Enhanced structure-function relationship in glaucoma with an anatomically and geometrically accurate neuroretinal rim measurement

yesPurpose: To evaluate the structure–function relationship between disc margin–based rim area (DM-RA) obtained with confocal scanning laser tomography (CSLT), Bruch's membrane opening–based horizontal rim width (BMO-HRW), minimum rim width (BMO-MRW), peripapillary retinal nerve fiber layer thickness (RNFLT) obtained with spectral-domain optical coherence tomography (SD-OCT), and visual field sensitivity. Methods: We examined 151 glaucoma patients with CSLT, SD-OCT, and standard automated perimetry on the same day. Optic nerve head (ONH) and RNFL with SD-OCT were acquired relative to a fixed coordinate system (acquired image frame [AIF]) and to the eye-specific fovea-BMO center (FoBMO) axis. Visual field locations were mapped to ONH and RNFL sectors with fixed Garway-Heath (VFGH) and patient-specific (VFPS) maps customized for various biometric parameters. Results: Globally and sectorally, the structure–function relationships between DM-RA and VFGH, BMO-HRWAIF and VFGH, and BMO-HRWFoBMO and VFPS were equally weak. The R2 for the relationship between DM-RA and VFGH ranged from 0.1% (inferonasal) to 11% (superotemporal) whereas that between BMO-HRWAIF and VFGH ranged from 0.1% (nasal) to 10% (superotemporal). Relatively stronger global and sectoral structure–function relationships with BMO-MRWAIF and with BMO-MRWFoBMO were obtained. The R2 between BMO-MRWAIF and VFGH ranged from 5% (nasal) to 30% (superotemporal), whereas that between BMO-MRWFoBMO and VFPS ranged from 5% (nasal) to 25% (inferotemporal). The structure–function relationship with RNFLT was not significantly different from that with BMO-MRW, regardless of image acquisition method. Conclusions: The structure–function relationship was enhanced with BMO-MRW compared with the other neuroretinal rim measurements, due mainly to its geometrically accurate properties

Neighborhood search approaches to non-coplanar beam orientation optimization for total marrow irradiation using IMRT

We consider the beam orientation optimization (BOO) problem for total marrow irradiation (TMI) treatment planning using intensity modulated radiation therapy (IMRT). Currently, IMRT is not widely used in TMI treatment delivery; furthermore, the effect of using non-coplanar beam orientations is not known. We propose and implement several variations of a single neighborhood search algorithm that solves the BOO problem effectively when gantry angles and couch translations are considered. Our work shows that the BOO problem for TMI cases can be solved in a clinically acceptable amount of time and leads to treatment plans that are more effective than the conventional approach to TMI.Total marrow irradiation Total body irradiation Intensity modulated radiation therapy Radiotherapy optimization Local search Beam orientation optimization