Otimização de esquemas terapêuticos do carcinoma da próstata envolvendo braquiterapia de baixa taxa de dose e radioterapia externa : abordagens física e radiobiológica

RESUMO: Este trabalho teve como objetivo a determinação de esquemas de tratamento alternativos para o carcinoma da próstata com radioterapia externa (EBRT) e braquiterapia de baixa taxa de dose (LDRBT) com implantes permanentes de Iodo-125, biologicamente equivalentes aos convencionalmente usados na prática clínica, com recurso a modelos teóricos e a métodos de Monte Carlo (MC). Os conceitos de dose biológica efetiva (BED) e de dose uniforme equivalente (EUD) foram utilizados, com o modelo linear-quadrático (LQ), para a determinação de regimes de tratamento equivalentes. Numa primeira abordagem, utilizou-se a BED para determinar: 1) esquemas hipofracionados de EBRT mantendo as complicações retais tardias de regimes convencionais com doses totais de 75,6 Gy, 77,4 Gy, 79,2 Gy e 81,0 Gy; e 2) a relação entre as doses totais de EBRT e LDRBT de modo a manter a BED do regime convencional de 45 Gy de EBRT e 110 Gy de LDRBT. Numa segunda abordagem, recorreu-se ao código de MC MCNPX para a simulação de distribuições de dose de EBRT e LDRBT em dois fantomas de voxel segmentados a partir das imagens de tomografia computorizada de pacientes com carcinoma da próstata. Os resultados das simulações de EBRT e LDRBT foram somados e determinada uma EUD total de forma a obterem-se: 1) esquemas equivalentes ao tratamento convencional de 25 frações de 1,8 Gy de EBRT em combinação com 110 Gy de LDRBT; e 2) esquemas equivalentes a EUD na próstata de 67 Gy, 72 Gy, 80 Gy, 90 Gy, 100 Gy e 110 Gy. Em todos os resultados nota-se um ganho terapêutico teórico na utilização de esquemas hipofracionados de EBRT. Para uma BED no reto equivalente ao esquema convencional, tem-se um aumento de 2% na BED da próstata com menos 5 frações. Este incremento dá-se de forma cada vez mais visível à medida que se reduz o número de frações, sendo da ordem dos 10-11% com menos 20 frações e dos 35-45% com menos 40 frações. Considerando os resultados das simulações de EBRT, obteve-se uma EUD média de 107 Gy para a próstata e de 42 Gy para o reto, com o esquema convencional de 110 Gy de LDRBT, seguidos de 25 frações de 1,8 Gy de EBRT. Em termos de probabilidade de controlo tumoral (igual EUD), é equivalente a este tratamento a administração de EBRT em 66 frações de 1,8 Gy, 56 de 2 Gy, 40 de 2,5 Gy, 31 de 3 Gy, 20 de 4 Gy ou 13 de 5 Gy. Relativamente à administração de 66 frações de 1,8 Gy, a EUD generalizada no reto reduz em 6% com o recurso a frações de 2,5 Gy e em 10% com frações de 4 Gy. Determinou-se uma BED total de 162 Gy para a administração de 25 frações de 1,8 Gy de EBRT em combinação com 110 Gy de LDRBT. Variando-se a dose total de LDRBT (TDLDRBT) em função da dose total de EBRT (TDEBRT), de modo a garantir uma BED de 162 Gy, obteve-se a seguinte relação:.......... Os resultados das simulações mostram que a EUD no reto diminui com o aumento da dose total de LDRBT para dose por fração de EBRT (dEBRT) inferiores a 2, Gy e aumenta para dEBRT a partir dos 3 Gy. Para quantidades de TDLDRBT mais baixas (<50 Gy), o reto beneficia de frações maiores de EBRT. À medida que se aumenta a TDLDRBT, a EUD generalizada no reto torna-se menos dependente da dEBRT. Este trabalho mostra que é possível a utilização de diferentes regimes de tratamento para o carcinoma da próstata com radioterapia que possibilitem um ganho terapêutico, quer seja administrando uma maior dose biológica com efeitos tardios constantes, quer mantendo a dose no tumor e diminuindo a toxicidade retal. A utilização com precaução de esquemas hipofracionados de EBRT, para além do benefício terapêutico, pode trazer vantagens ao nível da conveniência para o paciente e economia de custos. Os resultados das simulações deste estudo e conversão para doses de efeito biológico para o tratamento do carcinoma da próstata apresentam linhas de orientação teórica de interesse para novos ensaios clínicos. --------------------------------------------------ABSTRACT: The purpose of this work was to determine alternative radiotherapy regimens for the treatment of prostate cancer using external beam radiotherapy (EBRT) and low dose-rate brachytherapy (LDRBT) with Iodine-125 permanent implants which are biologically equivalent to conventional clinical treatments, by the use of theoretical models and Monte Carlo techniques. The concepts of biological effective dose (BED) and equivalent uniform dose (EUD), together with the linear-quadratic model (LQ), were used for determining equivalent treatment regimens. In a first approach, the BED concept was used to determine: 1) hypofractionated schemes of EBRT maintaining late rectal complications as with the conventional regimens with total doses of 75.6 Gy, 77.4 Gy, 79.2 Gy and 81.0 Gy; and 2) the relationship between total doses of EBRT and LDRBT in order to keep the BED of the conventional treatment of 45 Gy of EBRT and 110 Gy of LDRBT. In a second approach, the MC code MCNPX was used for simulating dose distributions of EBRT and LDRBT in two voxel phantoms segmented from the computed tomography of patients with prostate cancer. The results of the simulations of EBRT and LDRBT were added up and given an overall EUD in order to obtain: 1) equivalent to conventional treatment regimens of 25 fraction of 1.8 Gy of EBRT in combination with 110Gy of LDRBT; and 2) equivalent schemes of EUD of 67 Gy, 72 Gy, 80 Gy, 90 Gy, 100 Gy, and 110Gy to the prostate. In all the results it is noted a therapeutic gain using hypofractionated EBRT schemes. For a rectal BED equivalent to the conventional regimen, an increment of 2% in the prostate BED was achieved with less 5 fractions. This increase is visibly higher as the number of fractions decrease, amounting 10-11% with less 20 fractions and 35-45% with less 20 fractions. Considering the results of the EBRT simulations an average EUD of 107 Gy was achieved for the prostate and of 42 Gy for the rectum with the conventional scheme of 110 Gy of LDRBT followed by 25 fractions of 1.8 Gy of EBRT. In terms of tumor control probability (same EUD) it is equivalent to this treatment, for example, delivering the EBRT in 66 fractions of 1.8 Gy, 56 fractions of 2 Gy, 40 fractions of 2.5 Gy, 31 fractions of 3 Gy, 20 fractions of 4 Gy or 13 fractions of 5 Gy. Regarding the use of 66 fractions of 1.8 Gy, the rectum EUD is reduced to 6% with 2.5 Gy per fraction and to 10% with 4 Gy. A total BED of 162 Gy was achieved for the delivery of 25 fractions of 1.8 Gy of EBRT in combination with 110 Gy of LDRBT. By varying the total dose of LDRBT (TDLDRBT) with the total dose of EBRT (TDEBRT) so as to ensure a BED of 162 Gy, the following relationship was obtained: ....... The simulation results show that the rectum EUD decreases with the increase of the TDLDRBT, for EBRT dose per fracion (dEBRT) less than 2.5 Gy and increases for dEBRT above 3 Gy. For lower amounts of TDLDRBT (< 50Gy), the rectum benefits of larger EBRT fractions. As the TDLDRBT increases, the rectum gEUD becomes less dependent on the dEBRT. The use of different regimens which enable a therapeutic gain, whether deivering a higher dose with the same late biological effects or maintaining the dose to the tumor and reducing rectal toxicity is possible. The use with precaution of hypofractionated regimens, in addition to the therapeutic benefit, can bring advantages in terms of convenience for the patient and cost savings. The simulation results of this study together with the biological dose conversion for the treatment of prostate cancer serve as guidelines of interest for new clinical trials.

Modélisation radiobiologique pour la planification des traitements en radiothérapie à partir de données d’imagerie spécifiques aux patients

Un modèle de croissance et de réponse à la radiothérapie pour le glioblastome multiforme (GBM) basé le formalisme du modèle de prolifération-invasion (PI) et du modèle linéaire-quadratique a été développé et implémenté. La géométrie spécifique au patient est considérée en modélisant, d'une part, les voies d'invasion possibles des GBM avec l'imagerie du tenseur de diffusion (DTI) et, d'autre part, les barrières à la propagation à partir des images anatomiques disponibles. La distribution de dose réelle reçue par un patient donné est appliquée telle quelle dans les simulations, en respectant l'horaire de traitement. Les paramètres libres du modèle (taux de prolifération, coefficient de diffusion, paramètres radiobiologiques) sont choisis aléatoirement à partir de distributions de valeurs plausibles. Un total de 400 ensembles de valeurs pour les paramètres libres sont ainsi choisis pour tous les patients, et une simulation de la croissance et de la réponse au traitement est effectuée pour chaque patient et chaque ensemble de paramètres. Un critère de récidive est appliqué sur les résultats de chaque simulation pour identifier un lieu probable de récidive (SPR). La superposition de tous les SPR obtenus pour un patient donné permet de définir la probabilité d'occurrence (OP). Il est démontré qu'il existe des valeurs de OP élevées pour tous les patients, impliquant que les résultats du modèle PI ne sont pas très sensibles aux valeurs des paramètres utilisés. Il est également démontré comment le formalisme développé dans cet ouvrage pourrait permettre de définir un volume cible personnalisé pour les traitements de radiothérapie du GBM.

Wavelets and the generalization of the variogram

The experimental variogram computed in the usual way by the method of moments and the Haar wavelet transform are similar in that they filter data and yield informative summaries that may be interpreted. The variogram filters out constant values; wavelets can filter variation at several spatial scales and thereby provide a richer repertoire for analysis and demand no assumptions other than that of finite variance. This paper compares the two functions, identifying that part of the Haar wavelet transform that gives it its advantages. It goes on to show that the generalized variogram of order k=1, 2, and 3 filters linear, quadratic, and cubic polynomials from the data, respectively, which correspond with more complex wavelets in Daubechies's family. The additional filter coefficients of the latter can reveal features of the data that are not evident in its usual form. Three examples in which data recorded at regular intervals on transects are analyzed illustrate the extended form of the variogram. The apparent periodicity of gilgais in Australia seems to be accentuated as filter coefficients are added, but otherwise the analysis provides no new insight. Analysis of hyerpsectral data with a strong linear trend showed that the wavelet-based variograms filtered it out. Adding filter coefficients in the analysis of the topsoil across the Jurassic scarplands of England changed the upper bound of the variogram; it then resembled the within-class variogram computed by the method of moments. To elucidate these results, we simulated several series of data to represent a random process with values fluctuating about a mean, data with long-range linear trend, data with local trend, and data with stepped transitions. The results suggest that the wavelet variogram can filter out the effects of long-range trend, but not local trend, and of transitions from one class to another, as across boundaries.

Dynamic integrated system optimization and parameter estimation for discrete time optimal control of nonlinear systems

An algorithm for solving nonlinear discrete time optimal control problems with model-reality differences is presented. The technique uses Dynamic Integrated System Optimization and Parameter Estimation (DISOPE), which achieves the correct optimal solution in spite of deficiencies in the mathematical model employed in the optimization procedure. A version of the algorithm with a linear-quadratic model-based problem, implemented in the C+ + programming language, is developed and applied to illustrative simulation examples. An analysis of the optimality and convergence properties of the algorithm is also presented.

A new approach for the solution of the optimal set-point tracking problem for nonlinear systems

In this paper, a discrete time dynamic integrated system optimisation and parameter estimation algorithm is applied to the solution of the nonlinear tracking optimal control problem. A version of the algorithm with a linear-quadratic model-based problem is developed and implemented in software. The algorithm implemented is tested with simulation examples.

Hierarchical control and optimisation of the Tennessee Eastman process

Based on integrated system optimisation and parameter estimation a method is described for on-line steady state optimisation which compensates for model-plant mismatch and solves a non-linear optimisation problem by iterating on a linear - quadratic representation. The method requires real process derivatives which are estimated using a dynamic identification technique. The utility of the method is demonstrated using a simulation of the Tennessee Eastman benchmark chemical process.

Optimal control of nonlinear differential algebraic equation systems

A novel iterative procedure is described for solving nonlinear optimal control problems subject to differential algebraic equations. The procedure iterates on an integrated modified linear quadratic model based problem with parameter updating in such a manner that the correct solution of the original non-linear problem is achieved. The resulting algorithm has a particular advantage in that the solution is achieved without the need to solve the differential algebraic equations . Convergence aspects are discussed and a simulation example is described which illustrates the performance of the technique. 1. Introduction When modelling industrial processes often the resulting equations consist of coupled differential and algebraic equations (DAEs). In many situations these equations are nonlinear and cannot readily be directly reduced to ordinary differential equations.

Body-centric modelling, identification, and acceleration tracking control of a quadrotor UAV

This paper presents the mathematical development of a body-centric nonlinear dynamic model of a quadrotor UAV that is suitable for the development of biologically inspired navigation strategies. Analytical approximations are used to find an initial guess of the parameters of the nonlinear model, then parameter estimation methods are used to refine the model parameters using the data obtained from onboard sensors during flight. Due to the unstable nature of the quadrotor model, the identification process is performed with the system in closed-loop control of attitude angles. The obtained model parameters are validated using real unseen experimental data. Based on the identified model, a Linear-Quadratic (LQ) optimal tracker is designed to stabilize the quadrotor and facilitate its translational control by tracking body accelerations. The LQ tracker is tested on an experimental quadrotor UAV and the obtained results are a further means to validate the quality of the estimated model. The unique formulation of the control problem in the body frame makes the controller better suited for bio-inspired navigation and guidance strategies than conventional attitude or position based control systems that can be found in the existing literature.

Optimization of the rheological properties of probiotic yoghurts supplemented with milk proteins

This study aimed to optimize the rheological properties of probiotic yoghurts supplemented with skimmed milk powder (SMP) whey protein concentrate (WPC) and sodium caseinate (Na-Cn) by using an experimental design type simplex-centroid for mixture modeling It Included seven batches/trials three were supplemented with each type of the dairy protein used three corresponding to the binary mixtures and one to the ternary one in order to increase protein concentration in 1 g 100 g(-1) of final product A control experiment was prepared without supplementing the milk base Processed milk bases were fermented at 42 C until pH 4 5 by using a starter culture blend that consisted of Streptococcus thermophilus Lactobacillus delbrueckii subsp bulgaricus and Bifidobacterium (Humans subsp lactis The kinetics of acidification was followed during the fermentation period as well the physico-chemical analyses enumeration of viable bacteria and theological characteristics of the yoghurts Models were adjusted to the results (kinetic responses counts of viable bacteria and theological parameters) through three regression models (linear quadratic and cubic special) applied to mixtures The results showed that the addition of milk proteins affected slightly acidification profile and counts of S thermophilus and B animal`s subsp lactis but it was significant for L delbrueckii subsp bulgaricus Partially-replacing SMP (45 g/100 g) with WPC or Na-Cn simultaneously enhanced the theological properties of probiotic yoghurts taking into account the kinetics of acidification and enumeration of viable bacteria (C) 2010 Elsevier Ltd All rights reserved

Using geometric shape variations to create an inverse model for a sheet metal process

The output of the sheet metal forming process is subject to much variation. This paper develops a method to measure shape variation in channel forming and relate this back to the corresponding process parameter levels of the manufacturing set-up to create an inverse model. The shape variation in the channels is measured using a modified form of the point distribution model (also known as the active shape model). This means that channels can be represented by a weighting vector of minimal linear dimension that contains all the shape variation information from the average formed channel.

The inverse models were created using classifiers that related the weighting vectors to the process parameter levels for the blank holder force (BHF), die radii (DR) and tool gap (TG) of the parameters. Several classifiers were tested: linear, quadratic Gaussian and artificial neural networks. The quadratic Gaussian classifiers were the most accurate and the most consistent type of classifier over all the parameters.

Terminal approach navigation for autonomous robots in a sensory network

In this paper we present a technique based on precision guidance approach for the sensor delivery and reception problem between two mobile robots. A slave robot is employed to collect sensors and slack them on a tray carried by the mobile master robot. We define the terminal attitude of the slave robot with respect to the master and present a LQR control approach to solving the problem of achieving a desired terminal approach angle necessary for the appropriate sensor delivery. The approach criteria is defined in terms of both minimizing the miss distance and controlling the slave robot's body attitude with respect to the master robot at the terminal point.

Design of a norm-bounded LQG controller for power distribution networks with distributed generation

This paper presents a novel excitation control design to improve the voltage profile of power distribution networks with distributed generation and induction motor loads. The system is linearised by perturbation technique. Controller is designed using the linear-quadratic-Gaussian (LQG) controller synthesis method. The LQG controller is addressed with norm-bounded uncertainty. The approach considered in this paper is to find the smallest upper bound on the H∞ norm of the uncertain system and to design an optimal controller based on this bound. The design method requires the solution of a linear matrix inequality. The performance of the controller is tested on a benchmark power distribution system. Simulation results show that the proposed controller provides impressive oscillation damping compared to the conventional excitation controller.

Stable operation of distribution networks using D-STATCOM considering uncertainties in load compositions

This paper presents a novel control design for D-STATCOM to ensure grid code-compatible performance of distributed wind generators. The approach considered in this paper is to find the smallest upper bound on the H norm of the uncertain system and to design an optimal linear quadratic Gaussian (LQG) controller based on this bound. The change in the model due to variations of induction motor (IM) load compositions in the composite load is considered as an uncertain term in the design algorithm. The performance of the designed controller is demonstrated on a distribution test system representative of the Kumamoto area in Japan. It is found that the proposed controller enhances voltage stability of the distribution system under varying operating conditions

A control methodology for DFIG type wind turbines connected to distribution networks

This paper proposes a decentralised controller design for doubly-fed induction generators (DFIGs) to enhance dynamic performance of distribution networks. The change in the output power due to the variable nature of wind is considered as an uncertain term in the design algorithm. In addition, the interconnection effect of the other subsystems are considered in the design process. The H norm of the uncertain system is found out and simultaneous output-feedback linear controllers are designed based controller is verified on a 16 bus distribution test system for severe disturbances. Simulation results indicate that the designed controller is robust against uncertainties in operating conditions