Peripheral doses in patients undergoing Cyberknife treatment for intracranial lesions. A single centre experience

<p>Abstract</p> <p>Background</p> <p>Stereotactic radiosurgery/radiotherapy procedures are known to deliver a very high dose per fraction, and thus, the corresponding peripheral dose could be a limiting factor for the long term surviving patients. The aim of this clinical study was to measure the peripheral dose delivered to patients undergoing intracranial Cyberknife treatment, using the MOSFET dosimeters. The influence of the supplemental shielding, the number of monitor units and the collimator size to the peripheral dose were investigated.</p> <p>Methods</p> <p>MOSFET dosimeters were placed in preselected anatomical regions of the patient undergoing Cyberknife treatment, namely the thyroid gland, the nipple, the umbilicus and the pubic symphysis.</p> <p>Results</p> <p>The mean peripheral doses before the supplemental shielding was added to the Cyberknife unit were 51.79 cGy, 13.31 cGy and 10.07 cGy while after the shielding upgrade they were 38.40 cGy, 10.94 cGy, and 8.69 cGy, in the thyroid gland, the umbilicus and the pubic symphysis, respectively. The increase of the collimator size corresponds to an increase of the PD and becomes less significant at larger distances, indicating that at these distances the PD is predominate due to the head leakage and collimator scatter.</p> <p>Conclusion</p> <p>Weighting the effect of the number of monitor units and the collimator size can be effectively used during the optimization procedure in order to choose the most suitable treatment plan that will deliver the maximum dose to the tumor, while being compatible with the dose constraints for the surrounding organs at risk. Attention is required in defining the thyroid gland as a structure of avoidance in the treatment plan especially in patients with benign diseases.</p

Dosimetry during intramedullary nailing of the tibia: Patient and occupational exposure

Background Intramedullary nailing under fluoroscopic guidance is a common operation. We studied the intraoperative radiation dose received by both the patient and the personnel

Imaging performance of a CaWO4/CMOS sensor

The aim of this study was to investigate the modulation transfer function (MTF) and the effective gain transfer function (eGTF) of a non-destruc­­tive testing (NDT)/industrial inspection complementary metal oxide semi­conductor (CMOS) sensor in conjunction with a thin calcium tungstate (CaWO4) screen. Thin screen samples, with dimensions of 2.7x3.6 cm2 and thick­ness of 118.9 μm, estimated from scanning electron microscopy-SEM im­ages, were extracted from an Agfa Curix universal screen and coupled to the active area of an active pixel (APS) CMOS sensor. MTF was assessed using the slanted-edge method, following the IEC 62220-1-1:2015 method. MTF values were found high across the examined spatial frequency range. eGTF was found maximum when CaWO4 was combined with charge-coupled devices (CCD) of broadband anti-reflection (AR) coating (17.52 at 0 cycles/mm). The com­bi­nation of the thin CaWO4 screen with the CMOS sensor provided very pro­mis­ing image resolution and adequate efficiency properties, thus could be also con­sidered for use in CMOS based X-ray imaging devices, for various applications

Log-likelihood-based rule for image quality monitoring in the MLEM-based image reconstruction for PET

We address here the problem of the noise deterioration of the quality of the reconstructed images when employing the maximum likelihood expectation maximization (MLEM) algorithm for iterative image reconstruction in positron emission tomography (PET). It is observed that despite the fact the cost function (log-likelihood) is monotonically increasing, the image quality deteriorates after reaching a certain “optimum” point during the iterative process. The principal aim of the work is the discovery of a rule that would directly link the quality of the reconstructed images at each iteration with the log-likelihood. We assume that the true image corresponds to a log-likelihood value in correlation with the data acquired, which, when achieved, makes no sense looking for higher log-likelihood levels. We study here the hypothesis that there is a direct correlation of the log-likelihood of the true image (a quantity that is not known a priori in real PET scans) and acquired data, with certain properties of the pixel updating coefficients (PUC) in the MLEM algorithm. For the validation of this hypothesis we have employed Monte Carlo experiments using known phantoms. We show here that the minimum value of the PUC for the non-zero pixels might be one parameter that could be used to verify the above mentioned hypothesis

Automatic Extraction of Muscle Parameters with Attention UNet in Ultrasonography

Automatically delineating the deep and superficial aponeurosis of the skeletal muscles from ultrasound images is important in many aspects of the clinical routine. In particular, finding muscle parameters, such as thickness, fascicle length or pennation angle, is a time-consuming clinical task requiring both human labour and specialised knowledge. In this study, a multi-step solution for automating these tasks is presented. A process to effortlessly extract the aponeurosis for automatically measuring the muscle thickness has been introduced as a first step. This process consists mainly of three parts. In the first part, the Attention UNet has been incorporated to automatically delineate the boundaries of the studied muscles. Afterwards, a specialised post-processing algorithm was utilised to improve (and correct) the segmentation results. Lastly, the calculation of the muscle thickness was performed. The proposed method has achieved similar to a human-level performance. In particular, the overall discrepancy between the automatic and the manual muscle thickness measurements was equal to 0.4 mm, a significant result that demonstrates the feasibility of automating this task. In the second step of the proposed methodology, the fascicle&rsquo;s length and pennation angle are extracted through an unsupervised pipeline. Initially, filtering is applied to the ultrasound images to further distinguish the tissues from the other muscle structures. Later, the well-known K-Means algorithm is used to isolate them successfully. As the last step, the dominant angle of the segmented muscle tissues is reported and compared with manual measurements. The proposed pipeline is showing very promising results in the evaluated dataset. Specifically, in the calculation of the pennation angle, the overall discrepancy between the automatic and the manual measurements was less than 2.22&deg; (degrees), once more comparable with the human-level performance. Finally, regarding the fascicle length measurements, the results were divided based on the muscle properties. In the muscles where a large portion (or all) of the fascicles are located between the upper and lower aponeuroses, the proposed pipeline exhibits superb performance; otherwise, overall accuracy deteriorates due to errors caused by the trigonometric approximations needed for the length calculation

Muscle Cross-Sectional Area Segmentation in Transverse Ultrasound Images Using Vision Transformers

Automatically measuring a muscle’s cross-sectional area is an important application in clinical practice that has been studied extensively in recent years for its ability to assess muscle architecture. Additionally, an adequately segmented cross-sectional area can be used to estimate the echogenicity of the muscle, another valuable parameter correlated with muscle quality. This study assesses state-of-the-art convolutional neural networks and vision transformers for automating this task in a new, large, and diverse database. This database consists of 2005 transverse ultrasound images from four informative muscles for neuromuscular disorders, recorded from 210 subjects of different ages, pathological conditions, and sexes. Regarding the reported results, all of the evaluated deep learning models have achieved near-to-human-level performance. In particular, the manual vs. the automatic measurements of the cross-sectional area exhibit an average discrepancy of less than 38.15 mm2, a significant result demonstrating the feasibility of automating this task. Moreover, the difference in muscle echogenicity estimated from these two readings is only 0.88, another indicator of the proposed method’s success. Furthermore, Bland–Altman analysis of the measurements exhibits no systematic errors since most differences fall between the 95% limits of agreements and the two readings have a 0.97 Pearson’s correlation coefficient (p < 0.001, validation set) with ICC (2, 1) surpassing 0.97, showing the reliability of this approach. Finally, as a supplementary analysis, the texture of the muscle’s visible cross-sectional area was examined using deep learning to investigate whether a classification between healthy subjects and patients with pathological conditions solely from the muscle texture is possible. Our preliminary results indicate that such a task is feasible, but further and more extensive studies are required for more conclusive results

Computer Based Correlation of the Texture of P63 Expressed Nuclei with Histological Tumour Grade, in Laryngeal Carcinomas

Background. P63 immunostaining has been considered as potential prognostic factor in laryngeal cancer. Considering that P63 is mainly nuclear stain, a possible correlation between the texture of P63-stained nuclei and the tumor’s grade could be of value to diagnosis, since this may be related to biologic information imprinted as texture on P63 expressed nuclei. Objective. To investigate the association between P63 stained nuclei and histologic grade in laryngeal tumor lesions. Methods. Biopsy specimens from laryngeal tumour lesions of 55 patients diagnosed with laryngeal squamous cell carcinomas were immunohistochemically (IHC) stained for P63 expression. Four images were digitized from each patient’s IHC specimens. P63 positively expressed nuclei were identified, the percentage of P63 expressed nuclei was computed, and 118 textural, morphological, shape, and architectural features were calculated from each one of the 55 laryngeal lesions. Data were split into the low grade (21 grade I lesions) and high grade (34 grade II and grade III lesions) classes for statistical analysis. Results. With advancing grade, P63 expression decreased, P63 stained nuclei appeared of lower image intensity, more inhomogeneous, of higher local contrast, contained smaller randomly distributed dissimilar structures and had irregular shape. Conclusion. P63 expressed nuclei contain important information related to histologic grade

Information Capacity of Positron Emission Tomography Scanners

Background: The aim of the present study was to assess the upper information content bound of positron emission tomography (PET) images, by means of the information capacity (IC). Methods: The Geant4 Application for the Tomographic Emission (GATE) Monte Carlo (MC) package was used, and reconstructed images were obtained by using the software for tomographic image reconstruction (STIR). The case study for the assessment of the information content was the General Electric (GE) Discovery-ST PET scanner. A thin-film plane source aluminum (Al) foil, coated with a thin layer of silica and with a 18F-fludeoxyglucose (FDG) bath distribution of 1 MBq was used. The influence of the (a) maximum likelihood estimation-ordered subsets-maximum a posteriori probability-one step late (MLE-OS-MAP-OSL) algorithm, using various subsets (1 to 21) and iterations (1 to 20) and (b) different scintillating crystals on PET scanner&#8217;s performance, was examined. The study was focused on the noise equivalent quanta (NEQ) and on the single index IC. Images of configurations by using different crystals were obtained after the commonly used 2-dimensional filtered back projection (FBP2D), 3-dimensional filtered back projection re-projection (FPB3DRP) and the (MLE)-OS-MAP-OSL algorithms. Results: Results shown that the images obtained with one subset and various iterations provided maximum NEQ values, however with a steep drop-off after 0.045 cycles/mm. The single index IC data were maximized for the range of 8&#8315;20 iterations and three subsets. The PET scanner configuration incorporating lutetium orthoaluminate perovskite (LuAP) crystals provided the highest NEQ values in 2D FBP for spatial frequencies higher than 0.028 cycles/mm. Bismuth germanium oxide (BGO) shows clear dominance against all other examined crystals across the spatial frequency range, in both 3D FBP and OS-MAP-OSL. The particular PET scanner provided optimum IC values using FBP3DRP and BGO crystals (2.4829 bits/mm2). Conclusions: The upper bound of the image information content of PET scanners can be fully characterized and further improved by investigating the imaging chain components through MC methods

Peripheral dose measurement in high-energy photon radiotherapy with the implementation of MOSFET

AIM: To study the peripheral dose (PD) from high-energy photon beams in radiotherapy using the metal oxide semiconductor field effect transistor (MOSFET) dose verification system