Technique for sparing previously irradiated critical normal structures in salvage proton craniospinal irradiation

Abstract Background Cranial reirradiation is clinically appropriate in some cases but cumulative radiation dose to critical normal structures remains a practical concern. The authors developed a simple technique in 3D conformal proton craniospinal irradiation (CSI) to block organs at risk (OAR) while minimizing underdosing of adjacent target brain tissue. Methods Two clinical cases illustrate the use of proton therapy to provide salvage CSI when a previously irradiated OAR required sparing from additional radiation dose. The prior radiation plan was coregistered to the treatment planning CT to create a planning organ at risk volume (PRV) around the OAR. Right and left lateral cranial whole brain proton apertures were created with a small block over the PRV. Then right and left lateral “inverse apertures” were generated, creating an aperture opening in the shape of the area previously blocked and blocking the area previously open. The inverse aperture opening was made one millimeter smaller than the original block to minimize the risk of dose overlap. The inverse apertures were used to irradiate the target volume lateral to the PRV, selecting a proton beam range to abut the 50% isodose line against either lateral edge of the PRV. Together, the 4 cranial proton fields created a region of complete dose avoidance around the OAR. Comparative photon treatment plans were generated with opposed lateral X-ray fields with custom blocks and coplanar intensity modulated radiation therapy optimized to avoid the PRV. Cumulative dose volume histograms were evaluated. Results Treatment plans were developed and successfully implemented to provide sparing of previously irradiated critical normal structures while treating target brain lateral to these structures. The absence of dose overlapping during irradiation through the inverse apertures was confirmed by film. Compared to the lateral X-ray and IMRT treatment plans, the proton CSI technique improved coverage of target brain tissue while providing the least additional radiation dose to the previously irradiated OAR. Conclusions Proton craniospinal irradiation can be adapted to provide complete sparing of previously irradiated OARs. This technique may extend the option of reirradiation to patients otherwise deemed ineligible for further radiotherapy due to prior dose to critical normal structures.</p

Coastal Wetlands: a synthesis

Our understanding of the functioning of coastal wetland ecosystems has grown rapidly over the past decade. We have gained insight into the roles of geomorphic processes, hydrologic dynamics, biotic feedbacks, and disturbance agents in creating and molding a variety of coastal wetland ecosystems across climatic gradients. The variety is expressed not so much in the more obvious differences in vegetation cover, but rather how physical processes both facilitate and constrain a diversity of plant and\ud animal communities. At one level, coastal wetlands are the product of tidal forces and freshwater inputs at the margin of continents. At another level, biotic factors exert\ud feedback controls through biofilms, bioturbation of sediments, the buffeting of currents and waves, organic enrichment of sediments, and the closing of nutrient\ud cycles. Few ecosystems provide us with such clear examples of feedback controls. Still, much remains to be learned and understood. What we do understand about the structure and functioning of coastal wetlands should provide the theoretical underpinnings for effective management in protecting them for their many contributions to ecosystem goods and services. And what we do not understand should compel us to focus our attention and energies toward seeking optimal solutions to some of the most perplexing and urgent problems facing natural resource management

Coastal Wetlands: an integrated ecosystem approach

Coastal wetlands are under a great deal of pressure from the dual forces of rising sea level and the intervention of human populations both along the estuary and in the river catchment. Direct impacts include the destruction or degradation of wetlands from land reclamation and infrastructures. Indirect impacts derive from the discharge of pollutants, changes in river flows and sediment supplies, land clearing, and dam operations. As sea level rises, coastal wetlands in most areas of the world migrate landward to occupy former uplands. The competition of these lands from human development is intensifying, making the landward migration impossible in many cases. This book provides an understanding of the functioning of coastal ecosystems and the ecological services that they provide, and suggestions for their management. In this book a CD is included containing color figures of wetlands and estuaries in different parts of the world.\u

Coastal wetlands: A Synthesis

This book and this synthesis address the pressing need for better management of coastal wetlands worldwide because these wetlands are disappearing at an alarming rate; in some countries the loss is 70%–80% in the last 50 years. Managing requires understanding. Although our understanding of the functioning of coastal wetland ecosystems has grown rapidly over the past decade, still much remains to be learned and understood. We have gained insight into the roles of geomorphic processes, hydrologic dynamics, biotic feedback, and disturbance agents in creating and molding a variety of coastal wetland ecosystems across climatic gradients. The variety is expressed not so much in the more obvious differences in vegetation cover, but rather how physical processes both facilitate and constrain a diversity of plant and animal communities. At one level, coastal wetlands are the product of tidal forces and freshwater inputs at the margin of continents. At another level, the plants control the water currents in the tidal creeks draining the wetlands by generating a tidal current asymmetry that controls sediment transport and results in a deep tidal creek surrounded by shallow vegetated wetlands. The vegetation also influences the physics of water and sediment through several other processes including biofilms, bioturbation of sediments, the buffeting of currents and waves, organic enrichment of sediments, and the closing of nutrient cycles. Few ecosystems provide us with so many clear examples of such feedback controls. What we do understand about the structure and functioning of coastal wetlands should provide the theoretical underpinnings for effective management in protecting them for their many contributions to ecosystem goods and services. What we do not understand should compel us to focus our attention and energies toward seeking optimal solutions to some of the most perplexing and urgent problems facing natural resource management.Fil: Hopkinson, Charles S.. University of Georgia; Estados UnidosFil: Wolanski, Eric. James Cook University; Australia. Australian Institute of Marine Science; AustraliaFil: Cahoon, Donald R.. Patuxent Wildlife Research Center; Estados UnidosFil: Perillo, Gerardo Miguel E.. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Bahía Blanca. Instituto Argentino de Oceanografía. Universidad Nacional del Sur. Instituto Argentino de Oceanografía; ArgentinaFil: Brinson, Mark M.. No especifíca;Fil: Hopkinson, Charles S.. University of Georgia; Estados Unido

Turbulence measurements in a small subtropical estuary under king tide conditions

In natural waterways and estuaries, the understanding of turbulent mixing is critical to the knowledge of sediment transport, stormwater runoff during flood events, and release of nutrient-rich wastewater into ecosystems. In the present study, some field measurements were conducted in a small subtropical estuary with micro-tidal range and semi-diurnal tides during king tide conditions: i. e., the tidal range was the largest for both 2009 and 2010. The turbulent velocity measurements were performed continuously at high-frequency (50Hz) for 60 h. Two acoustic Doppler velocimeters (ADVs) were sampled simultaneously in the middle estuarine zone, and a third ADV was deployed in the upper estuary for 12 h only. The results provided an unique characterisation of the turbulence in both middle and upper estuarine zones under the king tide conditions. The present observations showed some marked differences between king tide and neap tide conditions. During the king tide conditions, the tidal forcing was the dominant water exchange and circulation mechanism in the estuary. In contrast, the long-term oscillations linked with internal and external resonance played a major role in the turbulent mixing during neap tides. The data set showed further that the upper estuarine zone was drastically less affected by the spring tide range: the flow motion remained slow, but the turbulent velocity data were affected by the propagation of a transient front during the very early flood tide motion at the sampling site. © 2012 Springer Science+Business Media B.V

Observations of small-scale processes associated with the internal tide encountering an island

Current-meter, temperature, and microstructure observations of the large-amplitude internal tide shoaling on the continental shelf of the east coast of northern New Zealand show the complexity of the internal kinematics and mixing. The propagation speed of the main internal wave was around 0.3 m s?1, and nonstationary time series analysis was used to locate the trailing short-wavelength internal waves in frequency (periods of around 40 min) and tidal-phase space. The average energy dissipation rate (5 × 10?8 m2 s?3) was an order of magnitude smaller than that observed on the open shelf in other studies, but peaks in dissipation rate were measured to be much greater. The vertical diffusivity of heat was around 10?4 m2 s?1, comparable to, or greater than, other studies. Examples of the scale and sporadic nature of larger mixing events were observed. The behavior was complicated by the nearby steeply shoaling coast of the Poor Knight Islands. Consistent reflected wave energy was not apparent