuristic Approaches for Multirobot Coverage Path Planning with Performance Analysis in Surveillance Systems.

In this study, we present a systematic exploration of hierarchical designs for multirobot coverage path planning (MCPP) with a special focus on surveillance applications. Unlike conventional studies centered on cleaning tasks, our investigation delves into the realm of surveillance problems, specifically incorporating the sensing range (SR) factor equipped on the robots. Conventional path-based MCPP strategies considering SR, primarily rely on naive approaches, generating nodes (viewpoints) to be visited and a global path based on these nodes. Therefore, our study proposes a general MCPP framework for surveillance by dealing with path-based and area-based structures comprehensively. As the traveling salesman problem (TSP) solvers, our approach incorporates not the naive approach but renowned and powerful algorithms such as genetic algorithms (GAs), and ant colony optimization (ACO) to enhance the planning process. We devise six distinct methods within the proposed MCPP framework. Two methods adopt area-based approaches which segments areas via a hierarchical max-flow routing algorithm based on SR and the number of robots. TSP challenges within each area are tackled using a GA or ACO, and the result paths are allocated to individual robots. The remaining four methods are categorized by the path-based approaches with global-local structures such as GA-GA, GA-ACO, ACO-GA, and ACO-ACO. Unlike conventional methods which requires a global path, we further incorporate ACO- or GA-based local planning. This supplementary step at the local level enhances the quality of the path-planning results, particularly when dealing with a large number of nodes, by preventing any degradation in global path-planning outcomes. An extensive comparative analysis is conducted to evaluate the proposed framework based on execution time, total path length, and idle time. The area-based approaches tend to show a better execution time and overall path length performance compared to the path-based approaches. However, the path-based MCPP methods have the advantage of having a smaller idle time than the area-based MCPP methods. Our study finds that the proposed area-based MCPP method excels in path planning, while the proposed path-based MCPP method demonstrates superior coverage balance performance. By selecting an appropriate MCPP structure based on the specific application requirements, leveraging the strengths of both methodologies, efficient MCPP execution becomes attainable. Looking forward, our future work will focus on tailoring these MCPP structures to diverse real-world conditions, aiming to propose the most suitable approach for specific applications.

Immobilized enzyme microreactors for analysis of tryptic peptides in β-casein and β-lactoglobulin

In this study, our primary objective was to develop an effective analytical method for studying trypsin-digested peptides of two proteins commonly found in cow's milk: β-casein (βCN) and β-lactoglobulin (βLG). To achieve this, we employed two distinct approaches: traditional in-gel protein digestion and protein digestion using immobilized enzyme microreactors (μ-IMER). Both methods utilized ZipTip pipette tips filled with C18 reverse phase media for sample concentration. The μ-IMER was fabricated through a multi-step process that included preconditioning the capillary, modifying its surface, synthesizing a monolithic support, and further surface modification. Its performance was evaluated under HPLC chromatography conditions using a small-molecule trypsin substrate (BAEE). Hydrolysates from both digestion methods were analyzed using MALDI-TOF MS. Our findings indicate that the μ-IMER method demonstrated superior sequence coverage for oxidized molecules in βCN (33 ± 1.5%) and βLG (65 ± 3%) compared to classical in-gel digestion (20 ± 2% for βCN; 49 ± 2% for βLG). The use of ZipTips further improved sequence coverage in both classical in-gel digestion (26 ± 1% for βCN; 60 ± 4% for βLG) and μ-IMER (41 ± 3% for βCN; 80 ± 5% for βLG). Additionally, phosphorylations were identified. For βCN, no phosphorylation was detected using classical digestion, but the use of ZipTips showed a value of 27 ± 4%. With μ-IMER and μ-IMER–ZipTip, the values increased to 30 ± 2% and 33 ± 1%, respectively. For βLG, the use of ZipTip enabled the detection of a higher percentage of modified peptides in both classical (79 ± 2%) and μ-IMER (79 ± 4%) digestions. By providing a comprehensive comparison of traditional in-gel digestion and μ-IMER methods, this study offers valuable insights into the advantages and limitations of each approach, particularly in the context of complex biological samples. The findings set a new benchmark in protein digestion and analysis, highlighting the potential of μ-IMER systems for enhanced sequence coverage and post-translational modification detection.

Clinical Evaluation of an Automated Iterative Optimization System for Radiation Oncology

Automation of radiotherapy treatment planning improves efficiency and consistency, while reducing planning time and errors. The objective of this study was to validate an Iterative Optimization Engine (IOE) within an existing automated IMRT/VMAT planning framework. The IOE was designed to reduce remaining manual intervention within the automation framework through measuring and codifying common user intervention within a commercial planning system. The IOE was developed for external beam IMRT/VMAT treatment planning on the Monaco Treatment Planning System. The IOE was built on an existing automation framework, utilizing the Application Programming Interface (API) to create completely automated treatment plans. A network of 40 centers in Australia evaluated automated treatment plans for head and neck disease sites where users decided manual intervention was required post automated planning to achieve clinician approval. The modifications to automated plans were recorded, analyzed, and codified into the API to remove the requirement for manual intervention. A subset of the automated plans was then retrospectively processed by the IOE with resulting plans being scored in three categories of 1) superior, 2) equivalent and 3) inferior based on DVH assessment with the original clinician approved plan as the baseline. The automation framework generated 546 head and neck plans from January 1 to February 1, 2023, of which 45% required manual intervention to achieve dosimetric criteria. After being processed by the IOE, 86% of plans showed equivalent or superior coverage and maximum dose, and 95% of plans demonstrated equivalent homogeneity or improved homogeneity. Multi-target plans showed equivalent or improved target dose for 67% of intermediate dose targets and 39% of low dose targets when multiple targets were treated simultaneously. Analysis of organs at risk showed 38% of plans with reduced Parotid mean dose, 92% improved Larynx mean dose, 43% reduced Spinal Cord maximum dose, 57% decreased Brainstem maximum dose, 85% reduced Oral Cavity mean dose and 56% reduced Pharynx mean dose. The addition of an IOE achieved a clinical improvement to target and OAR metrics in the assessed clinical plans. The automation framework will incorporate this work into clinical production to improve the overall effectiveness of the automated planning framework.

CT-Guided Online Adaptive Stereotactic Body Radiotherapy for Pancreas Ductal Adenocarcinoma: Dosimetric and Initial Clinical Experience

Retrospective analysis suggests that dose escalation to a biologically effective dose of more than 70 Gy may improve overall survival in patients with pancreatic ductal adenocarcinoma (PDAC), but such treatments in practice are limited by proximity of organs at risk (OARs). We hypothesized that CT-guided online adaptive radiotherapy (OART) can account for interfraction movement of OARs, reduce dose to OARs, and improve coverage of targets. This is a single institution retrospective analysis of patients with PDAC treated with OART on a CBCT-based OART platform. All patients were treated to 40 Gy in 5 fractions. PTV overlapping with a 5 mm planning risk volume expansion on the stomach, duodenum and bowel received 25 Gy. Initial treatment plans were created conventionally. For each fraction, PTV and OAR volumes were recontoured with AI assistance after initial cone beam CT (CBCT). The adapted plan was calculated, underwent QA, and then compared to the scheduled plan. A second CBCT was obtained prior to delivery of the selected plan. Total treatment time (first CBCT to end of radiation delivery) and active physician time (first to second CBCT) were recorded. PTV_4000 V95%, PTV_2500 V95%, and D0.03 cc to stomach, duodenum and bowel were reported for scheduled (S) and adapted (A) plans. CTCAEv5.0 toxicities were recorded. Statistical analysis was performed using a two-sided T test and α of 0.05. Seven patients with unresectable or locally-recurrent PDAC were analyzed, with a total of 35 fractions. Average total time was 33:00 minutes (22:25-49:40) and average active time was 22:48 minutes (14:15-39:34). All fractions were treated with adapted plans. All adapted plans met PTV_4000 V95.0% > 95.0% coverage goal and OAR dose constraints. Dosimetric data for scheduled and adapted plans per fraction are in Table 1. Median follow up was 1.7 months. 5 (71%) patients experienced either Grade 1 or 2 toxicities. No patients experienced Grade 3+ toxicities. Daily OART significantly reduced dose OARs while achieving superior PTV coverage. Treatment was generally well tolerated with no grade 3+ acute toxicity, and required only 22:48 minutes on average of active physician time. Our initial clinical experience demonstrates OART allows for safe dose escalation in the treatment of PDAC.

Dosimetric comparison between RapidArc and HyperArc in hippocampal-sparing whole-brain radiotherapy with a simultaneous integrated boost

The HyperArc technique is known for generating high-quality radiosurgical treatment plans for intracranial lesions or hippocampal-sparing whole-brain radiotherapy (WBRT). However, there is no reported feasibility of using the HyperArc technique in hippocampal-sparing WBRT with a simultaneous integrated boost (SIB). This study aimed to compare dosimetric parameters of 2 commercially-available volumetric-modulated arc radiotherapy techniques, HyperArc and RapidArc, when using hippocampal-sparing WBRT with a SIB to treat brain metastases.Treatment plans using HyperArc and RapidArc techniques were generated retrospectively for 19 previously treated patients (1 to 3 brain metastases). The planning target volumes for the whole brain (excluding the hippocampal avoidance region; PTVWB) and metastases (PTVmet) were prescribed 25 and 45 Gy, respectively, in 10 fractions. Each plan included homogeneous and inhomogeneous delivery to the PTVmet. Dosimetric parameters for the target (conformity index [CI], homogeneity index [HI], target coverage [D95%]), and nontarget organs at risk were compared for the HyperArc and RapidArc plans.For homogeneous delivery, dosimetric parameters, including mean CI, HI, and target coverage in PTVWB and PTVmet, were superior for HyperArc than RapidArc plans (all p < 0.01). The PTVWB and PTVmet target coverage for HyperArc plans was significantly greater than for RapidArc plans (96.17% vs 93.38%, p < 0.01; 94.02% vs 92.21%, p < 0.01, respectively). HyperArc plans had significantly lower mean hippocampal Dmax and Dmin values than RapidArc plans (Dmax: 15.53 Gy vs, 16.71 Gy, p < 0.01; Dmin: 8.33 Gy vs 8.93 Gy, p < 0.01, respectively). Similarly, inhomogeneous delivery of hyperArc produced a superior target and lower hippocampal dosimetric parameters than RapidArc, except for the HI of PTVmet (all p < 0.01).HyperArc generated superior conformity and target coverage with lower hippocampal doses than RapidArc. HyperArc could be an attractive technique for hippocampal-sparing WBRT with an SIB.

Confidence intervals for the Cox model test error from cross-validation.

Cross-validation (CV) is one of the most widely used techniques in statistical learning for estimating the test error of a model, but its behavior is not yet fully understood. It has been shown that standard confidence intervals for test error using estimates from CV may have coverage below nominal levels. This phenomenon occurs because each sample is used in both the training and testing procedures during CV and as a result, the CV estimates of the errors become correlated. Without accounting for this correlation, the estimate of the variance is smaller than it should be. One way to mitigate this issue is by estimating the mean squared error of the prediction error instead using nested CV. This approach has been shown to achieve superior coverage compared to intervals derived from standard CV. In this work, we generalize the nested CV idea to the Cox proportional hazards model and explore various choices of test error for this setting.

Comparison of intranasal medication delivery devices before and after functional endoscopic sinus surgery using Phacon sinus surgery models.

Functional endoscopic sinus surgery for chronic rhinosinusitis improves sinus drainage and intranasal medication delivery. This study compares medication delivery with commonly used devices in normal and altered anatomy (post functional endoscopic sinus surgery) using sinus surgery models (Phacon). Medication delivery was simulated via nasal drops, nasal spray and an irrigation device (Neilmed Sinus Rinse). Coverage was then calculated from endoscopic pictures taken at various anatomical sites in the normal nose and post functional endoscopic sinus surgery. In the normal nose, nasal spray did not penetrate the sphenoid sinus, and drops bypassed the vestibule anteriorly. Neilmed Sinus Rinse provided superior coverage at the sphenoid site following sphenoidectomy and the frontal site following Draf III. After ethmoidectomy, nasal drops overall provided less coverage than the other methods. Neilmed Sinus Rinse generally provided the best distribution, followed by the nasal spray and then nasal drops. The type and extent of surgery also affects medication delivery.

Poster 118: False Profile Radiograph Sourcil-Edge and Bone-Edge Measurements Both Correlate to Different Weight-Bearing Regions of the Acetabulum: A Three-Dimensional Analysis

Objectives: The acetabular sourcil has been thought of as the radiographic representation of the weightbearing dome of the acetabulum; however, there are limited modern data to support this supposition. In the literature, assessment of weightbearing acetabular coverage has been described using both the sourcil-edge and bone-edge as anatomic landmarks, leading to confusion and controversy in classification of hip dysplasia, indications for hip preservation surgery, and intraoperative coverage assessment. The purpose of this study was to localize the three-dimensional (3D) anatomic correlates of the sourcil-edge and bone-edge radiographic position on false profile radiographs. The authors hypothesized that the sourcil-edge on the false profile represents anterolateral coverage while the bone-edge represents anterior coverage. Methods: Forty hips were grouped by large or small differences between bone-edge and sourcil-edge anterior center edge angles (ACEA). The small difference group comprised the lowest quartile of sourcil-edge to bone-edge difference of an initial cohort of 80 hips, while the large difference group comprised the highest quartile of difference. 3D surface mesh models and digitally reconstructed radiographs (DRRs) were generated from hip computed tomography scans using the 3D Slicer Image Computing Platform (Figures 1 &amp; 3). Sourcil-edge, bone-edge, and ACEAs were identified on DRRs and registered to the 3D models with fiducial markers. Intersection of bone-edge and sourcil-edge projection lines with the acetabular rim were obtained from the 3D models (Figures 2 &amp; 4). 3D Anterior acetabular rim morphology was correlated with ACEA difference. Results: The bone-edge and sourcil-edge projections intersected the acetabular rim at a mean of 2:08 ± 0:25 and 1:20 ± 0:24 o’clock, respectively. The 3D models consistently demonstrated that, in both large and small discrepancy groups, the sourcil-edge corresponded to an area just posterior to the AIIS projection while the bone-edge corresponded to the weight-bearing region inferior to the AIIS (Figures 2 &amp; 4). Additionally, in large discrepancy hips, the bone-edge corresponded to a more prominent acetabular coverage in the region of the AIIS than when compared to the small discrepancy hips. Conclusions: This study demonstrates that both the sourcil-edge and bone-edge projections on false profile radiographs correlate with differing weightbearing regions of the acetabulum. The sourcil-edge ACEA represents coverage at 1:20 o’clock on the acetabular rim and is consistently posterior to the AIIS, while the bone-edge measurement represents the region of the acetabular rim at 2:08 o’clock and is consistently inferior to the AIIS. In hips with a large discrepancy between bone-edge and sourcil-edge (highest quartile), ACEA measurement differs by a mean of 19.7 degrees based on the selection of these radiographic landmarks. These findings have substantial implications for hip preservation surgery technique and clinical decision making. A comprehensive understanding of femoral head coverage is essential for the treatment of young adult hip pathology. Although the sourcil and bone edge are two of the most important radiographic landmarks for assessment of acetabular dysplasia, descriptions of these landmarks are often over simplified. Some authors have advocated for greater utilization of measurements of coverage to the bone edge as it can be more consistently identified. Other authors have advocated for utilizing the sourcil-edge measurement as this is more representative of the “weight bearing dome”. These descriptions are limited as they do not improve our understanding of the anatomic and radiographic structure of the anterior acetabular rim. Although the concept of the “weight bearing dome” is classically described, it lacks anatomic precision. The present study clarifies the anatomic features of the acetabular rim that correspond to these radiographic features. Increased difference between the sourcil-edge and bone edge is generated by the differences in undulation of the anterosuperior acetabular rim. Acetabuli that have maximal anterior rim prominence at or near the superior-most aspect of the acetabulum (generally counterclockwise from the AIIS) tend to demonstrate smaller discrepancy between the bone-edge and sourcil-edge (Figure 4). Acetabuli that have maximal rim prominence medial and anterior to the superior-most aspect of the acetabulum generally demonstrate larger discrepancy (Figure 2). The present anatomic description can be utilized by the hip arthroscopist to better determine which areas of the anterior rim may cause impingement. Similarly, while conducting a periacetabular osteotomy, the surgeon may use this information to better understand how acetabular rotation is contributing to both anterior and anterolateral coverage. In conclusion, on false profile radiographs, the sourcil-edge corresponds to superior femoral head coverage, while the bone-edge corresponds to anterosuperior coverage. False profile radiographs with a large discrepancy between sourcil-edge and bone-edge measurements demonstrate a prominent weight bearing surface in the region of the AIIS. These data regarding the radiographic phenomena of the acetabular rim can aid in clinical decision-making and intraoperative technique.

MDCT of Dehiscent or Thin Bone Coverage over the Superior Semicircular Canal: Assessment of Prevalence by Age and Contralateral Canal Bone Thickness

Objective: Superior semicircular canal dehiscence (SSCD) describes the presence of a defect in the superior bone coverage of the membranous SSC. The etiology of the defect is not known and its reported CT prevalence is variable. This study primarily aimed to report MDCT prevalences of SSCD and thin bone coverage over SSC among different age groups. A secondary aim was to assess for any association between SSCD and the thickness of contralateral bone coverage over SSC.&#x0D; Materials and Methods: Temporal bone MDCTs were retrospectively evaluated for SSCD and the thickness bone coverage over SSC. The prevalences of SSCD and thin bone coverage over SSC among different age groups, and the thickness of bone over SCC in SSCD and non-SSCD subjects were analyzed.&#x0D; Results: 509 subjects were included in the study. Age-adjusted models did not demonstrate a significant association between the age groups and the prevalence of SSCD (p=0.63) or between the age groups and the prevalence of thin bone coverage over SSC (p=0,81). Unilateral SSC roof thickness of ≤ 0.5 mm was significantly associated with increased prevalence of contralateral SSCD (p=0.05 and p=0.04). In subjects without radiological evidence of SSCD, right-or left-sided thin bone coverage over SSC was significantly associated with contralateral thin bone coverage (p

Automated treatment planning for proton pencil beam scanning using deep learning dose prediction and dose-mimicking optimization.

The purpose of this study is to investigate the use of a deep learning architecture for automated treatment planning for proton pencil beam scanning (PBS). A 3-dimensional (3D) U-Net model has been implemented in a commercial treatment planning system (TPS) that uses contoured regions of interest (ROI) binary masks as model inputs with a predicted dose distribution as the model output. Predicted dose distributions were converted to deliverable PBS treatment plans using a voxel-wise robust dose mimicking optimization algorithm. This model was leveraged to generate machine learning (ML) optimized plans for patients receiving proton PBS irradiation of the chest wall. Model training was carried out on a retrospective set of 48 previously-treated chest wall patient treatment plans. Model evaluation was carried out by generating ML-optimized plans on a hold-out set of 12 contoured chest wall patient CT datasets from previously treated patients. Clinical goal criteria and gamma analysis were used to compare dose distributions of the ML-optimized plans against the clinically approved plans across the test patients. Statistical analysis of mean clinical goal criteria indicates that compared to the clinical plans, the ML optimization workflow generated robust plans with similar dose to the heart, lungs, and esophagus while achieving superior dosimetric coverage to the PTV chest wall (clinical mean V95=97.6% vs. ML mean V95=99.1%, p<0.001) across the 12 test patients. ML-based automated treatment plan optimization using the 3D U-Net model can generate treatment plans of similar clinical quality compared to human-driven optimization.