Commissioning an Anthropomorphic Spine and Lung Phantom for Remote Dose Verification of Institutions Participating in RTOG 0631

The RPC developed a new phantom to ensure comparable and consistent radiation administration in spinal radiosurgery clinical trials. This study assessed the phantom’s dosimetric and anatomic utility. The ‘spine phantom’ is a water filled thorax with anatomy encountered in spinal radiosurgery: target volume, vertebral column, spinal canal, esophagus, heart, and lungs. The dose to the target volume was measured with axial and sagittal planes of radiochromic film and thermoluminescent dosimeters (TLD). The dose distributions were measured with the radiochromic film calibrated to the absolute dose measured by the TLD. Four irradiations were administered: a four angle box plan, a seven angle conformal plan, a seven angle IMRT plan, and a nine angle IMRT plan (denoted as IMRT plan #1 and plan #2, respectively). In each plan, at least 95% of the defined tumor volume received 8 Gy. For each irradiation the planned and administered dose distributions were registered via pinpricks, and compared using point dose measurements, dose profiles, isodose distributions, and gamma analyses. Based on previous experience at the RPC, a gamma analysis was considering passing if greater than 95% of pixels passed the criteria of 5% dose difference and 3 mm distance-to-agreement. Each irradiation showed acceptable agreement in the qualitative assessments and exceeded the 95% passing rate at the 5% / 3 mm criteria, except IMRT plan #1, which was determined to have been poorly localized during treatment administration. The measured and planned dose distributions demonstrated acceptable agreement at the 5% / 3 mm criteria, and the spine phantom was determined to be a useful tool for the remote assessment of an institution’s treatment planning and dose delivery regimen.

MODIFICATION AND IMPLEMENTATION OF THE RPC HETEROGENEOUS THORAX PHANTOM FOR VERIFICATION OF PROTON THERAPY TREATMENT PROCEDURES

The Radiological Physics Center (RPC) provides heterogeneous phantoms that are used to evaluate radiation treatment procedures as part of a comprehensive quality assurance program for institutions participating in clinical trials. It was hypothesized that the existing RPC heterogeneous thorax phantom can be modified to assess lung tumor proton beam therapy procedures involving patient simulation, treatment planning, and treatment delivery, and could confirm agreement between the measured dose and calculated dose within 5%/3mm with a reproducibility of 5%. The Hounsfield Units (HU) for lung equivalent materials (balsa wood and cork) was measured using a CT scanner. The relative linear stopping power (RLSP) of these materials was measured. The linear energy transfer (LET) of Gafchromic EBT2 film was analyzed utilizing parallel and perpendicular orientations in a water tank and compared to ion chamber readings. Both parallel and perpendicular orientations displayed a quenching effect underperforming the ion chamber, with the parallel orientation showing an average 31 % difference and the perpendicular showing an average of 15% difference. Two treatment plans were created that delivered the prescribed dose to the target volume, while achieving low entrance doses. Both treatment plans were designed using smeared compensators and expanded apertures, as would be utilized for a patient in the clinic. Plan 1a contained two beams that were set to orthogonal angles and a zero degree couch kick. Plan 1b utilized two beams set to 10 and 80 degrees with a 15 degree couch kick. EBT2 film and TLD were inserted and the phantom was irradiated 3 times for each plan. Both plans passed the criteria for the TLD measurements where the TLD values were within 7% of the dose calculated by Eclipse. Utilizing the 5%/3mm criteria, the 3 trial average of overall pass rate was 71% for Plan 1a. The 3 trial average for the overall pass rate was 76% for Plan 1b. The trials were then analyzed using RPC conventional lung treatment guidelines set forth by the RTOG: 5%/5mm, and an overall pass rate of 85%. Utilizing these criteria, only Plan 1b passed for all 3 trials, with an average overall pass rate of 89%.

Development of automated image analysis tools for verification of radiotherapy field accuracy with an electronic portal imaging device

The successful management of cancer with radiation relies on the accurate deposition of a prescribed dose to a prescribed anatomical volume within the patient. Treatment set-up errors are inevitable because the alignment of field shaping devices with the patient must be repeated daily up to eighty times during the course of a fractionated radiotherapy treatment. With the invention of electronic portal imaging devices (EPIDs), patient's portal images can be visualized daily in real-time after only a small fraction of the radiation dose has been delivered to each treatment field. However, the accuracy of human visual evaluation of low-contrast portal images has been found to be inadequate. The goal of this research is to develop automated image analysis tools to detect both treatment field shape errors and patient anatomy placement errors with an EPID. A moments method has been developed to align treatment field images to compensate for lack of repositioning precision of the image detector. A figure of merit has also been established to verify the shape and rotation of the treatment fields. Following proper alignment of treatment field boundaries, a cross-correlation method has been developed to detect shifts of the patient's anatomy relative to the treatment field boundary. Phantom studies showed that the moments method aligned the radiation fields to within 0.5mm of translation and 0.5$\sp\circ$ of rotation and that the cross-correlation method aligned anatomical structures inside the radiation field to within 1 mm of translation and 1$\sp\circ$ of rotation. A new procedure of generating and using digitally reconstructed radiographs (DRRs) at megavoltage energies as reference images was also investigated. The procedure allowed a direct comparison between a designed treatment portal and the actual patient setup positions detected by an EPID. Phantom studies confirmed the feasibility of the methodology. Both the moments method and the cross-correlation technique were implemented within an experimental radiotherapy picture archival and communication system (RT-PACS) and were used clinically to evaluate the setup variability of two groups of cancer patients treated with and without an alpha-cradle immobilization aid. The tools developed in this project have proven to be very effective and have played an important role in detecting patient alignment errors and field-shape errors in treatment fields formed by a multileaf collimator (MLC). ^

Explaining Emergence and Consequences of Specific Formal Controls in IS Outsourcing – A Process-View

IS outsourcing projects often fail to achieve project goals. To inhibit this failure, managers need to design formal controls that are tailored to the specific contextual demands. However, the dynamic and uncertain nature of IS outsourcing projects makes the design of such specific formal controls at the outset of a project challenging. Hence, the process of translating high-level project goals into specific formal controls becomes crucial for success or failure of IS outsourcing projects. Based on a comparative case study of four IS outsourcing projects, our study enhances current understanding of such translation processes and their consequences by developing a process model that explains the success or failure to achieve high-level project goals as an outcome of two unique translation patterns. This novel process-based explanation for how and why IS outsourcing projects succeed or fail has important implications for control theory and IS project escalation literature.

The influence of formal and informal sales controls on customer-directed selling behaviors and sales unit effectiveness

Adaptive selling (AS) and customer-oriented selling (COS) constitute two key customer-directed selling behaviors for the success of the modern sales force. However, knowledge regarding the organizational factors that can induce salespeople to engage in those behaviors is strikingly limited. Against this background, we develop a comprehensive model that delineates the influences of formal and informal sales controls on AS and COS and, through them, on sales unit effectiveness. Based on a sample of sales managers in a major European Union country, we present new evidence that (a) formal and informal sales controls exert differential impact on salespeople's AS and COS behaviors; (b) AS directly and positively influences sales unit effectiveness; (c) COS affects sales unit effectiveness only indirectly, i.e. by fostering AS; and (d) outcome and cultural controls directly improve sales unit effectiveness. We conclude with a discussion of our findings for academics and practitioners.

Integración de la Medicina Tradicional y del Sistema de Salud Formal en las Estrategias Familiares Andinas

La medicina tradicional no solamente sigue vigente en los Andes bolivianos, sino constituye la opción de primera elección para las familias rurales. Un estudio realizado en dos comunidades de la Subcentral Waka Playa, Municipio Tapacarí, muestra que los campesinos quechua-hablantes de los valles interandinos integran el sistema tradicional con el sistema de salud formal en el marco de sus estrategias familiares, reflejando un diálogo ínter-ontológico entre diferentes concepciones de salud y de enfermedad. A lo largo de una larga interacción con su entorno natural, los pobladores de los Andes han desarrollado concepciones específicas sobre el ser humano, su relación con la naturaleza, la salud y la enfermedad. Este proceso resultó en un sistema de salud complejo, donde intervienen expertos locales como son los curanderos-adivinos y los parteros y que se basa en un amplio uso y conocimiento de la flora y fauna nativas. A parte de estos conocimientos especializados, la medicina tradicional andina se expresa también en las prácticas terapéuticas diarias de la población, transmitidas y re-inventadas de generación en generación en el contexto de la familia y de la comunidad. La introducción del sistema de salud formal en el área de estudio en los años 90, representado por una posta de salud, impactó las comunidades locales principalmente por el acceso a vacunas – y la consecuente erradicación de algunas enfermedades - y a métodos contraceptivos. Sin embargo, la biomedicina es todavía de acceso muy limitado además de, según la población local, no tener la capacidad para curar ciertas enfermedades locales como el “susto,” el “mal viento” o la “colerina”. Como en otras áreas del conocimiento ecológico local, se observa una pérdida general de los conocimientos vinculados a la medicina tradicional andina debido a varios factores socioeconómicos, el más impactante siendo el proceso masivo de migración de las zonas rurales a los centros urbanos y al trópico boliviano. Sin embargo, estos conocimientos todavía se mantienen vigentes y son altamente valorizados por la población local, como un elemento del mantenimiento de sus formas de vida y de relacionamiento con la “Madre Tierra” (Pachamama). Las familias de Waka Playa integran la medicina tradicional y el sistema de salud formal en sus estrategias de vida, en diferentes grados según factores como la migración, la educación, el sexo y la edad. El uso de la flora medicinal local también es diferenciado según la localización de la vivienda principal de las familias y la consecuente concentración geográfica de sus actividades en las diferentes zonas de producción agroecológicas. Por ultimo, el interés personal influye sobre el grado y el tipo de conocimiento de cada familia. La medicina tradicional juega un rol fundamental en el bien-estar de las familias campesinas andinas y por ello constituye un potencial importante para un desarrollo sostenible. En esta perspectiva, la revalorización de los saberes locales y la construcción de puentes de diálogo con el sistema de salud local son sumamente importantes. Este punto de vista tiene perspectivas prometedoras en el contexto político actual boliviano, que apoya la medicina tradicional en el marco del reconocimiento de las identidades indígenas, en miras a un desarrollo endógeno.

The Emergence of Formal Control Specificity in Information Systems Outsourcing: A Process-View

Information systems (IS) outsourcing projects often fail to achieve initial goals. To avoid project failure, managers need to design formal controls that meet the specific contextual demands of the project. However, the dynamic and uncertain nature of IS outsourcing projects makes it difficult to design such specific formal controls at the outset of a project. It is hence crucial to translate high-level project goals into specific formal controls during the course of a project. This study seeks to understand the underlying patterns of such translation processes. Based on a comparative case study of four outsourced software development projects, we inductively develop a process model that consists of three unique patterns. The process model shows that the performance implications of emergent controls with higher specificity depend on differences in the translation process. Specific formal controls have positive implications for goal achievement if only the stakeholder context is adapted, while they are negative for goal achievement if in the translation process tasks are unintendedly adapted. In the latter case projects incrementally drift away from their initial direction. Our findings help to better understand control dynamics in IS outsourcing projects. We contribute to a process theoretic understanding of IS outsourcing governance and we derive implications for control theory and the IS project escalation literature.

A Mathematical Model for Simplifying Representations of Objects in a Geographic Information System

The study of operations on representations of objects is well documented in the realm of spatial engineering. However, the mathematical structure and formal proof of these operational phenomena are not thoroughly explored. Other works have often focused on query-based models that seek to order classes and instances of objects in the form of semantic hierarchies or graphs. In some models, nodes of graphs represent objects and are connected by edges that represent different types of coarsening operators. This work, however, studies how the coarsening operator "simplification" can manipulate partitions of finite sets, independent from objects and their attributes. Partitions that are "simplified first have a collection of elements filtered (removed), and then the remaining partition is amalgamated (some sub-collections are unified). Simplification has many interesting mathematical properties. A finite composition of simplifications can also be accomplished with some single simplification. Also, if one partition is a simplification of the other, the simplified partition is defined to be less than the other partition according to the simp relation. This relation is shown to be a partial-order relation based on simplification. Collections of partitions can not only be proven to have a partial- order structure, but also have a lattice structure and are complete. In regard to a geographic information system (GIs), partitions related to subsets of attribute domains for objects are called views. Objects belong to different views based whether or not their attribute values lie in the underlying view domain. Given a particular view, objects with their attribute n-tuple codings contained in the view are part of the actualization set on views, and objects are labeled according to the particular subset of the view in which their coding lies. Though the scope of the work does not mainly focus on queries related directly to geographic objects, it provides verification for the existence of particular views in a system with this underlying structure. Given a finite attribute domain, one can say with mathematical certainty that different views of objects are partially ordered by simplification, and every collection of views has a greatest lower bound and least upper bound, which provides the validity for exploring queries in this regard.

VERIFICATION OF DNA PREDICTED PROTEIN SEQUENCES BY ENZYME HYDROLYSIS AND MASS SPECTROMETRIC ANALYSIS

The focus of this thesis lies in the development of a sensitive method for the analysis of protein primary structure which can be easily used to confirm the DNA sequence of a protein's gene and determine the modifications which are made after translation. This technique involves the use of dipeptidyl aminopeptidase (DAP) and dipeptidyl carboxypeptidase (DCP) to hydrolyze the protein and the mass spectrometric analysis of the dipeptide products.^ Dipeptidyl carboxypeptidase was purified from human lung tissue and characterized with respect to its proteolytic activity. The results showed that the enzyme has a relatively unrestricted specificity, making it useful for the analysis of the C-terminal of proteins. Most of the dipeptide products were identified using gas chromatography/mass spectrometry (GC/MS). In order to analyze the peptides not hydrolyzed by DCP and DAP, as well as the dipeptides not identified by GC/MS, a FAB ion source was installed on a quadrupole mass spectrometer and its performance evaluated with a variety of compounds.^ Using these techniques, the sequences of the N-terminal and C-terminal regions and seven fragments of bacteriophage P22 tail protein have been verified. All of the dipeptides identified in these analysis were in the same DNA reading frame, thus ruling out the possibility of a single base being inserted or deleted from the DNA sequence. The verification of small sequences throughout the protein sequence also indicates that no large portions of the protein have been removed after translation. ^