Bragatston study protocol: a multicentre cohort study on automated quantification of cardiovascular calcifications on radiotherapy planning CT scans for cardiovascular risk prediction in patients with breast cancer

Introduction Cardiovascular disease (CVD) is an important cause of death in breast cancer survivors. Some breast cancer treatments including anthracyclines, trastuzumab and radiotherapy can increase the risk of CVD, especially for patients with pre-existing CVD risk factors. Early identification of patients at increased CVD risk may allow switching to less cardiotoxic treatments, active surveillance or treatment of CVD risk factors. One of the strongest independent CVD risk factors is the presence and extent of coronary artery calcifications (CAC). In clinical practice, CAC are generally quantified on ECGtriggered cardiac CT scans. Patients with breast cancer treated with radiotherapy routinely undergo radiotherapy planning CT scans of the chest, and those scans could provide the opportunity to routinely assess CAC before a potentially cardiotoxic treatment. The Bragatston study aims to investigate the association between calcifications in the coronary arteries, aorta and heart valves (hereinafter called ‘cardiovascular calcifications’) measured automatically on planning CT scans of patients with breast cancer and CVD risk. Methods and analysis In a first step, we will optimise and validate a deep learning algorithm for automated quantification of cardiovascular calcifications on planning CT scans of patients with breast cancer. Then, in a multicentre cohort study (University Medical Center Utrecht, Utrecht, Erasmus MC Cancer Institute, Rotterdam and Radboudumc, Nijmegen, The Netherlands), the association between cardiovascular calcifications measured on planning CT scans of patients with breast cancer (n≈16 000) and incident (non-)fatal CVD events will be evaluated. To assess the added predictive value of these calcifications over traditional CVD risk factors and treatment characteristics, a case-cohort analysis will be performed among all cohort members diagnosed with a CVD event during follow-up (n≈200) and a random sample of the baseline cohort (n≈600). Ethics and dissemination The Institutional Review Boards of the participating hospitals decided that the Medical R

Tunable plasmon resonances in anisotropic metal nanostructures

Coherent oscillations of free electrons in a metal, localized in a small volume or at an interface between a metal and a dielectric medium, have attracted a lot of attention in the past decades. These so-called surface plasmons have special optical properties that can be used in many applications ranging from optoelectronics to sensing of small quantities of molecules. One of the key issues is that electromagnetic energy can be confined to a relatively small volume close to the metal surface. This field enhancement and the resonance frequency strongly depend on the shape and size of the metal structures. In this thesis, several fabrication methods to create these metal structures on the nanometer to micrometer scale are presented. The optical properties are studied with a special emphasis on the effect of shape anisotropy. Self-assembled 2D colloidal crystals are used as mask to fabricate arrays of metal triangles on a substrate. One of the limitations of this nanosphere lithography technique is that the size of the holes in the colloidal mask (through which the metal is evaporated) is determined by the size of the colloids in the mask. The masks, however, can be modified by use of MeV ion beams and/or wet-chemical growth of a thin layer of silica, resulting in a reduced hole size. Arbitrary symmetry and spacing can be obtained by use of optical tweezers and angle-resolved metal deposition. In contrast to pure metals, amorphous materials like silica are known to show anisotropic plastic deformation at constant volume when subject to MeV ion irradiation. Gold cores embedded in a silica matrix, however, show an elongation along the direction of the ion beam, whereas silver cores rather disintegrate. Silver nanocrystals in an ion-exchanged soda-lime glass redistribute themselves in arrays along the ion beam direction. The optical extinction becomes polarization-dependent, with red- and blue-shifts of the plasmon resonances for polarizations longitudinal and transverse to the arrays, respectively. The band splitting is attributed to near-field electromagnetic plasmon coupling within the arrays. Finite difference time domain simulations indicate that the combination of particle center-to-center spacing and diameter, rather than inter-particle spacing alone, is the key parameter determining the coupling strength. The resonant electric field is concentrated in the very small gaps between the particles in the array. With the MeV ion beam technique, it is possible to fabricate large substrates with relatively monodisperse oblate ellipsoidal silica-core/metal-shell colloids, with the short axis aligned in the direction of the ion beam. The optical extinction of these particles, is a complex function of the core radius and the shell thickness, due to a competition between phase retardation effects and the coupling between the surface plasmons at the inner and outer surfaces of the shell. After deformation, the extinction is angle- and polarization-dependent. Calculations indicate that large Au-shell particles can sustain cavity modes, for which the electric field is enhanced in almost the full volume of the dielectric core. The resonance frequency is sensitive to the size, shape and dielectric constant of the core, and the polarization direction

Tunable plasmon resonances in anisotropic metal nanostructures

Coherent oscillations of free electrons in a metal, localized in a small volume or at an interface between a metal and a dielectric medium, have attracted a lot of attention in the past decades. These so-called surface plasmons have special optical properties that can be used in many applications ranging from optoelectronics to sensing of small quantities of molecules. One of the key issues is that electromagnetic energy can be confined to a relatively small volume close to the metal surface. This field enhancement and the resonance frequency strongly depend on the shape and size of the metal structures. In this thesis, several fabrication methods to create these metal structures on the nanometer to micrometer scale are presented. The optical properties are studied with a special emphasis on the effect of shape anisotropy. Self-assembled 2D colloidal crystals are used as mask to fabricate arrays of metal triangles on a substrate. One of the limitations of this nanosphere lithography technique is that the size of the holes in the colloidal mask (through which the metal is evaporated) is determined by the size of the colloids in the mask. The masks, however, can be modified by use of MeV ion beams and/or wet-chemical growth of a thin layer of silica, resulting in a reduced hole size. Arbitrary symmetry and spacing can be obtained by use of optical tweezers and angle-resolved metal deposition. In contrast to pure metals, amorphous materials like silica are known to show anisotropic plastic deformation at constant volume when subject to MeV ion irradiation. Gold cores embedded in a silica matrix, however, show an elongation along the direction of the ion beam, whereas silver cores rather disintegrate. Silver nanocrystals in an ion-exchanged soda-lime glass redistribute themselves in arrays along the ion beam direction. The optical extinction becomes polarization-dependent, with red- and blue-shifts of the plasmon resonances for polarizations longitudinal and transverse to the arrays, respectively. The band splitting is attributed to near-field electromagnetic plasmon coupling within the arrays. Finite difference time domain simulations indicate that the combination of particle center-to-center spacing and diameter, rather than inter-particle spacing alone, is the key parameter determining the coupling strength. The resonant electric field is concentrated in the very small gaps between the particles in the array. With the MeV ion beam technique, it is possible to fabricate large substrates with relatively monodisperse oblate ellipsoidal silica-core/metal-shell colloids, with the short axis aligned in the direction of the ion beam. The optical extinction of these particles, is a complex function of the core radius and the shell thickness, due to a competition between phase retardation effects and the coupling between the surface plasmons at the inner and outer surfaces of the shell. After deformation, the extinction is angle- and polarization-dependent. Calculations indicate that large Au-shell particles can sustain cavity modes, for which the electric field is enhanced in almost the full volume of the dielectric core. The resonance frequency is sensitive to the size, shape and dielectric constant of the core, and the polarization direction

Chemical modification of colloidal masks for nanolithography

A method is presented to tune the holes in colloidal masks used for nanolithography. Using a simple wet-chemical method, a thin layer of silica is grown on masks of silica particles. The size of the holes is controlled by the amount of tetraethoxysilane (TEOS) added. More accurate tuning of the hole size is possible in the presence of a calibrated seed dispersion of silica colloids.Wedemonstrate modified masks that were used to create arrays of metal nanoparticles with a size ranging from 400 nm, for unmodified masks, down to tens of nanometers. The method is easy-to-use, fast, and inexpensive

Optical properties of spherical and oblate spheroidal gold shell colloids

The surface plasmon modes of spherical and oblate spheroidal core−shell colloids composed of a 312 nm diameter silica core and a 20 nm thick Au shell are investigated. Large arrays of uniaxially aligned core−shell colloids with size aspect ratios ranging from 1.0 to 1.7 are fabricated using a novel ion irradiation technique. Angle- and polarization-resolved extinction spectroscopy is performed on the arrays. Extinction spectra on spherical particles reveal dipole, quadrupole, and octupole resonances in good agreement with calculations using Mie theory. Optical extinction measurements on oblate spheroidal core−shell show strong red- and blue-shifts for polarizations along major and minor axes, respectively, that increase with size anisotropy. The measured spectral shifts of the dipole, quadrupole, and octupole resonant modes with angle and anisotropy are in good agreement with T-matrix calculations. The data provide insight into the tunable resonant behavior of surface plasmons in oblate spheroidal core−shell particles

Optical cavity modes in gold shell colloids

Core-shell colloids composed of a dielectric core surrounded by a metal shell show geometric cavity resonances with optical properties that are distinctly different than those of the collective plasmon modes of the metal shell. We use finite-difference time domain calculations on silica colloids with a core diameter of 456 nm, surrounded by a 38 nm thick Au shell, to study the temporal evolution of the mode field intensity inside the cavity upon pulsed excitation. Calculations using Mie theory and the T-matrix method are used to analytically determine the dipolar cavity resonance spectrum, which is found superimposed on the broad collective dipolar plasmonic resonance modes. We characterize resonance wavelength and linewidth in terms of a geometric mode confined inside the cavity. Cavity linewidth can be controlled by metal shell thickness and quality factors Q>150 are observed. Due to the small cavity mode volume V=0.2(λ/n)3, a Purcell factor as high as P=54 is calculated. Introducing shape anisotropy lifts the cavity mode degeneracy, yielding blue- and redshifted longitudinal and transverse resonant modes, respectively. The relatively large volume over which the field enhancement is observed in these spherical and anisotropic metal shell cavities, combined with cavity quality factors that are much higher than that of the collective plasmonic modes, makes them attractive for application in nanoscale light sources, sensors, or lasers

Single-institution clinical experience using robust intensity modulated proton therapy in chordoma and chondrosarcoma of the mobile spine and sacrum: feasibility and need for plan adaptation

Background: Due to its specific physical characteristics, proton irradiation is especially suited for irradiation of chordomas and chondrosarcoma in the axial skeleton. Robust plan optimization renders the proton beam therapy more predictable upon individual setup errors. Reported experience with the planning and delivery of robustly optimized plans in chordoma and chondrosarcoma of the mobile spine and sacrum, is limited. In this study, we report on the clinical use of robustly optimized, intensity modulated proton beam therapy in these patients.Methods: We retrospectively reviewed patient, treatment and acute toxicity data of all patients with chordoma and chondrosarcoma of the mobile spine and sacrum, treated between 1 April 2019 and 1 April 2020 at our institute. Anatomy changes during treatment were evaluated by weekly cone-beam CTs (CBCT), supplemented by scheduled control-CTs or ad-hoc control-CTs. Acute toxicity was scored weekly during treatment and at 3 months after therapy according to CTCAE 4.0.Results: 17 chordoma and 3 chondrosarcoma patients were included. Coverage of the high dose clinical target volume was 99.8% (range 56.1-100%) in the nominal and 80.9% (range 14.3-99.6%) in the voxel-wise minimum dose distribution. Treatment plan adaptation was needed in 5 out of 22 (22.7%) plans. Reasons for plan adaptation were either reduced tumor coverage or increased dose to the OAR.Conclusions: Robustly optimized intensity modulated proton beam therapy for chordoma and chondrosarcoma of the mobile spine is feasible. Plan adaptations due to anatomical changes were required in approximately 23 percent of treatment courses. (C) 2021 The Authors. Published by Elsevier B.V.Orthopaedics, Trauma Surgery and Rehabilitatio