Predicting respiratory motion for real-time tumour tracking in radiotherapy

Purpose. Radiation therapy is a local treatment aimed at cells in and around a tumor. The goal of this study is to develop an algorithmic solution for predicting the position of a target in 3D in real time, aiming for the short fixed calibration time for each patient at the beginning of the procedure. Accurate predictions of lung tumor motion are expected to improve the precision of radiation treatment by controlling the position of a couch or a beam in order to compensate for respiratory motion during radiation treatment. Methods. For developing the algorithmic solution, data mining techniques are used. A model form from the family of exponential smoothing is assumed, and the model parameters are fitted by minimizing the absolute disposition error, and the fluctuations of the prediction signal (jitter). The predictive performance is evaluated retrospectively on clinical datasets capturing different behavior (being quiet, talking, laughing), and validated in real-time on a prototype system with respiratory motion imitation. Results. An algorithmic solution for respiratory motion prediction (called ExSmi) is designed. ExSmi achieves good accuracy of prediction (error $4-9$ mm/s) with acceptable jitter values (5-7 mm/s), as tested on out-of-sample data. The datasets, the code for algorithms and the experiments are openly available for research purposes on a dedicated website. Conclusions. The developed algorithmic solution performs well to be prototyped and deployed in applications of radiotherapy

Clinical Utility of Echocardiography in Former Preterm Infants with Bronchopulmonary Dysplasia.

BackgroundThe clinical utility of echocardiography for the diagnosis of pulmonary vascular disease (PVD) in former preterm infants with bronchopulmonary dysplasia (BPD) is not established. Elevated pulmonary vascular resistance (PVR) rather than pulmonary artery pressure (PAP) is the hallmark of PVD. We evaluated the utility of echocardiography in infants with BPD in diagnosing pulmonary hypertension and PVD (PVR >3 Wood units × m2) assessed by cardiac catheterization.MethodsA retrospective single center study of 29 infants born ≤29 weeks of gestational age with BPD who underwent cardiac catheterization and echocardiography was performed. PVD was considered present by echocardiography if the tricuspid valve regurgitation jet peak velocity was >2.9 m/sec, post-tricuspid valve shunt systolic flow velocity estimated a right ventricular systolic pressure >35 mm Hg, or systolic septal flattening was present. The utility (accuracy, sensitivity, and positive predictive value [PPV]) of echocardiography in the diagnosis of PVD was tested. Subgroup analysis in patients without post-tricuspid valve shunts was performed. Echocardiographic estimations of right ventricular pressure, dimensions, function, and pulmonary flow measurements were evaluated for correlation with PVR.ResultsThe duration between echocardiography and cardiac catheterization was a median of 1 day (interquartile range, 1-4 days). Accuracy, sensitivity, and PPV of echocardiography in diagnosing PVD were 72%, 90.5%, and 76%, respectively. Accuracy, sensitivity, and PPV increased to 93%, 91.7%, and 100%, respectively, when infants with post-tricuspid valve shunts were excluded. Echocardiography had poor accuracy in estimating the degree of PAP elevation by cardiac catheterization. In infants without post-tricuspid valve shunts, there was moderate to good correlation between indexed PVR and right ventricular myocardial performance index (rho = 0.89, P = .005), systolic to diastolic time index (0.84, P < .001), right to left ventricular diameter ratio at end systole (0.66, P = .003), and pulmonary artery acceleration time (0.48, P = .05).ConclusionsEchocardiography performs well in screening for PVD in infants with BPD and may be diagnostic in the absence of a post-tricuspid valve shunt. However, cardiac catheterization is needed to assess the degree of PAP elevation and PVR. The diagnostic utility of echocardiographic measurements that correlate with PVR should be evaluated prospectively in this patient population

Individualisation of time-motion analysis : a method comparison and case report series

© Georg Thieme Verlag KG. This study compared the intensity distribution of time-motion analysis data, when speed zones were categorized by different methods. 12 U18 players undertook a routine battery of laboratory- and field-based assessments to determine their running speed corresponding to the respiratory compensation threshold (RCT), maximal aerobic speed (MAS), maximal oxygen consumption (vVO 2max ) and maximal sprint speed (MSS). Players match-demands were tracked using 5 Hz GPS units in 22 fixtures (50 eligible match observations). The percentage of total distance covered running at high-speed (%HSR), very-high speed (%VHSR) and sprinting were determined using the following speed thresholds: 1) arbitrary; 2) individualised (IND) using RCT, vVO 2max and MSS; 3) individualised via MAS per se; 4) individualised via MSS per se; and 5) individualised using MAS and MSS as measures of locomotor capacities (LOCO). Using MSS in isolation resulted in 61 % and 39 % of player's % HSR and % VHSR, respectively, being incorrectly interpreted, when compared to the IND technique. Estimating the RCT from fractional values of MAS resulted in erroneous interpretations of % HSR in 50 % of cases. The present results suggest that practitioners and researchers should avoid using singular fitness characteristics to individualise the intensity distribution of time-motion analysis data. A combination of players' anaerobic threshold, MAS, and MSS characteristics are recommended to individualise player-tracking data