Improvement of Prediction Performance for Radiation Pneumonitis by Using 3-Dimensional Dosiomic Features

INTRODUCTION

Patients with early non-small-cell lung cancer (NSCLC) have a relatively long survival time after stereotactic body radiation therapy (SBRT). Predicting radiation-induced pneumonia (RP) has important clinical and social implications for improving the quality of life of such patients. This study developed an RP prediction model by using 3-dimensional (3D) dosiomic features. The model can be used to guide radiation therapy to reduce toxicity.

METHODS

Radiomic features were extracted from pre-treatment CT, dose-volume histogram (DVH) parameters and dosiomic features were extracted from the 3D dose distribution of 140 lung cancer patients. Four predictive models: (1) CT; (2) CT + DVH; (3) CT + Rtdose; and (4) Hybrid, CT + DVH + Rtdose, were trained to predict symptomatic RP by extremely randomized trees. Accuracy, sensitivity, specificity, and area under the receiver operator characteristic curve were evaluated.

RESULT

Results showed that the fraction regimen was correlated with symptomatic RP (P < .001). The proposed model achieved promising prediction results. The performance metrics for CT, CT + DVH, CT + Rtdose, and Hybrid were as follows: accuracy: 0.786, 0.821, 0.821, and 0.857; sensitivity: 0.625, 1, 0.875, and 1; specificity: 0.8, 0.565, 0.5, and 0.875; and area under the receiver operator characteristic curve: 0.791, 0.809, 0.907, and 0.920, respectively.

CONCLUSION

Dosiomic features can improve the performance of the predictive model for symptomatic RP compared with that obtained with the CT + DVH model. The model proposed in this study can help radiation oncologists individually predict the incidence rate of RP.

A planning strategy may reduce the risk of heart diseases and radiation pneumonia: Avoiding the specific heart substructures

BACKGROUND

Dose to heart substructures is a better predictor for major adverse cardiac events (MACE) than mean heart dose (MHD). We propose an avoidance planning strategy for important cardiac substructures.

MATERIAL AND METHODS

Two plans, clinical and cardiac substructure-avoidance plan, were generated for twenty patients. Five dose-sensitive substructures, including left ventricle, pulmonary artery, left anterior descending branch, left circumflex branch and the coronary artery were chosen. The avoidance plan aims to meet the target criteria and organ-at-risk (OARs) constraints while minimizing the dose parameters of the above five substructures. The dosimetric assessments included the mean dose and the maximum dose of cardiac substructures and several volume parameters. In addition, we also evaluated the relative risk of coronary artery disease (CAD), chronic heart failure (CHF), and radiation pneumonia (RP).

RESULTS

Pearson correlation coefficient and R2 value of linear regression fitting demonstrated that MHD had poor prediction ability for the mean dose of the cardiac substructures. Compared to clinical plans, an avoidance plan is able to statistically significantly decrease the dose to key substructures. Meanwhile, the dose to OARs and the coverage of the target are comparable in the two plans. In addition, it can be observed that the avoidance plan statistically decreases the relative risks of CAD, CHF, and RP.

CONCLUSIONS

The substructure-avoidance planning strategy that incorporates the cardiac substructures into optimization process, can protect the important heart substructures, such as left ventricle, left anterior descending branch and pulmonary artery, achieving the substantive sparing of dose-sensitive cardiac structures, and have the potential to decrease the relative risks of CAD, CHF, and RP.

A novel lung-avoidance planning strategy based on 4DCT ventilation imaging and CT density characteristics for stage III non-small-cell lung cancer patients

BACKGROUND

Functional planning based merely on 4DCT ventilation imaging has limitations. In this study, we proposed a radiotherapy planning strategy based on 4DCT ventilation imaging and CT density characteristics.

MATERIALS AND METHODS

For 20 stage III non-small-cell lung cancer (NSCLC) patients, clinical plans and lung-avoidance plans were generated. Through deformable image registration (DIR) and quantitative image analysis, a 4DCT ventilation map was calculated. High-, medium-, and low-ventilation regions of the lung were defined based on the ventilation value. In addition, the total lung was also divided into high-, medium-, and low-density areas according to the HU threshold. The lung-avoidance plan aimed to reduce the dose to functional and high-density lungs while meeting standard target and critical structure constraints. Standard and dose-function metrics were compared between the clinical and lung-avoidance plans.

RESULTS

Lung avoidance plans led to significant reductions in high-function and high-density lung doses, without significantly increasing other organ at risk (OAR) doses, but at the expense of a significantly degraded homogeneity index (HI) and conformity index (CI; p < 0.05) of the planning target volume (PTV) and a slight increase in monitor units (MU) as well as in the number of segments (p > 0.05). Compared with the clinical plan, the mean lung dose (MLD) in the high-function and high-density areas was reduced by 0.59 Gy and 0.57 Gy, respectively.

CONCLUSION

A lung-avoidance plan based on 4DCT ventilation imaging and CT density characteristics is feasible and implementable, with potential clinical benefits. Clinical trials will be crucial to show the clinical relevance of this lung-avoidance planning strategy.

A novel CRT-IMRT-combined (Co-CRIM) planning technique for peripheral lung stereotactic body radiotherapy in pinnacle treatment planning system

Objectives

This study attempts to explore a novel peripheral lung stereotactic body radiotherapy (SBRT) planning technique that can balance the pros and cons of three‐dimensional conformal radiotherapy (CRT) and intensity‐modulated radiation therapy (IMRT) / volumetric modulated arc therapy (VMAT).

Methods

Treatment plans were retrospectively designed based on CRT, IMRT, VMAT, and the proposed CRT‐IMRT‐combined (Co‐CRIM) techniques using Pinnacle treatment planning system (TPS) for 20 peripheral lung cancer patients. Co‐CRIM used an inverse optimization algorithm available in Pinnacle TPS. To develop a Co‐CRIM plan, the number of segments in each field was limited to one, the minimum segment area was set to the internal target volume (ITV), and the minimum monitor units (MU) of the segment was the quotient of fractional dose divided by twice the number of total fields. The performance of Co‐CRIM was then compared with other techniques.

Results

For conformity index (CI), Co‐CRIM performed comparably to IMRT/VMAT but better than CRT. For gradient index (GI), Co‐CRIM was similar to IMRT/VMAT or CRT. For heterogeneity index (HI), Co‐CRIM was comparable to IMRT/VMAT, higher than CRT. The dosimetric results of spinal cord and lung with Co‐CRIM were better than CRT, comparable to IMRT, but inferior to VMAT. The MU resulted from Co‐CRIM was lower than IMRT/VMAT but higher than CRT. For plan verification γ passing rate, Co‐CRIM was higher than IMRT/VMAT, comparable to CRT. For planning time, Co‐CRIM was shorter than CRT or VMAT but similar to IMRT.

Conclusions

The proposed Co‐CRIM technique on Pinnacle TPS is an effective planning technique for peripheral lung SBRT.

Evaluation of IGRT-Induced Imaging Doses and Secondary Cancer Risk for SBRT Early Lung Cancer Patients In Silico Study

Objectives:

This study performed dosimetry studies and secondary cancer risk assessments on using electronic portal imaging device (EPID) and cone beam computed tomography (CBCT) as image guided tools for the early lung cancer patients treated with SBRT.

Methods:

The imaging doses from MV-EPID and kV-CBCT of the Edge accelerator were retrospectively added to sixty-one SBRT treatment plans of early lung cancer patients. The MV-EPID imaging dose (6MV Photon beam) was calculated in Pinnacle TPS, and the kV-CBCT imaging dose was simulated and calculated by modeling of the kV energy beam in TPS using Pinnacle automatic modeling program. Three types of plans, namely Plan_EPID, Plan_CBCT and Plan_origin, were generated with incorporating doses of EPID, CBCT and no imaging, respectively, for analysis. The effects of imaging doses on dose-volume-histogram (DVH) and plan quality were analyzed, and the excess absolute risk (EAR) of secondary cancer for ipsilateral lung was evaluated.

Results:

The regions that received less than 50 cGy were significantly impacted by the imaging doses, while the isodose lines greater than 1000 cGy were barely changed. The DVH values of ipsilateral lung increased the most in Plan_EPID, followed by Plan_CBCT. Compared to Plan_origin on the average, the estimated EAR of ipsilateral lung in Plan_EPID increased by 3.43%, while the corresponding EAR increase in Plan_CBCT was much smaller (about 0.4%). Considering only the contribution of the imaging dose, the EAR values for the ipsilateral lung due to the MV-EPID dose in 5 years,10 years and 15 years were 1.49 cases, 2.09 cases and 2.88 cases per 10⁴PY respectively, and those due to the kV-CBCT dose were about 9 times lower, correspondingly.

Conclusions:

The imaging doses produced by MV-EPID and kV-CBCT had little effects on the target dose coverage. The secondary cancer risk caused by MV-EPID dose is more than 8.5 times that of kV-CBCT.

Effect of MU-weighted multi-leaf collimator position error on dose distribution of SBRT radiotherapy in peripheral non-small cell lung cancer

PURPOSE

Position accuracy of the multi-leaf collimator (MLC) is essential in stereotactic body radiotherapy (SBRT). This study is aimed to investigate the dosimetric impacts of the MU-weighted MLC positioning uncertainties of SBRT for patients with early stage peripheral non-small cell lung cancer (NSCLC).

METHODS

Three types of MLC position error were simulated: Type 1, random error; Type 2, system shift, in which both MLC banks shifted to the left or right direction; and Type 3, in which both MLC banks moved with same magnitudes in the opposite directions. Two baseline plans were generated: an automatic plan (AP) and a manually optimized plan (MP). Multi-leaf collimator position errors were introduced to generate simulated plans with the preset MLC leaf position errors, which were then reimported into the Pinnacle system to generate simulated plans, respectively. The dosimetric parameters (CI, nCI, GI, etc.) and gEUD values of PTV and OARs were calculated. Linear regression between MU-weighted/unweighted MLC position error and gEUD was performed to obtain dose sensitivity.

RESULTS

The dose sensitivities of the PTVs were -4.93, -38.94, -41.70, -55.55, and 30.33 Gy/mm for random, left shift, right shift, system close, and system open MLC errors, respectively. There were significant differences between the MU-weighted and the unweighted dose sensitivity, which was -38.94 Gy/mm vs -3.42 Gy/mm (left shift), -41.70 Gy/mm vs -3.56 Gy/mm (right shift), -55.55 Gy/mm vs -4.84 Gy/mm (system close), and 30.33 vs 2.64 Gy/mm (system open). For the system open/close MLC errors, as the PTV volume became larger, the dose sensitivity decreased. APs provided smaller dose sensitivity for the system shift and system close MLC errors compared to the conventional MPs.

CONCLUSIONS

There was significant difference in dose sensitivity between MU-weighted and unweighted MLC position error of SBRT radiotherapy in peripheral NSCLC. MU is suggested to be included in the dosimetric evaluation of the MLC misalignments, since it is much closer to clinical radiotherapy.

Thermodynamic and microstructural study of Ti2AlNb oxides at 800 °C

The high-temperature structural applications of Ti2AlNb-based alloys, such as in jet engines and gas turbines, inevitably require oxidation resistance. The objective of this study is to seek fundamental insight into the oxidation behavior of a Ti2AlNb-based alloy via detailed microstructural characterization of oxide scale and scale/substrate interface after oxidation at 800 °C using X-ray diffraction (XRD), scanning electron microscopy (SEM), electron probe microanalysis (EPMA), and transmission electron microscopy (TEM). The oxide scale exhibits a complex multi-layered structure consisting of (Al,Nb)-rich mixed oxide layer (I)/mixed oxide layer (II)/oxygen-rich layer (III)/substrate from the outside to inside, where the substrate is mainly composed of B2 and O-Ti2AlNb phases. High-resolution TEM examinations along with high-angle annular dark-field (HAADF) imaging reveal: (1) the co-existence of two types (α and δ) of Al2O3 oxides in the outer scale, (2) the presence of metastable oxide products of TiO and Nb2O5, (3) an amorphous region near the scale/substrate interface including the formation of AlNb2, and (4) O-Ti2AlNb phase oxidized to form Nb2O5, TiO2 and Al2O3.

A biomechanical, radiologic, and clinical comparison of outcome after multilevel cervical laminectomy or laminoplasty in the rabbit

STUDY DESIGN

A rabbit model was used to compare clinical outcome, radiographic changes, and biomechanical flexibility after cervical laminectomy and open-door laminoplasty.

OBJECTIVE

This study tested the hypothesis that radiographic changes and biomechanical flexibility could explain the differences in clinical outcome after cervical laminectomy and laminoplasty.

SUMMARY OF BACKGROUND DATA

Although multilevel cervical laminoplasty is thought to have advantages over cervical laminectomy, clinical outcome studies have been contradictory, and no experimental study has examined the possible mechanisms for the differences after healing.

METHODS

Twenty-four New Zealand White rabbits were randomized into four groups: normal, sham, C3-C6 wide laminectomy, and C3-C6 open-door laminoplasty. Clinical, radiographic, and biomechanical data were collected and compared up to 3 months after surgery.

RESULTS

Laminectomy had a statistically significant poorer clinical outcome when compared with laminoplasty after 3 months of healing. Radiologic analysis showed statistically significant angular deformity in the laminectomy group compared with laminoplasty and control groups at 3 months. In contrast, biomechanical measures of flexibility, neutral zone, and range of motion showed only small differences between any of the groups at any time.

CONCLUSIONS

The presence of deformity, and not a change in flexibility, is responsible for the differences in clinical outcome observed after laminectomy compared with laminoplasty in this model.

[Study of psychological nursing to ease pain during labor]

100 labouring women were selected in the hospital and divided into psychological support group and control group randomly (50 in each group) in this study. The former was given psychological education and support by special staff and the later was managed in routine methods. The result showed that the serious pain rate of the psychological support group was lower than that of the control group in the first stage of labour (P < 0.01). There was a significant difference between the pain levels in two groups in the second stage of labor (P < 0.05). The time of the first stage, the second stage, and total labor course in the psychological support group was shorter than that of the control group (P < 0.05). The normal labor rate of the psychological support group was much higher than that of the control group (P < 0.001). This study indicated that providing psychological support to the parturients may reduce the pain level during delivery and decrease the difficult labor rate.