Unintended cardiac irradiation during left-sided breast cancer radiotherapy

Objective: Cardiac irradiation during left-sided breast radiotherapy may lead to
deleterious cardiac side effects. Using image guided radiotherapy, it is possible
to exclude the heart from treatment fields and monitor reproducibility of virtual simulation (VS) fields at treatment delivery using electronic portal imaging (EPI). Retrospectively, we evaluate the incidence of cardiac irradiation at VS and subsequent unintended cardiac irradiation during treatment.

Methods: Patients receiving left-sided radiotherapy to the breast or chest wall,
treated with a glancing photon field technique during a four-month period, were
included. VS images and EPIs during radiotherapy delivery were visually assessed.
The presence of any portion of the heart within the treatment field at VS or during treatment was recorded. Central lung distance and maximum heart distance were recorded.

Results: Of 128 patients, 45 (35.1%) had any portion of the heart within the
planned treatment field. Of these, inclusion of the heart was clinically unavoidable in 25 (55.6%). Of those with no heart included in the treatment fields at VS, 41 (49.4%) had presence of the heart as assessed on EPI during treatment.

Conclusion: Unintended cardiac irradiation during left-sided breast radiotherapy treatment occurs in a sizeable proportion of patients.

Advances in knowledge: Despite the use of three-dimensional computed tomography simulation and cardiac shielding, sizeable proportions of patients receiving left-sided breast cancer radiotherapy have unintended cardiac irradiation.

Monitoring daily MLC positional errors using trajectory log files and EPID measurements for IMRT and VMAT deliveries

This work investigated the differences between multileaf collimator (MLC) positioning accuracy determined using either log files or electronic portal imaging devices (EPID) and then assessed the possibility of reducing patient specific quality control (QC) via phantom-less methodologies. In-house software was developed, and validated, to track MLC positional accuracy with the rotational and static gantry picket fence tests using an integrated electronic portal image. This software was used to monitor MLC daily performance over a 1 year period for two Varian TrueBeam linear accelerators, with the results directly compared with MLC positions determined using leaf trajectory log files. This software was validated by introducing known shifts and collimator errors. Skewness of the MLCs was found to be 0.03 ± 0.06° (mean ±1 standard deviation (SD)) and was dependent on whether the collimator was rotated manually or automatically. Trajectory log files, analysed using in-house software, showed average MLC positioning errors with a magnitude of 0.004 ± 0.003 mm (rotational) and 0.004 ± 0.011 mm (static) across two TrueBeam units over 1 year (mean ±1 SD). These ranges, as indicated by the SD, were lower than the related average MLC positioning errors of 0.000 ± 0.025 mm (rotational) and 0.000 ± 0.039 mm (static) that were obtained using the in-house EPID based software. The range of EPID measured MLC positional errors was larger due to the inherent uncertainties of the procedure. Over the duration of the study, multiple MLC positional errors were detected using the EPID based software but these same errors were not detected using the trajectory log files. This work shows the importance of increasing linac specific QC when phantom-less methodologies, such as the use of log files, are used to reduce patient specific QC. Tolerances of 0.25 mm have been created for the MLC positional errors using the EPID-based automated picket fence test. The software allows diagnosis of any specific leaf that needs repair and gives an indication as to the course of action that is required.

An EPID-based method for comprehensive verification of gantry, EPID and the MLC carriage positional accuracy in Varian linacs during arc treatments

Background

]In modern radiotherapy, it is crucial to monitor the performance of all linac components including gantry, collimation system and electronic portal imaging device (EPID) during arc deliveries. In this study, a simple EPID-based measurement method has been introduced in conjunction with an algorithm to investigate the stability of these systems during arc treatments with the aim of ensuring the accuracy of linac mechanical performance.

The Varian EPID sag, gantry sag, changes in source-to-detector distance (SDD), EPID and collimator skewness, EPID tilt, and the sag in MLC carriages as a result of linac rotation were separately investigated by acquisition of EPID images of a simple phantom comprised of 5 ball-bearings during arc delivery. A fast and robust software package was developed for automated analysis of image data. Twelve Varian linacs of different models were investigated.

The average EPID sag was within 1 mm for all tested linacs. All machines showed less than 1 mm gantry sag. Changes in SDD values were within 1.7 mm except for three linacs of one centre which were within 9 mm. Values of EPID skewness and tilt were negligible in all tested linacs. The maximum sag in MLC leaf bank assemblies was around 1 mm. The EPID sag showed a considerable improvement in TrueBeam linacs.

The methodology and software developed in this study provide a simple tool for effective investigation of the behaviour of linac components with gantry rotation. It is reproducible and accurate and can be easily performed as a routine test in clinics.

Introduction of a novel dose saving acquisition mode for the PortalVision aS500 EPID to facilitate on-line patient setup verification

In external beam radiotherapy, electronic portal imaging becomes more and more an indispensable tool for the verification of the patient setup. For the safe clinical introduction of high dose conformal radiotherapy like intensity modulated radiation therapy, on-line patient setup verification is a prerequisite to ensure that the planned dosimetric coverage of the tumor volume is actually realized in the patient. Since the direction of setup fields often deviates from the direction of the treatment beams, extra dose is delivered to the patient during the acquisition of these portal images which may reach clinical relevance. The aim of this work was to develop a new acquisition mode for the PortalVision aS500 electronic portal imaging device from Varian Medical Systems that allows one to take portal images with reduced dose while keeping good image quality. The new acquisition mode, called RadMode, selectively enables and disables beam pulses during image acquisition allowing one to stop wasting valuable dose during the initial acquisition of "reset frames." Images of excellent quality can be taken with 1 MU only. This low dose per image facilitates daily setup verification with considerably reduced extra dose.

Dosimetric properties of an amorphous silicon EPID for verification of modulated electron radiotherapy

Purpose: To investigate the dosimetric properties of an electronic portal imaging device (EPID) for electron beam detection and to evaluate its potential for quality assurance (QA) of modulated electron radiotherapy (MERT). Methods: A commercially available EPID was used to detect electron beams shaped by a photon multileaf collimator (MLC) at a source-surface distance of 70 cm. The fundamental dosimetric properties such as reproducibility, dose linearity, field size response, energy response, and saturation were investigated for electron beams. A new method to acquire the flood-field for the EPID calibration was tested. For validation purpose, profiles of open fields and various MLC fields (square and irregular) were measured with a diode in water and compared to the EPID measurements. Finally, in order to use the EPID for QA of MERT delivery, a method was developed to reconstruct EPID two-dimensional (2D) dose distributions in a water-equivalent depth of 1.5 cm. Comparisons were performed with film measurement for static and dynamic monoenergy fields as well as for multienergy fields composed by several segments of different electron energies. Results: The advantageous EPID dosimetric properties already known for photons as reproducibility, linearity with dose, and dose rate were found to be identical for electron detection. The flood-field calibration method was proven to be effective and the EPID was capable to accurately reproduce the dose measured in water at 1.0 cm depth for 6 MeV, 1.3 cm for 9 MeV, and 1.5 cm for 12, 15, and 18 MeV. The deviations between the output factors measured with EPID and in water at these depths were within ±1.2% for all the energies with a mean deviation of 0.1%. The average gamma pass rate (criteria: 1.5%, 1.5 mm) for profile comparison between EPID and measurements in water was better than 99% for all the energies considered in this study. When comparing the reconstructed EPID 2D dose distributions at 1.5 cm depth to film measurements, the gamma pass rate (criteria: 2%, 2 mm) was better than 97% for all the tested cases. Conclusions: This study demonstrates the high potential of the EPID for electron dosimetry, and in particular, confirms the possibility to use it as an efficient verification tool for MERT delivery.

Rigid and non-rigid point-based medical image registration

The primary goal of this dissertation is to develop point-based rigid and non-rigid image registration methods that have better accuracy than existing methods. We first present point-based PoIRe, which provides the framework for point-based global rigid registrations. It allows a choice of different search strategies including (a) branch-and-bound, (b) probabilistic hill-climbing, and (c) a novel hybrid method that takes advantage of the best characteristics of the other two methods. We use a robust similarity measure that is insensitive to noise, which is often introduced during feature extraction. We show the robustness of PoIRe using it to register images obtained with an electronic portal imaging device (EPID), which have large amounts of scatter and low contrast. To evaluate PoIRe we used (a) simulated images and (b) images with fiducial markers; PoIRe was extensively tested with 2D EPID images and images generated by 3D Computer Tomography (CT) and Magnetic Resonance (MR) images. PoIRe was also evaluated using benchmark data sets from the blind retrospective evaluation project (RIRE). We show that PoIRe is better than existing methods such as Iterative Closest Point (ICP) and methods based on mutual information. We also present a novel point-based local non-rigid shape registration algorithm. We extend the robust similarity measure used in PoIRe to non-rigid registrations adapting it to a free form deformation (FFD) model and making it robust to local minima, which is a drawback common to existing non-rigid point-based methods. For non-rigid registrations we show that it performs better than existing methods and that is less sensitive to starting conditions. We test our non-rigid registration method using available benchmark data sets for shape registration. Finally, we also explore the extraction of features invariant to changes in perspective and illumination, and explore how they can help improve the accuracy of multi-modal registration. For multimodal registration of EPID-DRR images we present a method based on a local descriptor defined by a vector of complex responses to a circular Gabor filter.

Rigid and Non-rigid Point-based Medical Image Registration

The primary goal of this dissertation is to develop point-based rigid and non-rigid image registration methods that have better accuracy than existing methods. We first present point-based PoIRe, which provides the framework for point-based global rigid registrations. It allows a choice of different search strategies including (a) branch-and-bound, (b) probabilistic hill-climbing, and (c) a novel hybrid method that takes advantage of the best characteristics of the other two methods. We use a robust similarity measure that is insensitive to noise, which is often introduced during feature extraction. We show the robustness of PoIRe using it to register images obtained with an electronic portal imaging device (EPID), which have large amounts of scatter and low contrast. To evaluate PoIRe we used (a) simulated images and (b) images with fiducial markers; PoIRe was extensively tested with 2D EPID images and images generated by 3D Computer Tomography (CT) and Magnetic Resonance (MR) images. PoIRe was also evaluated using benchmark data sets from the blind retrospective evaluation project (RIRE). We show that PoIRe is better than existing methods such as Iterative Closest Point (ICP) and methods based on mutual information. We also present a novel point-based local non-rigid shape registration algorithm. We extend the robust similarity measure used in PoIRe to non-rigid registrations adapting it to a free form deformation (FFD) model and making it robust to local minima, which is a drawback common to existing non-rigid point-based methods. For non-rigid registrations we show that it performs better than existing methods and that is less sensitive to starting conditions. We test our non-rigid registration method using available benchmark data sets for shape registration. Finally, we also explore the extraction of features invariant to changes in perspective and illumination, and explore how they can help improve the accuracy of multi-modal registration. For multimodal registration of EPID-DRR images we present a method based on a local descriptor defined by a vector of complex responses to a circular Gabor filter.

Imaging of dipole sources and transfer of modulated signals using phase conjugating lens techniques

The authors discuss the imaging properties and transfer of amplitude and phase-modulated signals through a phase conjugating lens (PCL). The authors outline the mechanisms of the near-field and far-field subwavelength imaging of Hertzian dipole sources using PCL, particularly the authors show that one-dimensional subwavelength resolution of multiple sources is possible in the far-field using a PCL augmented with specially designed scatterers located in both the adjacent vicinity of the sources and in the mirror symmetric positions in the image plane. These scatterers enable evanescent-to-propagating spectrum and its dual, propagating-to-evanescent, field conversion. Thus, the subwavelength information encoded into propagating waves on the source side can be extracted on the image side. Next, for the first time the transfer of amplitude and phase modulated signals through a PCL augmented with evanescent-to-propagating spectrum conversion is discussed and it has been demonstrated that multiple amplitude or phase modulated dipole sources can be distinguished in the far-field with subwavelength resolution without the necessity for numerical post-processing of the received data. From the study conducted here, it is concluded that a system of transmitters/receivers augmented with a PCL and appropriate scatterers operates without the need for any numerical processing of the receive data in order to separate channel information from very close proximity stations.

An analysis of geometric uncertainty calculations for prostate radiotherapy in clinical practice.

Margins are used in radiotherapy to assist in the calculation of planning target volumes. These margins can be determined by analysing the geometric uncertainties inherent to the radiotherapy planning and delivery process. An important part of this process is the study of electronic portal images collected throughout the course of treatment. Set-up uncertainties were determined for prostate radiotherapy treatments at our previous site and the new purpose-built centre, with margins determined using a number of different methods. In addition, the potential effect of reducing the action level from 5 mm to 3 mm for changing a patient set-up, based on off-line bony anatomy-based portal image analysis, was studied. Margins generated using different methodologies were comparable. It was found that set-up errors were reduced following relocation to the new centre. Although a significant increase in the number of corrections to a patient's set-up was predicted if the action level was reduced from 5 mm to 3 mm, minimal reduction in patient set-up uncertainties would be seen as a consequence. Prescriptive geometric uncertainty analysis not only supports calculation and justification of the margins used clinically to generate planning target volumes, but may also best be used to monitor trends in clinical practice or audit changes introduced by new equipment, technology or practice. Simulations on existing data showed that a 3 mm rather than a 5 mm action level during off-line, bony anatomy-based portal imaging would have had a minimal benefit for the patients studied in this work.

Theoretical considerations to the verification of dynamic multileaf collimated fields with a SLIC-type portal image detector

The verification possibilities of dynamically collimated treatment beams with a scanning liquid ionization chamber electronic portal image device (SLIC-EPID) are investigated. The ion concentration in the liquid of a SLIC-EPID and therefore the read-out signal is determined by two parameters of a differential equation describing the creation and recombination of the ions. Due to the form of this equation, the portal image detector describes a nonlinear dynamic system with memory. In this work, the parameters of the differential equation were experimentally determined for the particular chamber in use and for an incident open 6 MV photon beam. The mathematical description of the ion concentration was then used to predict portal images of intensity-modulated photon beams produced by a dynamic delivery technique, the sliding window approach. Due to the nature of the differential equation, a mathematical condition for 'reliable leaf motion verification' in the sliding window technique can be formulated. It is shown that the time constants for both formation and decay of the equilibrium concentration in the chamber is in the order of seconds. In order to guarantee reliable leaf motion verification, these time constants impose a constraint on the rapidity of the image-read out for a given maximum leaf speed. For a leaf speed of 2 cm s(-1), a minimum image acquisition frequency of about 2 Hz is required. Current SLIC-EPID systems are usually too slow since they need about a second to acquire a portal image. However, if the condition is fulfilled, the memory property of the system can be used to reconstruct the leaf motion. It is shown that a simple edge detecting algorithm can be employed to determine the leaf positions. The method is also very robust against image noise.

Image indexing and retrieval using an ART-2A neural network architecture

Traditional content-based image retrieval (CBIR) systems use low-level features such as colors, shapes, and textures of images. Although, users make queries based on semantics, which are not easily related to such low-level characteristics. Recent works on CBIR confirm that researchers have been trying to map visual low-level characteristics and high-level semantics. The relation between low-level characteristics and image textual information has motivated this article which proposes a model for automatic classification and categorization of words associated to images. This proposal considers a self-organizing neural network architecture, which classifies textual information without previous learning. Experimental results compare the performance results of the text-based approach to an image retrieval system based on low-level features. (c) 2008 Wiley Periodicals, Inc.

Plant Leaf Identification Using Gabor Wavelets

This article presents a novel method of plant classification using Gabor wavelet filters to extract texture filters in a foliar surface. The aim of this promising method is to add to the results obtained by other leaf attributes (such as shape, contour, color, among others), increasing, therefore, the percentage of classification of plant species. To corroborate the efficiency of the technique, an experiment using 20 species from Brazilian flora was done and discussed. The results are also compared with texture Fourier descriptors and cooccurrence matrices. (C) 2009 Wiley Periodicals, Inc. Int J Imaging Syst Technol, 19, 236-243, 2009; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/ima.20201

Desenvolvimento de sistema de educação continuada a distância e interconsulta em hepatites virais

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Qual é a sua tribo? O uso do TAI online no desvelamento de conhecimentos sociais ocultos

The Implicit Association Test (IAT) has succeeded in accessing mental phenomena hardly exposed through self-report and explicit measures well known in the traditional studies on psychology. Although this measurement technique is among the most consistent in international publications, the few articles in Brazil have not deepened on theoretical issues that underlie the practice. This created a gap between the spread of this measure in the country and the production seen in international laboratories, both at quantitative and qualitative terms. In this context, the online labs implemented in several countries, including Brazil, created unique opportunities to overcome these disparities. Our work sought theoretical and conceptual clarification, contextualized to the historical development of the IAT and its online version, displaying affordably an unprecedented presentation of the virtual tool adapted to the Brazilian public. In a second step, we investigated empirically the data obtained by the Brazilian electronic portal "Countries", analyzing the degree of implicit and explicit nationalism of 2271 Brazilian subjects collected from early 2009 to late 2014. Our goal was to determine whether the data results obtained in a time of major sporting confrontation (FIFA World Cup 2010 and 2014) differ from periods when the tournament did not happen. Analyzes showed differences on the eve of the sporting confrontation, when the increase in the implicit nationalism was clearly superior, even with no effect by self-reports. In an independent analysis of a cultural context, there is an oscillation of explicit nationalism over the years, but not for the implicit action. In addition, it was found in women greater degree of implicit and explicit nationalism than in men, with both sexes presenting their preferences towards Brazil. In an end section, we suggest that nationalism may be a by-product of universal mental mechanisms that evolved to identify of the belonging group categorization, corroborating with the group favoritism. We propose that the intensification of the group preference on the eve of the competition has as its ancestral function strengthen the cohesion of the group in preparation to confrontational situations. We pointed out the need for studies on the differences between the sexes in matters relating to group membership belonging. It was expected largest nationalist attitudes in men reflecting the maintenance of cohesive groups in ancient societies. Thus, it appears a singular importance impart the traditional TAI studies with its online version for future investigations of human behavior in various areas of knowledge.

Qual é a sua tribo? O uso do TAI online no desvelamento de conhecimentos sociais ocultos

The Implicit Association Test (IAT) has succeeded in accessing mental phenomena hardly exposed through self-report and explicit measures well known in the traditional studies on psychology. Although this measurement technique is among the most consistent in international publications, the few articles in Brazil have not deepened on theoretical issues that underlie the practice. This created a gap between the spread of this measure in the country and the production seen in international laboratories, both at quantitative and qualitative terms. In this context, the online labs implemented in several countries, including Brazil, created unique opportunities to overcome these disparities. Our work sought theoretical and conceptual clarification, contextualized to the historical development of the IAT and its online version, displaying affordably an unprecedented presentation of the virtual tool adapted to the Brazilian public. In a second step, we investigated empirically the data obtained by the Brazilian electronic portal "Countries", analyzing the degree of implicit and explicit nationalism of 2271 Brazilian subjects collected from early 2009 to late 2014. Our goal was to determine whether the data results obtained in a time of major sporting confrontation (FIFA World Cup 2010 and 2014) differ from periods when the tournament did not happen. Analyzes showed differences on the eve of the sporting confrontation, when the increase in the implicit nationalism was clearly superior, even with no effect by self-reports. In an independent analysis of a cultural context, there is an oscillation of explicit nationalism over the years, but not for the implicit action. In addition, it was found in women greater degree of implicit and explicit nationalism than in men, with both sexes presenting their preferences towards Brazil. In an end section, we suggest that nationalism may be a by-product of universal mental mechanisms that evolved to identify of the belonging group categorization, corroborating with the group favoritism. We propose that the intensification of the group preference on the eve of the competition has as its ancestral function strengthen the cohesion of the group in preparation to confrontational situations. We pointed out the need for studies on the differences between the sexes in matters relating to group membership belonging. It was expected largest nationalist attitudes in men reflecting the maintenance of cohesive groups in ancient societies. Thus, it appears a singular importance impart the traditional TAI studies with its online version for future investigations of human behavior in various areas of knowledge.