Variability in spine radiosurgery treatment planning - results of an international multi-institutional study

Background: The aim of this study was to quantify the variability in spinal radiosurgery (SRS) planning practices between five international institutions, all member of the Elekta Spine Radiosurgery Research Consortium. Methods: Four institutions provided one representative patient case each consisting of the medical history, CT and MR imaging. A step-wise planning approach was used where, after each planning step a consensus was generated that formed the basis for the next planning step. This allowed independent analysis of all planning steps of CT-MR image registration, GTV definition, CTV definition, PTV definition and SRS treatment planning. In addition, each institution generated one additional SRS plan for each case based on intra-institutional image registration and contouring, independent of consensus results. Results: Averaged over the four cases, image registration variability ranged between translational 1.1 mm and 2.4 mm and rotational 1.1° and 2.0° in all three directions. GTV delineation variability was 1.5 mm in axial and 1.6 mm in longitudinal direction averaged for the four cases. CTV delineation variability was 0.8 mm in axial and 1.2 mm in longitudinal direction. CTV-to-PTV margins ranged between 0 mm and 2 mm according to institutional protocol. Delineation variability was 1 mm in axial directions for the spinal cord. Average PTV coverage for a single fraction18 Gy prescription was 87 ± 5 %; Dmin to the PTV was 7.5 ± 1.8 Gy averaged over all cases and institutions. Average Dmax to the PRV_SC (spinal cord + 1 mm) was 10.5 ± 1.6 Gy and the average Paddick conformity index was 0.69 ± 0.06. Conclusions: Results of this study reflect the variability in current practice of spine radiosurgery in large and highly experienced academic centers. Despite close methodical agreement in the daily workflow, clinically significant variability in all steps of the treatment planning process was demonstrated. This may translate into differences in patient clinical outcome and highlights the need for consensus and established delineation and planning criteria

High efficiency realization for a wide-coverage unification grammar

We give a detailed account of an algorithm for efficient tactical generation from underspecified logical-form semantics, using a wide-coverage grammar and a corpus of real-world target utterances. Some earlier claims about chart realization are critically reviewed and corrected in the light of a series of practical experiments. As well as a set of algorithmic refinements, we present two novel techniques: the integration of subsumption-based local ambiguity factoring, and a procedure to selectively unpack the generation forest according to a probability distribution given by a conditional, discriminative model

The global positioning system and its application to enhanced 911

Near term development in the area of location determination is being driven by the need to meet an FCC mandate to provide emergency services to a rapidly growing number of cellular phone users. Many approaches are being considered to meet this enhanced 911 (E911) mandate including various applications of existing cellular technology as well as the application of the Global Positioning System (GPS). This paper describes the requirements for E911 and examines the use of the GPS for providing E911 service. The GPS concept is explored and explained using an analytical model developed with Microsoft's Excel. The results from the Excel model are presented and shown to compare well with those of a similar model. Sources of GPS position errors are then described and their effects are quantified. Techniques for mitigating these errors are also described. Finally, other competing concepts for E911 location determination are presented and compared to the GPS based approach. It is then explained that through error reduction and cost effective handset integration, the GPS can be a viable approach for enhanced 911.Includes bibliographical references (leaves 46-47)California State University, Northridge. Department of Engineering

A laminated polymer film formulation for enteric delivery of live vaccine and probiotic bacteria

Live bacterial cells (LBC) are administered orally as attenuated vaccines, to deliver biopharmaceutical agents, and as probiotics to improve gastrointestinal health. However, LBC present unique formulation challenges and must survive gastrointestinal antimicrobial defenses including gastric acid after administration. We present a simple new formulation concept, termed Polymer Film Laminate (PFL). LBC are ambient dried onto cast acid-resistant enteric polymer films that are then laminated together to produce a solid oral dosage form. LBC of a model live bacterial vaccine and a probiotic were dried directly onto a cast film of enteric polymer. The effectiveness at protecting dried cells in a simulated gastric fluid (pH 2.0) depended on the composition of enteric polymer film used, with a blend of ethylcellulose plus Eudragit L100 55 providing greater protection from acid than Eudragit alone. However, although PFL made from blended polymers films completely released low molecular weight dye into intestinal conditions (pH 7.0), they failed to release LBC. In contrast, PFL made from Eudragit alone successfully protected dried probiotic or vaccine LBC from simulated gastric fluid for 2h, and subsequently released all viable cells within 60min of transfer into simulated intestinal fluid. Release kinetics could be controlled by modifying the lamination method