Search

Background/Objectives: Medulloblastoma is the most common malignant brain tumor in children. In recent decades, the therapeutic landscape has undergone significant changes, with stereotactic radiosurgery (SRS) emerging as a promising treatment for recurrent cases. Our study provides a comprehensive analysis of the long-term efficacy and safety of SRS in recurrent medulloblastomas across both pediatric and adult patients at a single institution. Methods: We retrospectively reviewed the clinical and radiological records of patients who underwent CyberKnife SRS for recurrent cranial medulloblastomas at our institution between 1998 and 2023. Follow-up data were available for 15 medulloblastomas in 10 patients. The cohort comprised eight pediatric patients (ages 3–18) and two adult patients (ages 19–75). The median age at the time of SRS was 13 years, the median tumor volume accounted for 1.9 cc, the median biologically equivalent dose (BED) was 126 Gy, and the single-fraction equivalent dose (SFED) was 18 Gy. The SRS was administered at 75% of the median isodose line. Results: Following a median follow-up of 39 months (range: 6–78), 53.3% of the medulloblastomas progressed, 13.3% regressed, and 33.3% remained stable. The 3-year local tumor control (LTC) rate for all medulloblastomas was 65%, with lower rates observed in the adult cohort (50%) and higher rates in pediatric patients (67%). The 3-year overall survival (OS) rate was 70%, with significantly higher rates in pediatric patients (75%) compared to adult patients (50%). The 3-year progression-free survival (PFS) rate was 58.3%, with higher rates in pediatric patients (60%) compared to adult patients (50%). Two pediatric patients developed radiation-induced edema, while two adult patients experienced radiation necrosis at the latest follow-up, with both adult patients passing away. Conclusions: Our study provides a complex perspective on the efficacy and safety of CyberKnife SRS in treating recurrent cranial medulloblastomas across pediatric and adult populations. The rarity of adverse radiation events (AREs) underscores the safety profile of SRS, reinforcing its role in enhancing treatment outcomes. The intricacies of symptomatic outcomes, intertwined with factors such as age, tumor location, and prior surgeries, emphasize the need for personalized treatment approaches. Our findings underscore the imperative for ongoing research and the development of more refined treatment strategies for recurrent medulloblastomas. Given the observed disparities in treatment outcomes, a more meticulous tailoring of treatment approaches becomes crucial. [ABSTRACT FROM AUTHOR]

Detection and segmentation of brain metastases (BMs) play a pivotal role in diagnosis, treatment planning, and follow-up evaluations for effective BM management. Given the rising prevalence of BM cases and its predominantly multiple onsets, automated segmentation is becoming necessary in stereotactic radiosurgery. It not only alleviates the clinician's manual workload and improves clinical workflow efficiency but also ensures treatment safety, ultimately improving patient care. Recent strides in machine learning, particularly in deep learning (DL), have revolutionized medical image segmentation, achieving state-of-the-art results. This review aims to analyze auto-segmentation strategies, characterize the utilized data, and assess the performance of cutting-edge BM segmentation methodologies. Additionally, we delve into the challenges confronting BM segmentation and share insights gleaned from our algorithmic and clinical implementation experiences. [ABSTRACT FROM AUTHOR]

Deformable image registration (DIR) of fractional high-dose-rate (HDR) CT images is challenging due to the presence of applicators in the brachytherapy image. Point-to-point correspondence fails because of the undesired deformation vector fields (DVF) propagated from the applicator region (AR) to the surrounding tissues, which can potentially introduce significant DIR errors in dose mapping. This paper proposes a novel segmentation and point-matching enhanced efficient DIR (named SPEED) scheme to facilitate dose accumulation among HDR treatment fractions. In SPEED, a semi-automatic seed point generation approach is developed to obtain the incremented fore/background point sets to feed the random walks algorithm, which is used to segment and remove the AR, leaving empty AR cavities in the HDR CT images. A feature-based 'thin-plate-spline robust point matching' algorithm is then employed for AR cavity surface points matching. With the resulting mapping, a DVF defining on each voxel is estimated by B-spline approximation, which serves as the initial DVF for the subsequent Demons-based DIR between the AR-free HDR CT images. The calculated DVF via Demons combined with the initial one serve as the final DVF to map doses between HDR fractions. The segmentation and registration accuracy are quantitatively assessed by nine clinical HDR cases from three gynecological cancer patients. The quantitative analysis and visual inspection of the DIR results indicate that SPEED can suppress the impact of applicator on DIR, and accurately register HDR CT images as well as deform and add interfractional HDR doses.

Purpose: To develop an angular correction methodology and characterize a high‐resolution complementary metal‐oxide‐semiconductor (CMOS) array for patient specific quality assurance on a robotic arm linear accelerator. Methods: Beam path files from the treatment planning software (TPS) were used to calculate the angle of radiation beam with respect to the detector plane. Beams from multiple discrete angles were delivered to the CMOS detector array and an angular dependency look up table (LUT) was created. The LUT was then used to correct for the angular dependency of the detector. An iso‐centric 5 mm fixed cone, non iso‐centric multi‐target fixed cone, 10 mm Iris and a multi‐leaf collimator (MLC) based collimated plan were delivered to the phantom and compared to the TPS with and without angular correction applied. Additionally, the CMOS array was compared to gafchromic film and a diode array. Results: Large errors of up to 30% were observed for oblique angles. When angular correction was applied, the gamma passing rate increased from 99.2% to 100% (average gamma value decreased from 0.29 to 0.14) for the 5‐mm iso‐centric cone plan. Similarly, the passing rate increased from 84.0% to 100% for the Iris plan and from 49.98% to 98.4% for the MLC plan when angular correction was applied. For the multi‐target plan, applying angular correction improved the gamma passing rate from 94% to 99.6%. The 5 mm iso‐centric fixed cone plan was also delivered to film, and the gamma passing rate was 91.3% when using gafchromic film as the reference dataset, whereas the diode array provided insufficient sampling for this plan. Conclusion: A methodology of calculating the beam angle based on the beam path files was developed and validated. The array was demonstrated to be superior to other quality assurance tools because of its sub‐millimeter spatial resolution and immediate read out of the results. [ABSTRACT FROM AUTHOR]

Iron ion is the common transition metal ion in atmospheric aerosol, which can affect the components and optics of secondary organic aerosol (SOA). In the current study, the atmospheric photooxidation of toluene to produce SOA in the presence of ferric chloride fine particles is simulated in a smog chamber; on-line and off-line mass spectrometry and spectroscopic instruments are used to characterize constituents and optics of SOA. Compare with SOA formed in the absence of fine particles, the laser desorption/ionization mass spectra of toluene SOA generated in the presence of ferric chloride fine particles show ion peaks of m/z = 163 and 178, the UV-Vis spectra of the extracting solution for toluene SOA have peaks near 400 and 700 nm, and the electrospray ionization mass spectra contain peaks at m/z = 248 and 300. Based on this spectral information, it is shown that gaseous methylcatechol formed from photooxidation of toluene may react with iron ion on the surface of fine particles by complexing and oxidation–reduction, resulting in methylbenzoquinone products and metallo-organic complex ions such as [Fe(III)(CH3C6H3OO)]+, [Fe(III)(CH3C6H3 OO)2]− and [Fe(III)(CH3C6H3OO)Cl2]−. These products have strong light absorption ability, resulting in an increase in the averaged mass absorption coefficient () in the 200~1000 nm range and the MAC at 365 nm (MAC365) for toluene SOA, while and MAC365 progressively increase with an increasing concentration of ferric chloride fine particles. These results serve as experimental references for the study of the formation mechanism and optical properties of metallo-organic complexes in atmospheric aerosol particles in regions experiencing high levels of fine particles of metal and automobile exhaust pollution. [ABSTRACT FROM AUTHOR]

We report a synchrotron radiation vacuum ultraviolet photoionization study of the hydroperoxyl radical (HO2), a key reaction intermediate in combustion and atmospheric chemistry as well as astrochemistry, using double imaging photoelectron photoion coincidence spectroscopy. The HO2 radical is formed in a microwave discharge flow tube reactor through a set of reactions initiated by F atoms in a CH4/O2/He gas mixture. The high-resolution threshold photoelectron spectrum of HO2 in the 11 eV–12 eV energy range is acquired without interferences from other species and assigned with the aid of theoretically calculated adiabatic ionization energies (AIEs) and Franck–Condon factors. The three vibrational modes of the radical cation HO2+, the H–O stretch, the H–O–O bend, and the O–O stretch, have been identified, and their individual frequencies are measured. In addition, the AIEs of the X3A″ ground state and the a1A′ first excited electronic state of HO2+ are experimentally determined at 11.359 ± 0.003 eV and 11.639 ± 0.005 eV, respectively, in agreement with high-level theoretically computed results. Furthermore, the former AIE value provides validation of thermochemical networks used to extract the enthalpy of formation of the HO2 radical. [ABSTRACT FROM AUTHOR]

We present here a synchrotron radiation vacuum ultraviolet photoionization study of the simplest alkoxy radical, CH3O, a key reaction intermediate in atmospheric and combustion chemistry. A microwave discharge fast flow tube connected to a molecular beam sampling system is employed as a chemical reactor to initiate reactions and generate radicals. The CH3O+ cation from direct ionization of the CH3O radical is detected successfully in the photoionization mass spectrum close to its ionization threshold. In addition, after identifying and removing the contribution of the 13C-isotopic formaldehyde H213CO with the same isobaric mass m/z = 31, the high-resolution threshold photoelectron spectrum of CH3O is obtained and assigned with the aid of calculated Franck–Condon factors. The adiabatic ionization energy of CH3O is determined at 10.701 eV with an accuracy of 0.005 eV. [ABSTRACT FROM AUTHOR]

The vacuum ultraviolet photoionization of the methyl peroxy radical, CH3O2, and unimolecular dissociation of internal energy selected CH3O2+ cations were investigated in the 9.7–12.0 eV energy range by synchrotron-based double imaging photoelectron photoion coincidence. A microwave discharge flow tube was employed to produce CH3O2 via the reaction of methyl radicals (CH3) with oxygen gas. After identifying and separating the different sources of CH3+ from photoionization of CH3 or dissociative photoionization of CH3O2, the high resolution slow photoelectron spectrum (SPES) of CH3O2 was obtained, exhibiting two broad bands superimposed with a complex vibrational structure. The first band of the SPES is attributed to the X3A″ and a1A′ overlapped electronic states of CH3O2+ and the second is assigned to the b1A′ electronic state with the help of theoretical calculations. The adiabatic ionization energy of CH3O2 is derived as 10.215 ± 0.015 eV, in good agreement with high-accuracy theoretical data from the literature. The vertical ionization energy of the b1A′ electronic state is measured to be 11.5 eV and this state fully dissociates into CH3+ and O2 fragments. The 0 K adiabatic appearance energy (AE0K) of the CH3+ fragment ion is determined to be 11.15 ± 0.02 eV. [ABSTRACT FROM AUTHOR]

Purpose: Deep inspiration breath‐hold (DIBH) is crucial in reducing the lung and cardiac dose for treatment of left‐sided breast cancer. We compared the stability and reproducibility of two DIBH techniques: Active Breathing Coordinator (ABC) and VisionRT (VRT). Materials and Methods: We examined intra‐ and inter‐fraction positional variation of the left lung. Eight left‐sided breast cancer patients were monitored with electronic portal imaging during breath‐hold (BH) at every fraction. For each patient, half of the fractions were treated using ABC and the other half with VRT, with an equal amount starting with either ABC or VRT. The lung in each portal image was delineated, and the variation of its area was evaluated. Intrafraction stability was evaluated as the mean coefficient of variation (CV) of the lung area for the supraclavicular (SCV) and left lateral (LLat) field over the course of treatment. Reproducibility was the CV for the first image of each fraction. Daily session time and total imaging monitor units (MU) used in patient positioning were recorded. Results: The mean intrafraction stability across all patients for the LLat field was 1.3 ± 0.7% and 1.5 ± 0.9% for VRT and ABC, respectively. Similarly, this was 1.5 ± 0.7% and 1.6 ± 0.8% for VRT and ABC, respectively, for the SCV field. The mean interfraction reproducibility for the LLat field was 11.0 ± 3.4% and 14.9 ± 6.0% for VRT and ABC, respectively. Similarly, this was 13.0 ± 2.5% and 14.8 ± 9% for VRT and ABC, respectively, for the SCV. No difference was observed in the number of verification images required for either technique. Conclusions: The stability and reproducibility were found to be comparable between ABC and VRT. ABC can have larger interfractional variation with less feedback to the treating therapist compared to VRT as shown in the increase in geometric misses at the matchline. [ABSTRACT FROM AUTHOR]