Evaluating the Gray Level Co-Occurrence Matrix-Based Texture Features of Magnetic Resonance Images for Glioblastoma Multiform Patients' Treatment Response Assessment

Background

Medical images of cancer patients are usually evaluated qualitatively by clinical specialists which makes the accuracy of the diagnosis subjective and related to the skills of clinicians. Quantitative methods based on the textural feature analysis may be useful to facilitate such evaluations. This study aimed to analyze the gray level co-occurrence matrix (GLCM)-based texture features extracted from T1-axial magnetic resonance (MR) images of glioblastoma multiform (GBM) patients to determine the distinctive features specific to treatment response or disease progression.

Methods

20 GLCM-based texture features, in addition to mean, standard deviation, entropy, RMS, kurtosis, and skewness were extracted from step I MR images (obtained 72 h after surgery) and step II MR images (obtained three months later). Responded and not responded patients to treatment were classified manually based on the radiological evaluation of step II images. Extracted texture features from Step I and Step II images were analyzed to determine the distinctive features for each group of responsive or progressive diseases. MATLAB 2020 was applied to feature extraction. SPSS version 26 was used for the statistical analysis. P value < 0.05 was considered statistically significant.

Results

Despite no statistically significant differences between Step I texture features for two considered groups, almost all step II extracted GLCM-based texture features in addition to entropy M and skewness were significantly different between responsive and progressive disease groups.

Conclusions

GLCM-based texture features extracted from MR images of GBM patients can be used with automatic algorithms for the expeditious prediction or interpretation of response to the treatment quantitatively besides qualitative evaluations.

Auto-segmentation of head and neck tumors in positron emission tomography images using non-local means and morphological frameworks

Purpose

Accurately segmenting head and neck cancer (HNC) tumors in medical images is crucial for effective treatment planning. However, current methods for HNC segmentation are limited in their accuracy and efficiency. The present study aimed to design a model for segmenting HNC tumors in three-dimensional (3D) positron emission tomography (PET) images using Non-Local Means (NLM) and morphological operations.

Material and Methods

The proposed model was tested using data from the HECKTOR challenge public dataset, which included 408 patient images with HNC tumors. NLM was utilized for image noise reduction and preservation of critical image information. Following pre-processing, morphological operations were used to assess the similarity of intensity and edge information within the images. The Dice score, Intersection Over Union (IoU), and accuracy were used to evaluate the manual and predicted segmentation results.

Results

The proposed model achieved an average Dice score of 81.47 ± 3.15, IoU of 80 ± 4.5, and accuracy of 94.03 ± 4.44, demonstrating its effectiveness in segmenting HNC tumors in PET images.

Conclusions

The proposed algorithm provides the capability to produce patient-specific tumor segmentation without manual interaction, addressing the limitations of current methods for HNC segmentation. The model has the potential to improve treatment planning and aid in the development of personalized medicine. Additionally, this model can be extended to effectively segment other organs from limited annotated medical images.

Green synthesis of 2,4-dinitro-substituted bischalcones using bifunctional magnetic nanocatalyst

Flavonoids have many biological properties, such as anticancer activity. Chalcones, one of their subunits, attribute their biological activity to their enone part. The presence of dinitrophenyl group in bischalcone because of its radiosensitivity property is important. Radiosensitivity property reduces radiation time in cancer patients and reduces damage to their healthy tissues. In this regard, 2,4-dinitrophenyl bischalcones were synthesized. The presence of 2,4-dinitrobenzaldehyde as a fixed component in synthesis pathway, leads to a reduction in yield of synthesis by common catalysts. Therefore, in this study, for bis-chalone synthesis, we used Graphene Oxide/Fe3O4/L-Proline nanocomposite as a green recoverable bifunctional organocatalyst. This catalyst was recovered simply by applying an external magnet and reused for eight runs. In this research, chalcones and asymmetric bis-chalcones have been synthesized with diverse substitutes in high yields (78–97%). Also, short reaction times (10–82 min), and simple experimental procedures with easy work-up are advantages of the introduced procedure. The synthesized compounds were characterized by melting point and analytical techniques. The chemical structures of synthesized compounds were confirmed by means of IR, 1HNMR, and 13CNMR.

Evaluating the effects of variation in CT scanning parameters on the image quality and Hounsfield units for optimization of dose in radiotherapy treatment planning: A semi-anthropomorphic thorax phantom study

Aim

The diagnosis accuracy of computed tomography (CT) systems and the reliability of calculated Hounsfield Units (HUs) are critical in tumor detection and cancer patients' treatment planning. This study evaluated the effects of scan parameters (Kilovoltage peak or kVp, milli-Ampere-second or mAS reconstruction kernels and algorithms, reconstruction field of view, and slice thickness) on image quality, HUs, and the calculated dose in the treatment planning system (TPS).

Materials and Methods

A quality dose verification phantom was scanned several times by a 16-slice Siemens CT scanner. The DOSIsoft ISO gray TPS was applied for dose calculations. The SPSS.24 software was used to analyze the results and the P-value <0.05 was considered significant.

Results

Reconstruction kernels and algorithms significantly affected noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). The noise increased and CNR decreased by raising the sharpness of reconstruction kernels. SNR and CNR had considerable increments at iterative reconstruction compared with the filtered back-projection algorithm. The noise decreased by raising mAS in soft tissues. Also, KVp had a significant effect on HUs. TPS--calculated dose variations were less than 2% for mediastinum and backbone and less than 8% for rib.

Conclusions

Although HU variation depends on image acquisition parameters across a clinically feasible range, its dosimetric impact on the calculated dose in TPS can be neglected. Hence, it can be concluded that the optimized values of scan parameters can be applied to obtain the maximum diagnostic accuracy and calculate HUs more precisely without affecting the calculated dose in the treatment planning of cancer patients.

Brachytherapy outcome modeling in cervical cancer patients: A predictive machine learning study on patient-specific clinical, physical and dosimetric parameters

PURPOSE

To predict clinical response in locally advanced cervical cancer (LACC) patients by a combination of measures, including clinical and brachytherapy parameters and several machine learning (ML) approaches.

METHODS

Brachytherapy features such as insertion approaches, source metrics, dosimetric, and clinical measures were used for modeling. Four different ML approaches, including LASSO, Ridge, support vector machine (SVM), and Random Forest (RF), were applied to extracted measures for model development alone or in combination. Model performance was evaluated using the area under the curve (AUC) of receiver operating characteristics curve, sensitivity, specificity, and accuracy. Our results were compared with a reference model developed by simple logistic regression applied to three distinct clinical features identified by previous papers.

RESULTS

One hundred eleven LACC patients were included. Nine data sets were obtained based on the features, and 36 predictive models were built. In terms of AUC, the model developed using RF applied to dosimetric, physical, and total BT sessions features were found as the most predictive [AUC; 0.82 (0.95 confidence interval (CI); 0.79 -0.93), sensitivity; 0.79, specificity; 0.76, and accuracy; 0.77]. The AUC (0.95 CI), sensitivity, specificity, and accuracy for the reference model were found as 0.56 (0.52 ...0.68), 0.51, 0.51, and 0.48, respectively. Most RF models had significantly better performance than the reference model (Bonferroni corrected p-value < 0.0014).

CONCLUSION

Brachytherapy response can be predicted using dosimetric and physical parameters extracted from treatment parameters. Machine learning algorithms, including Random Forest, could play a critical role in such predictive modeling.

Segmentation of the prostate, its zones, anterior fibromuscular stroma, and urethra on the MRIs and multimodality image fusion using U-Net model

Background

Due to the large variability in the prostate gland of different patient groups, manual segmentation is time-consuming and subject to inter-and intra-reader variations. Hence, we propose a U-Net model to automatically segment the prostate and its zones, including the peripheral zone (PZ), transitional zone (TZ), anterior fibromuscular stroma (AFMS), and urethra on the MRI [T2-weighted (T2W), diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC)], and multimodality image fusion.

Methods

A total of 91 eligible patients were retrospectively identified; 50 patients were considered for training process in a 10-fold cross-validation fashion and 41 ones for external test. Firstly, images were registered, and cropping was performed through a bounding box. In addition to T2W, DWI, and ADC separately, fused images were used. We considered three combinations, including T2W + DWI, T2W + ADC, and DWI + ADC, using wavelet transform. U-Net was applied to segment the prostate and its zones, AFMS, and urethra in a 10-fold cross-validation fashion. Eventually, dice score (DSC), intersection over union (IoU), precision, recall, and Hausdorff distance (HD) were used to evaluate the proposed model.

Results

Using T2W images alone on the external test images, higher DSC, IoU, precision, and recall was achieved than the individual DWI and ADC images. DSC of 95%, 94%,98%, 94%, and 88%, IoU of 88%, 88.5%, 96%, 90%, and 79%, precision of 95.9%, 93.9%, 97.6%, 93.83%, and 87.82%, and recall of 94.2%, 94.2%, 98.3%, 94%, 87.93% was achieved for the whole prostate, PZ, TZ, urethra, and AFMS, respectively. The results clearly show that the best segmentation was obtained when the model is trained using T2W + DWI images. DSC of 99.06%, 99,05%, 99.04%, 99.09%, and 98.08%, IoU of 97.09%, 97.02%, 98.12%, 98.13%, and 96%, precision of 99.24%, 98.22%, 98.91%, 99.23%, and 98.9%, and recall of 98.3%, 99.8%, 99.02%, 98.93%, and 97.51% was achieved for the whole prostate, PZ, TZ, urethra, and AFMS, respectively. The min of the HD in the testing set for three combinations was 0.29 for the T2W + ADC procedure in the whole prostate class.

Conclusions

Better performance was achieved using T2W + DWI images than T2W, DWI, and ADC separately or T2W + ADC and DWI + ADC in combination.

Radiotherapy Interruption in Cancer Patients: Rates and Causes at Ahvaz Golestan Hospital

Introduction: Radiotherapy is one of the most common cancer treatment modalities. The goal of this study was to establish the rates and causes of radiotherapy interruptions in cancer patients at Ahvaz Golestan Hospital.Methods: In this retrospective study, the data were collected during period from 2012 to 2013, from cancer patients who received radiation therapy at Golestan Hospital. Demographic characteristics and radiotherapy interruption frequency and reasons were reviewed and analyzed. Results: Among 1476 cases, 70.7% of patients had no radiotherapy interruption. The most common cause of treatment interruption was equipment damages and/or maintenance in 29.5% of patients. There were statistically significant relations between radiotherapy interruption with site of cancer (P=0.014) and living place of patients (P=0.006), respectively.Conclusion: Generally, treatment interruption at our center was not much higher than other centers; however, the most common cause of treatment interruption was equipment damages and/or maintenance, which was higher than most centers.

Calculation of Equivalent Square Fields in Radiation Therapy by an Improved Vadash Correction Factor for Collimator Exchange Effects

Background and objectives:

To determine the head scatter factor, a formalism presented by Vadash and Bjärngard has been employed to assess collimator exchange effects. The aim of this study was to determine the best Vadash correction factor (A) by introducing a new method based on the output factor measured in air for different square and rectangular fields.

Materials and Methods:

A new simple mathematical method based on selection of the best dosimetric data was proposed to obtain the A value for Vadash to predict the equivalent square field size. Measurements were performed with a Farmer chamber 0.6 cc in SSD 100 cm and build up cap of Plexiglas, 1.5 and 3.5 cm equal to water, for 6 and 18 MV, respectively, with a Perimus Plus linear accelerator. The output factor in air (OF_air) was measured for square and rectangular fields. MATLAB software (version R2014a) was employed for calculations and curve fitting.

Results:

A power model with a constant value was applied to the output factor in air as a function of square field size. The output factor in air ranged from 0.983 to 1.038 at 6MV and from 0.731 to 1.05 at 18 MV with the Y collimator having a greater effect. Obtained values for A were 1.42 and 1.55 with respect to σ_min=0.98 and 2.3 for 6 and 18 MV energies, respectively.

Conclusion:

The proposed A values minimize the collimator exchange effect in calculating equivalent squares, which plays an important role in patient dose calculation and treatment planning.

Radiotherapy Enhancement with Electroporation in Human Intestinal Colon Cancer HT-29 Cells

Background: The efficiency of radiotherapy for tumors can be enhanced with different radiosensitizers. Previous studies have shown that electroporation (EP) can sensitize some cancer cell lines to ionizing radiation (IR). HT-29 is a radiation resistant colorectal cancer cell line, representative of a cancer type which is the second cause of cancer mortalities in developed countries. The present study aimed to evaluate radiosensitizing effects of EP on HT-29 cells in vitro exposed to 6 MV X-ray photon beams. Methods: HT-29 cells were exposed to a 6 MV X-ray photon beam as the control or to a combination of electroporation and irradiation. The response of cells was evaluated by colony formation assay and survival curves. Results: The survival fraction of the HT-29 cells was significantly decreased by electroporation prior to radiotherapy. A single electric pulse increased colorectal HT-29 cancer cell sensitivity to megavoltage radiation by a factor of 1.36. Conclusion: Our findings showed that EP before radiotherapy can significantly enhance tumor cell sensitivity. This combined treatment modality should be assessed for its applicability in clinic settings for employment against radioresistant cancers. However, to facilitate achieving this goal, many different tumors with a broad range of radiosensitivities should be evaluated.

Analytical investigation of magnetic field effects on Proton lateral deflection and penetrating depth in the water phantom: A relativistic approach

Background

Integrated proton therapy - MRI systems are capable of delivering high doses to the target tissues near sensitive organs and achieve better therapeutic results; however, the applied magnetic field for imaging, influences the protons path, changes the penetration depth and deflects the particles, laterally, leading to dose distribution variations.

Objective

To determine the effects of a magnetic field on the range and the lateral deflection of protons, analytically.

Methods

An analytical survey based on protons energy and range power law relation, without using small angle assumption was done. The penetration depth and lateral deflection of protons with therapeutic energy ranges 60–250 MeV in the presence of uniform magnetic fields of 0–10T intensities, were calculated analytically. Calculations were done for relativistic conditions with Mathematica software version 7.0, and MATLAB 7.0 was applied to plot curves and curve fittings.

Results

In the presence of a magnetic field, the depth of Bragg peak was decreased and it was shifted laterally. A second order polynomial model with power equation for its coefficients and a power model with quadratic polynomial coefficients predicted the maximum lateral deflection (y_max) and maximum penetration depth (z_max) variations with energy and magnetic field intensity, respectively.

Conclusion

The applied correction for deflection angle will give more reliable results in initial energy of 250 MeV and 3T magnetic field intensity. For lower energies and magnetic field intensities the differences are negligible, clinically.

Assessment of two hemispherical and hemispherical-conical miniature sources used in electronic brachytherapy using Monte Carlo Simulation

Introduction

Since the heart of the electronic brachytherapy system is a tube of a miniature x-ray and due to the increasing use of electronic brachytherapy, there is an urgent need for acquiring knowledge about the X-ray spectrum produced, and distribution of x-ray dose. This study aimed to assess the optimal target thickness (TT), the X-ray source spectrum, and the absorbed dose of two miniature sources of hemispherical and hemispherical-conical used in electronic brachytherapy systems, through a Monte Carlo simulation.

Methods

Considering the advantages of MCNPX Code (2.6.0), two input files corresponding to the characteristics of the investigated miniature sources were prepared for this code and then were used for simulation. The optimal thickness (OT) of gold and tungsten targets was determined for the energy levels of 40, 45, and 50 kilo-electron-volts.

Results

In this study, the values of the size of the optimal thickness of 0.92, 1.01 and 1.06 μ for gold target and values of 0.99, 1.08 and 1.34 μ for tungsten target were obtained for energies 40, 45 and 50 keV that using these values, the optimum thickness of 0.92, X-ray spectrum within and outside targets, axial and radial doses for the used energy were calculated for two miniature sources.

Conclusion

It was found that the energy of incident electron, target shape, cross-sectional area of the produced bremsstrahlung, atomic number of materials constituting of the target and output window are the factors with the greatest impacts on the produced X-ray spectrum and the absorbed dose.

Dose-Response Curves of the FDXR and RAD51 Genes with 6 and 18 MV Beam Energies in Human Peripheral Blood Lymphocytes

BACKGROUND

Rapid dose assessment using biological dosimetry methods is essential to increase the chance of survival of exposed individuals in radiation accidents.

OBJECTIVES

We compared the expression levels of the FDXR and RAD51 genes at 6 and 18 MV beam energies in human peripheral blood lymphocytes. The results of our study can be used to analyze radiation energy in biological dosimetry.

METHODS

For this in vitro experimental study, from 36 students in the medical physics and virology departments, seven voluntary, healthy, non-smoking male blood donors of Khuzestan ethnicity with no history of exposure to ionization radiation were selected using simple randomized sampling. Sixty-three peripheral blood samples were collected from the seven healthy donors. Human peripheral blood was then exposed to doses of 0, 0.2, 0.5, 2, and 4 Gy with 6 and 18 MV beam energies in a Linac Varian 2100C/D (Varian, USA) at Golestan hospital in Ahvaz, Iran. After RNA extraction and cDNA synthesis, the expression levels of FDXR and RAD51 were determined 24 hours post-irradiation using the gel-purified reverse transcription polymerase chain reaction (RT-PCR) technique and TaqMan strategy (by real-time PCR).

RESULTS

The expression level of FDXR gene was significantly increased at doses of 2 Gy and 4 Gy in the 6 - 18 MV energy range (P < 0.001 and P < 0.008, respectively). The medians with interquartile ranges (IQRs) of the copy numbers of the FDXR gene at 2 Gy and 4 Gy doses under 6 and 18 MV beam energies were 2393.59 (1798.21, 2575.37) and 2983.00 (2199.48, 3643.82) and 3779.12 (3051.40, 5120.74) and 5051.26 (4704.83, 5859.17), respectively. However, RAD51 gene expression levels only showed a significant difference between samples at a dose of 2 Gy with 6 and 18 MV beam energies, respectively (P < 0.040). The medians with IQRs of the copy numbers of the RAD51 gene were 2092.77 (1535.78, 2705.61) and 3412.57 (2979.72, 4530.61) at beam energies of 6 and 18 MV, respectively.

CONCLUSIONS

The data suggest that the expression analysis of the FDXR gene, contrary to that of the RAD51 gene, may be suitable for assessment of high-energy X-ray. In addition, RAD51 is not a suitable gene for dose assessment in biological dosimetry.

An Analytical Method to Calculate Phantom Scatter Factor for Photon Beam Accelerators

Introduction

One of the important input factors in the commissioning of the radiotherapy treatment planning systems is the phantom scatter factor (Sp) which requires the same collimator opening for all radiation fields. In this study, we have proposed an analytical method to overcome this issue.

Methods

The measurements were performed using Siemens Primus Plus with photon energy 6 MV for field sizes from 5×5cm² to 40×40cm². Phantom scatter factor was measured through the division of total scatter output factors (Scp), and collimator scatter factor (Sc).

Results

The mean percent difference between the measured and calculated Sp was 1.00% and -3.11% for 5×5, 40×40 cm² field size respectively.

Conclusion

This method is applicable especially for small fields used in IMRT which, measuring collimator scatter factor is not reliable due to the lateral electron disequilibrium.

Dosimetric Characteristics of 6 MV Modified Beams by Physical Wedges of a Siemens Linear Accelerator

Physical wedges still can be used as missing tissue compensators or filters to alter the shape of isodose curves in a target volume to reach an optimal radiotherapy plan without creating a hotspot. The aim of this study was to investigate the dosimetric properties of physical wedges filters such as off-axis photon fluence, photon spectrum, output factor and half value layer. The photon beam quality of a 6 MV Primus Siemens modified by 150 and 450 physical wedges was studied with BEAMnrc Monte Carlo (MC) code. The calculated present depth dose and dose profile curves for open and wedged photon beam were in good agreement with the measurements. Increase of wedge angle increased the beam hardening and this effect was more pronounced at the heal region. Using such an accurate MC model to determine of wedge factors and implementation of it as a calculation algorithm in the future treatment planning systems is recommended.

Determination of an Effective Wedge Angle by Combination of Two Arbitrary Universal Wedge Fields in Radiation Therapy of Cancer Patients with Megavoltage Photon Beams

BACKGROUND

Wedge filters are commonly used in radiation oncology for eliminating hot spots and creating a uniform dose distribution in optimizing isodose curves in the target volume for clinical aspects. These are some limited standard physical wedges (15°, 30°, 45°, 60°),or creating an arbitrary wedge angle, like motorized wedge or dynamic wedge,... The new formulation is presented by the combination of wedge fields for determining an arbitrary effective wedge angles. The isodose curves also are derived for these wedges.

MATERIALS AND METHODS

we performed the dosimetry of Varian Clinac 2100C/D with Scanditronix Wellhofer water blue phantom, CU500E, OmniPro - Accept software and 0.13cc ionization chamber for 6Mv photon beam in depth of 10cm (reference depth) for universal physical wedges (15°, 30°, 45°, and 60°) and reference field 10x10cm2. By combining the isodose curve standard wedge fields with compatible weighting dose for each field, the effective isodose curve is calculated for any wedge angle.

RESULTS

The relation between a given effective wedge angle and the weighting of each combining wedge fields was derived. A good agreement was found between the measured and calculated wedge angles and the maximum deviation did not exceed 3°. The difference between the measured and calculated data decreased when the combined wedge angles were closer. The results are in agreement with the motorized single wedge appliance in the literature.

CONCLUSIONS

This technique showed that the effective wedge angle that is obtained from this method is adequate for clinical applications and the motorized wedge formalism is a special case of this consideration.

Analytical Consideration of Surface Dose and Kerma for Megavoltage Photon Beams in Clinical Radiation Therapy

BACKGROUND

In radiation therapy, estimation of surface doses is clinically important. This study aimed to obtain an analytical relationship to determine the skin surface dose, kerma and the depth of maximum dose, with energies of 6 and 18 megavoltage (MV).

MATERIALS AND METHODS

To obtain the dose on the surface of skin, using the relationship between dose and kerma and solving differential equations governing the two quantities, a general relationship of dose changes relative to the depth was obtained. By dosimetry all the standard square fields of 5x5cm to 40x40cm, an equation similar to response to differential equations of the dose and kerma were fitted on the measurements for any field size and energy. Applying two conditions: a) equality of the area under dose distribution and kerma changes in versus depth in 6 and 18 MV, b) equality of the kerma and dose at x=dmax and using these results, coefficients of the obtained analytical relationship were determined. By putting the depth of zero in the relation, amount of PDD and kerma on the surface of the skin, could be obtained.

RESULTS

Using the MATLAB software, an exponential binomial function with R-Square >0.9953 was determined for any field size and depth in two energy modes 6 and 18MV, the surface PDD and kerma was obtained and both of them increase due to the increase of the field, but they reduce due to increased energy and from the obtained relation, depth of maximum dose can be determined.

CONCLUSIONS

Using this analytical formula, one can find the skin surface dose, kerma and thickness of the buildup region.

Hypothalamic-pituitary-gonadal axis responses of the male rats to short and long time alternative magnetic fields (50 Hz) exposure

BACKGROUND

Electromagnetic fields are associated with production, transmission and use of electricity. In this study we have investigated the effects of short and long time alternative magnetic fields' (AMF, 50 Hz) exposure on the secretion of hypothalamic-pituitary-gonadal axis in the male rats.

METHODS

Forty eight Wistar male rats, same range of age and weight were divided into four groups and each group contained 12 rats. After one-week adaptation each group were exposed to AMF (0, 25, 50 and 100 μT respectively) for 17 days, 5 hours a day. In the second protocol the time of exposure extended to 34 days. After experiments rats' blood serums were removed from their blood samples and kept frozen for usage. The results were analyzed by one way-ANOVA statistical method (p < 0.05).

RESULTS

Chronic exposures (5h/day for 34 days) to AMFs had no effect on serum's testosterone and LH. But, AMF at 100 μT induced an increase of serum's FSH level in comparison with 25 μT, 50 μT and control groups. In contrast, sub-chronic AMFs (5 h/day for 17 days) induced a decrease of serum's testosterone in control group in comparison with 25, 50 and 100 μT groups. But these AMFs had no effect on serum's LH and FSH levels.

CONCLUSIONS

Increased level of FSH suggests damage to the seminiferous tubules. Our results suggest that AMFs probably causes dysfunction in gonadal axis at the hypothalamic-pituitary level in male rats in different protocols.