Inter-fraction motion robustness and organ sparing potential of proton therapy for cervical cancer

Purpose: Large-field photon radiotherapy is current standard in the treatment of cervical cancer patients. However, with the increasing availability of Pencil Beam Scanning Proton Therapy (PBS-PT) and robust treatment planning techniques, protons may have significant advantages for cervical cancer patients in the reduction of toxicity. In this study, PBS-PT and photon Volumetric Modulated Arc Therapy (VMAT) were compared, examining target coverage and organ at risk (OAR) dose, taking inter- and intra-fraction motion into account. Materials and methods: Twelve cervical cancer patients were included in this in-silico planning study. In all cases, a planning CT scan, five weekly repeat CT scans (reCTs) and an additional reCT 10 min after the first reCT were available. Two-arc VMAT and robustly optimised two- and four-field (2F and 4F) PBS-PT plans were robustly evaluated on planCTs and reCTs using set-up and range uncertainty. Nominal OAR doses and voxel-wise minimum target coverage robustness were compared. Results: Average voxel-wise minimum accumulated doses for pelvic target structures over all patients were adequate for both photon and proton treatment techniques (D98 > 95%, [91.7–99.3%]). Average accumulated dose of the para-aortic region was lower than the required 95%, D98 > 94.4% [91.1–98.2%]. With PBS-PT 4F, dose to all OARs was significantly lower than with VMAT. Major differences were observed for mean bowel bag V15Gy: 60% [39–70%] for VMAT vs 30% [10–52%] and 32% [9–54%] for PBS-PT 2F and 4F and for mean bone marrow V10Gy: 88% [82–97%] for VMAT vs 66% [60–73%] and 67% [60–75%] for PBS-PT 2F and 4F. Conclusion: Robustly optimised PBS-PT for cervical cancer patients shows equivalent target robustness against inter- and intra-fraction variability compared to VMAT, and offers significantly better OAR sparing

Influence of eye movement on lens dose and optic nerve target coverage during craniospinal irradiation

PURPOSE: Optic nerves are part of the craniospinal irradiation (CSI) target volume. Modern radiotherapy techniques achieve highly conformal target doses while avoiding organs-at-risk such as the lens. The magnitude of eye movement and its influence on CSI target- and avoidance volumes are unclear. We aimed to evaluate the movement-range of lenses and optic nerves and its influence on dose distribution of several planning techniques. METHODS: Ten volunteers underwent MRI scans in various gaze directions (neutral, left, right, cranial, caudal). Lenses, orbital optic nerves, optic discs and CSI target volumes were delineated. 36-Gy cranial irradiation plans were constructed on synthetic CT images in neutral gaze, with Volumetric Modulated Arc Therapy, pencil-beam scanning proton therapy, and 3D-conventional photons. Movement-amplitudes of lenses and optic discs were analyzed, and influence of gaze direction on lens and orbital optic nerve dose distribution. RESULTS: Mean eye structures’ shift from neutral position was greatest in caudal gaze; −5.8±1.2 mm (±SD) for lenses and 7.0±2.0 mm for optic discs. In 3D-conventional plans, caudal gaze decreased Mean Lens Dose (MLD). In VMAT and proton plans, eye movements mainly increased MLD and diminished D98 orbital optic nerve (D98(OON)) coverage; mean MLD increased up to 5.5 Gy [total ΔMLD range −8.1 to 10.0 Gy], and mean D98(OON) decreased up to 3.3 Gy [total ΔD98(OON) range −13.6 to 1.2 Gy]. VMAT plans optimized for optic disc Internal Target Volume and lens Planning organ-at-Risk Volume resulted in higher MLD over gaze directions. D98(OON) became ≥95% of prescribed dose over 95/100 evaluated gaze directions, while all-gaze bilateral D98(OON) significantly changed in 1 of 10 volunteers. CONCLUSION: With modern CSI techniques, eye movements result in higher lens doses and a mean detriment for orbital optic nerve dose coverage of <10% of prescribed dose

Application of Generator-Electric Motor System for Emergency Propulsion of a Vessel in the Event of Loss of the Full Serviceability of the Diesel Main Engine

Oil tanker disasters have been a cause of major environmental disasters, with multi-generational impacts. One of the greatest hazards is damage to the propulsion system that causes the ship to turn sideways to a wave and lose stability, which in storm conditions usually leads to capsizing and sinking Despite the perceived consequences of maritime disasters in the current solutions for the propulsion of oil tankers, there are no legal or real solutions for independent emergency main propulsion in this type of ship. Stressing that the reliability of the propulsion system has a significant impact on the ship’s safety at sea, the authors presented a new solution in the form of a power take-off/power take-in (PTO/PTI) system. This is the emergency use of a shaft generator as the main electric motor, operating in parallel in a situation when the main engine (ME), (the main engine of the ship’s direct high-power propulsion system that is slow-speed) loses the operational capability to propel the ship. Since one cause of wear, or failure, of the main engines is improper operational decisions, the paper shows the wear mechanism in relation to the accuracy of operational decisions. Using classical reliability theory, it also shows that the use of the proposed system results in an increase in the reliability of the propulsion system. The main topic of the paper was the use of an electrical system called PTO/PTI as an emergency propulsion system on the largest commercial vessels, such as bulk carriers and crude oil tankers, which has not been used before in maritime technical solutions. Semi-Markov processes, continuous in time, discrete in states, and which are used in technology, were also proposed as a tool describing the process of the operation of such a ship propulsion system, and they are useful to support operational decisions affecting the state of the technical condition of the engine. There are two ship operation strategies that can be adopted: the four-state model, for normal operation, and the three-state model, which operates with the occurrence of failure. For these types of models, their limiting distributions were defined in the form of probabilities. It was also demonstrated that faster than expected engine wear and the occurrence of inoperability of the main engine can be caused by wrong operational decisions made by the shipowner or crew. Using this type of main engine operating methodology, it is possible to support the decision of the engineer to stop the main engine and to subject it to the process of restoration to an acceptable state of technical condition (before the failure or during the failure in severe storm conditions), with the parallel use of the proposed electric propulsion (PTO/PTI) as an emergency propulsion, giving the crew a chance to maintain the steering necessary to maintain safe lateral stability

Application of Generator-Electric Motor System for Emergency Propulsion of a Vessel in the Event of Loss of the Full Serviceability of the Diesel Main Engine

Oil tanker disasters have been a cause of major environmental disasters, with multi-generational impacts. One of the greatest hazards is damage to the propulsion system that causes the ship to turn sideways to a wave and lose stability, which in storm conditions usually leads to capsizing and sinking Despite the perceived consequences of maritime disasters in the current solutions for the propulsion of oil tankers, there are no legal or real solutions for independent emergency main propulsion in this type of ship. Stressing that the reliability of the propulsion system has a significant impact on the ship&rsquo;s safety at sea, the authors presented a new solution in the form of a power take-off/power take-in (PTO/PTI) system. This is the emergency use of a shaft generator as the main electric motor, operating in parallel in a situation when the main engine (ME), (the main engine of the ship&rsquo;s direct high-power propulsion system that is slow-speed) loses the operational capability to propel the ship. Since one cause of wear, or failure, of the main engines is improper operational decisions, the paper shows the wear mechanism in relation to the accuracy of operational decisions. Using classical reliability theory, it also shows that the use of the proposed system results in an increase in the reliability of the propulsion system. The main topic of the paper was the use of an electrical system called PTO/PTI as an emergency propulsion system on the largest commercial vessels, such as bulk carriers and crude oil tankers, which has not been used before in maritime technical solutions. Semi-Markov processes, continuous in time, discrete in states, and which are used in technology, were also proposed as a tool describing the process of the operation of such a ship propulsion system, and they are useful to support operational decisions affecting the state of the technical condition of the engine. There are two ship operation strategies that can be adopted: the four-state model, for normal operation, and the three-state model, which operates with the occurrence of failure. For these types of models, their limiting distributions were defined in the form of probabilities. It was also demonstrated that faster than expected engine wear and the occurrence of inoperability of the main engine can be caused by wrong operational decisions made by the shipowner or crew. Using this type of main engine operating methodology, it is possible to support the decision of the engineer to stop the main engine and to subject it to the process of restoration to an acceptable state of technical condition (before the failure or during the failure in severe storm conditions), with the parallel use of the proposed electric propulsion (PTO/PTI) as an emergency propulsion, giving the crew a chance to maintain the steering necessary to maintain safe lateral stability

Proton PBS Planning Techniques, Robustness Evaluation, and OAR Sparing for the Whole-Brain Part of Craniospinal Axis Irradiation

Proton therapy is a promising modality for craniospinal irradiation (CSI), offering dosimetric advantages over conventional treatments. While significant attention has been paid to spine fields, for the brain fields, only dose reduction to the lens of the eye has been reported. Hence, the objective of this study is to assess the potential gains and feasibility of adopting different treatment planning techniques for the entire brain within the CSI target. To this end, eight previously treated CSI patients underwent retrospective replanning using various techniques: (1) intensity modulated proton therapy (IMPT) optimization, (2) the modification/addition of field directions, and (3) the pre-optimization removal of superficially placed spots. The target coverage robustness was evaluated and dose comparisons for lenses, cochleae, and scalp were conducted, considering potential biological dose increases. The target coverage robustness was maintained across all plans, with minor reductions when superficial spot removal was utilized. Single- and multifield optimization showed comparable target coverage robustness and organ-at-risk sparing. A significant scalp sparing was achieved in adults but only limited in pediatric cases. Superficial spot removal contributed to scalp V30 Gy reduction at the expense of lower coverage robustness in specific cases. Lens sparing benefits from multiple field directions, while cochlear sparing remains impractical. Based on the results, all investigated plan types are deemed clinically adoptable.</p

Proton PBS Planning Techniques, Robustness Evaluation, and OAR Sparing for the Whole-Brain Part of Craniospinal Axis Irradiation

Proton therapy is a promising modality for craniospinal irradiation (CSI), offering dosimetric advantages over conventional treatments. While significant attention has been paid to spine fields, for the brain fields, only dose reduction to the lens of the eye has been reported. Hence, the objective of this study is to assess the potential gains and feasibility of adopting different treatment planning techniques for the entire brain within the CSI target. To this end, eight previously treated CSI patients underwent retrospective replanning using various techniques: (1) intensity modulated proton therapy (IMPT) optimization, (2) the modification/addition of field directions, and (3) the pre-optimization removal of superficially placed spots. The target coverage robustness was evaluated and dose comparisons for lenses, cochleae, and scalp were conducted, considering potential biological dose increases. The target coverage robustness was maintained across all plans, with minor reductions when superficial spot removal was utilized. Single- and multifield optimization showed comparable target coverage robustness and organ-at-risk sparing. A significant scalp sparing was achieved in adults but only limited in pediatric cases. Superficial spot removal contributed to scalp V30 Gy reduction at the expense of lower coverage robustness in specific cases. Lens sparing benefits from multiple field directions, while cochlear sparing remains impractical. Based on the results, all investigated plan types are deemed clinically adoptable