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OBJECTIVE The objective of this scoping review is to identify, collate, and map the evidence on simulation interprofessional education activities in any setting for the education of health professional students. INTRODUCTION Simulation interprofessional education activities comprise in-person and collaborative online learning embedded in formal curricula. Though the number of simulation interprofessional education activities has increased with the knowledge of the importance of effective interprofessional collaboration, the literature still lacks a description of the characteristics of existing activities. INCLUSION CRITERIA This scoping review will consider interprofessional education activities taking place within a simulation environment. Included papers will report on activities with two or more types of learners in health professional programs. METHODS The proposed scoping review will be conducted in accordance with the JBI methodology for scoping reviews. Databases searched will include PubMed, CINAHL, and ERIC. Results will be limited to English-language publications from 2016 to the present year. Data extraction will be performed using a purposefully developed data extraction tool. Teams of reviewers will screen abstracts and full texts of articles for potential inclusion, and decisions will be determined via consensus of two out of three reviewers. Extracted data will be presented in diagrammatic or tabular form in a manner that aligns with the objective of this scoping review. A narrative summary will accompany the tabulated and/or charted results and will describe how the results relate to the review's objective and questions, and how the results might inform future simulation interprofessional education activities in health professions education.

Purpose To develop a simplified aluminum compensator system for total body irradiation (TBI) that is easy to assemble and modify in a short period of time for customized patient treatments. Methods The compensator is composed of a combination of 0.3 cm thick aluminum bars, two aluminum T‐tracks, spacers, and metal bolts. The system is mounted onto a plexiglass block tray. The design consists of 11 fixed sectors spanning from the patient's head to feet. The outermost sectors utilize 7.6 cm wide aluminum bars, while the remaining sectors use 2.5 cm wide aluminum bars. There is a magnification factor of 5 from the compensator to the patient treatment plane. Each bar of aluminum is interconnected at each adjacent sector with a tongue and groove arrangement and fastened to the T‐track using a metal washer, bolt, and nut. Inter‐bar leakage of the compensator was tested using a water tank and diode. End‐to‐end measurements were performed with an ion chamber in a solid water phantom and also with a RANDO phantom using internal and external optically stimulated luminescent detectors (OSLDs). In‐vivo patient measurements from the first 20 patients treated with this aluminum compensator were compared to those from 20 patients treated with our previously used lead compensator system. Results The compensator assembly time was reduced to 20–30 min compared to the 2–4 h it would take with the previous lead design. All end‐to‐end measurements were within 10% of that expected. The median absolute in‐vivo error for the aluminum compensator was 3.7%, with 93.8% of measurements being within 10% of that expected. The median error for the lead compensator system was 5.3%, with 85.1% being within 10% of that expected. Conclusion This design has become the standard compensator at our clinic. It allows for quick assembly and customization along with meeting the Task Group 29 recommendations for dose uniformity.

Purpose For mobile lung tumors, four‐dimensional computer tomography (4D CT) is often used for simulation and treatment planning. Localization accuracy remains a challenge in lung stereotactic body radiation therapy (SBRT) treatments. An attractive image guidance method to increase localization accuracy is 4D cone‐beam CT (CBCT) as it allows for visualization of tumor motion with reduced motion artifacts. However, acquisition and reconstruction of 4D CBCT differ from that of 4D CT. This study evaluates the discrepancies between the reconstructed motion of 4D CBCT and 4D CT imaging over a wide range of sine target motion parameters and patient waveforms. Methods A thorax motion phantom was used to examine 24 sine motions with varying amplitudes and cycle times and seven patient waveforms. Each programmed motion was imaged using 4D CT and 4D CBCT. The images were processed to auto segment the target. For sine motion, the target centroid at each phase was fitted to a sinusoidal curve to evaluate equivalence in amplitude between the two imaging modalities. The patient waveform motion was evaluated based on the average 4D data sets. Results The mean difference and root‐mean‐square‐error between the two modalities for sine motion were −0.35 ± 0.22 and 0.60 mm, respectively, with 4D CBCT slightly overestimating amplitude compared with 4D CT. The two imaging methods were determined to be significantly equivalent within ±1 mm based on two one‐sided t tests (p

Purpose Studies have evaluated the viability of using open‐face masks as an immobilization technique to treat intracranial and head and neck cancers. This method offers less stress to the patient with comparable accuracy to closed‐face masks. Open‐face masks permit implementation of surface guided radiation therapy (SGRT) to assist in positioning and motion management. Research suggests that changes in patient facial expressions may influence the SGRT system to generate false positional corrections. This study aims to quantify these errors produced by the SGRT system due to face motion. Methods Ten human subjects were immobilized using open‐face masks. Four discrete SGRT regions of interest (ROIs) were analyzed based on anatomical features to simulate different mask openings. The largest ROI was lateral to the cheeks, superior to the eyebrows, and inferior to the mouth. The smallest ROI included only the eyes and bridge of the nose. Subjects were asked to open and close their eyes and simulate fear and annoyance and peak isocenter shifts were recorded. This was performed in both standard and SRS specific resolutions with the C‐RAD Catalyst HD system. Results All four ROIs analyzed in SRS and Standard resolutions demonstrated an average deviation of 0.3 ± 0.3 mm for eyes closed and 0.4 ± 0.4 mm shift for eyes open, and 0.3 ± 0.3 mm for eyes closed and 0.8 ± 0.9 mm shift for eyes open. The average deviation observed due to changing facial expressions was 1.4 ± 0.9 mm for SRS specific and 1.6 ± 1.6 mm for standard resolution. Conclusion The SGRT system can generate false positional corrections for face motion and this is amplified at lower resolutions and smaller ROIs. These errors should be considered in the overall tolerances and treatment plan when using open‐face masks with SGRT and may warrant additional radiographic imaging.

Two end-to-end tests evaluate the accuracy of a surface-guided radiation therapy (SGRT) system (CRAD Catalyst HD) for position verification in comparison to a stereoscopic x-ray imaging system (Brainlab Exactrac ) for single-isocenter, multiple metastases stereotactic radiosurgery (SRS) using 3D polymer gel inserts.A 3D-printed phantom (Prime phantom, RTsafe PC, Athens, Greece) with two separate cylindrical polymer gel inserts were immobilized in open-face masks and treated with a single isocentric, multitarget SRS plan. Planning was done in Brainlab (Elements) to treat five metastatic lesions in one fraction, and initial setup was done using cone beam computed tomography. Positional verification was done using orthogonal X-ray imaging (Brainlab Exactrac) and/or a surface imaging system (CRAD Catalyst HD, Uppsala, Sweden), and shift discrepancies were recorded for each couch angle. Forty-two hours after irradiation, the gel phantom was scanned in a 1.5 Tesla MRI, and images were fused with the patient computed tomography data/structure set for further analysis of spatial dose distribution.Discrepancies between the CRAD Catalyst HD system and Brainlab Exactrac were 1 mm in the translational direction and 0.5° in the angular direction at noncoplanar couch angles. Dose parameters (DDose metrics for a setup with surface imaging was found to be consistent with setup using x-ray imaging, demonstrating high accuracy and reproducibility for treatment delivery. Results indicate the feasibility of using surface imaging for position verification at noncoplanar couch angles for single-isocenter, multiple-target SRS using end-to-end quality assurance (QA) testing with 3D polymer gel dosimetry.

Purpose: Monaco treatment planning system (TPS) version 5.1 uses a Monte-Carlo (MC)-based dose calculation engine. The aim of this study is to verify and compare the Monaco-based dose calculations with both Pinnacle3 collapsed cone convolution superposition (CCCS) and Eclipse anisotropic analytical algorithm (AAA) calculations. Materials and Methods: For this study, 18 previously treated lung and head-and-neck (HN) cancer patients were chosen to compare the dose calculations between Pinnacle, Monaco, and Eclipse. Plans were chosen from those that had been treated using the Elekta VersaHD or a Novalis Tx linac. All of the treated volumetric-modulated arc therapy plans used 6 MV or 10 MV photon beams. The original plans calculated with CCCS or AAA along with the recalculated ones using MC from the three TPS were exported into Velocity software for intercomparison. Results: To compare the dose calculations, Planning target volume (PTV) heterogeneity indexes and conformity indexes were calculated from the dose volume histograms (DVH) of all plans. While mean lung dose (MLD), lung V5 and V20 values were recorded for lung plans, the computed dose to parotids, brainstem, and mandible were documented for HN plans. In plan evaluation, percent differences of the above dosimetric values in Monaco computation were compared against each of the other TPS computations. Conclusion: It could be concluded through this research that there can be differences in the calculation of dose across different TPSs. Although relatively small, these differences could become apparent when compared using DVH. These differences most likely arise from the different dose calculation algorithms used in each TPS. Monaco employs the MC allowing it to have much more detailed calculations that result in it being seen as the most accurate and the gold standard.

Purpose Prognostic indices such as the Brain Metastasis Graded Prognostic Assessment have been used in clinical settings to aid physicians and patients in determining an appropriate treatment regimen. These indices are derivative of traditional survival analysis techniques such as Cox proportional hazards (CPH) and recursive partitioning analysis (RPA). Previous studies have shown that by evaluating CPH risk with a nonlinear deep neural network, DeepSurv, patient survival can be modeled more accurately. In this work, we apply DeepSurv to a test case: breast cancer patients with brain metastases who have received stereotactic radiosurgery. Methods Survival times, censorship status, and 27 covariates including age, staging information, and hormone receptor status were provided for 1673 patients by the NCDB. Monte Carlo cross-validation with 50 samples of 1400 patients was used to train and validate the DeepSurv, CPH, and RPA models independently. DeepSurv was implemented with L2 regularization, batch normalization, dropout, Nesterov momentum, and learning rate decay. RPA was implemented as a random survival forest (RSF). Concordance indices of test sets of 140 patients were used for each sample to assess the generalizable predictive capacity of each model. Results Following hyperparameter tuning, DeepSurv was trained at 32 min per sample on a 1.33 GHz quad-core CPU. Test set concordance indices of 0.7488 ± 0.0049, 0.6251 ± 0.0047, and 0.7368 ± 0.0047, were found for DeepSurv, CPH, and RSF, respectively. A Tukey HSD test demonstrates a statistically significant difference between the mean concordance indices of the three models. Conclusion Our results suggest that deep learning-based survival prediction can outperform traditional models, specifically in a case where an accurate prognosis is highly clinically relevant. We recommend that where appropriate data are available, deep learning-based prognostic indicators should be used to supplement classical statistics.

Purpose To create an open‐source visualization program that allows one to find potential cone collisions while planning intracranial stereotactic radiosurgery cases. Methods Measurements of physical components in the treatment room (gantry, cone, table, localization stereotactic radiation surgery frame, etc.) were incorporated into a script in MATLAB (MathWorks, Natick, MA) that produces three‐dimensional visualizations of the components. A localization frame, used during simulation, fully contains the patient. This frame was used to represent a safety zone for collisions. Simple geometric objects are used to approximate the simulated components. The couch is represented as boxes, the gantry head and cone are represented by cylinders, and the patient safety zone can be represented by either a box or ellipsoid. These objects are translated and rotated based upon the beam geometry and the treatment isocenter to mimic treatment. A simple graphical user interface (GUI) was made in MATLAB (compatible with GNU Octave) to allow users to pass the treatment isocenter location, the initial and terminal gantry angles, the couch angle, and the number of angular points to visualize between the initial and terminal gantry angle. Results The GUI provides a fast and simple way to discover collisions in the treatment room before the treatment plan is completed. Twenty patient arcs were used as an end‐to‐end validation of the system. Seventeen of these appeared the same in the software as in the room. Three of the arcs appeared closer in the software than in the room. This is due to the treatment couch having rounded corners, whereas the software visualizes sharp corners. Conclusions This simple GUI can be used to find the best orientation of beams for each patient. By finding collisions before a plan is being simulated in the treatment room, a user can save time due to replanning of cases.

Purpose Single‐isocenter multiple brain metastasis stereotactic radiosurgery is an efficient treatment modality increasing in clinical practice. The need to provide accurate, patient‐specific quality assurance (QA) for these plans is met by several options. This study reviews some of these options and explores the use of the Octavius 4D as a solution for patient‐specific plan quality assurance. Methods The Octavius 4D Modular Phantom (O4D) with the 1000 SRS array was evaluated in this study. The array consists of 977 liquid‐filled ion chambers. The center 5.5 cm × 5.5 cm area has a detector spacing of 2.5 mm. The ability of the O4D to reconstruct three‐dimensional (3D) dose was validated against a 3D gel dosimeter, ion chamber, and film measurements. After validation, 15 patients with 2–11 targets had their plans delivered to the phantom. The criteria used for the gamma calculation was 3%/1 mm. The portion of targets which were measurable by the phantom was countable. The accompanying software compiled the measured doses allowing each target to be counted from the measured dose distribution. Results Spatial resolution was sufficient to verify the high dose distributions characteristic of SRS. Amongst the 15 patients there were 74 targets. Of the 74 targets, 61 (82%) of them were visible on the measured dose distribution. The average gamma passing rate was 99.3% (with sample standard deviation of 0.68%). Conclusions The high resolution provided by the O4D with 1000 SRS board insert allows for very high‐resolution measurement. This high resolution in turn can allow for high gamma passing rates. The O4D with the 1000 SRS array is an acceptable method of performing quality assurance for single‐isocenter multiple brain metastasis SRS.

At the conclusion of road construction projects, an erosion control product (e.g., blankets, spray mulch) is installed to reduce soil loss and promote plant growth. Wildlife, such as snakes (suborder Serpentes), are prone to entanglement in erosion control blankets (ECBs) that contain polypropylene mesh with fused apertures. Previous reports have noted that the occurrences of entanglements are not uniform in their distribution across an ECB, but primarily occur where the edge of the mesh is exposed. We conducted an experiment to determine if modification to the installation methods of ECBs affects the likelihood of snake entanglement. We conducted entanglement trials to compare the likelihood of snake entanglement between two treatments: 1) exposed ECB edge (i.e., perimeter) and 2) buried ECB edge. Snakes were less likely to attempt to pass through the mesh on the buried edge treatment and all entanglements occurred on the exposed edge treatment. These results provide support that modification to the installation methods reduces snake entanglement in ECBs in some settings. However, we conducted our study in an experimental setting, and it should be evaluated under natural field conditions. This research can be used to inform several parties including contractors, habitat managers, and agency decision makers on additional steps that can be taken for products that fit their application needs to minimize risks to wildlife.

I n the United States, roads are prominent across the landscape, negatively impacting wildlife and ecological processes via road mortality (Brady and Richardson 2017). The extensive roadway system in the United States requires consistent maintenance that results in soil erosion potential. For example, as of August of 2019 in Texas, there were 6,739 active roadway projects, with another 6,448 projects listed to begin within the next four years (Texas Department of Transportation 2019). Despite regulatory and mitigation efforts, soil erosion and stream sedimentation are known to occur at construction sites due to exposure of the soil to environmental factors that influence erosion rates (Kaufman 2000; Benik et al. 2003). At the conclusion of construction projects, the Texas Department of Transportation (TxDOT) mandates that erosion control products (ECPs) are deployed on unpacked soil to prevent soil erosion potential and to promote plant growth (Babcock and McLaughlin 2013; Texas Department of Transportation 2018a). The TxDOT maintains an approved product list (APL) of all ECPs (ranging from mesh blankets to sprays and mulches) that can be used by contractors at the conclusion of a roadway construction project. To be placed on the APL, products must pass two performance standards: (1) protect the seedbed of an embankment or drainage channel from the loss of sediment during simulated rainfall or channel flow events, and (2) promote the establishment of warm-season, perennial vegetation …

Background Interprofessional communication is fundamental to the delivery of healthcare and can be taught in medical school and other health professional schools through interprofessional education (IPE) activities. Simulation centers have become a predominant location for simulation IPE activities with infrastructure able to support high fidelity activities in a controlled environment. In this secondary analysis of a scoping review conducted on simulation-based IPE, we describe the characteristics of previously reported simulation IPE activities involving undergraduate medical students in a simulation center focused on interprofessional communication. Methods Electronic searches of PubMed, CINAHL, and ERIC databases in accordance with PRISMA-ScR guidelines were conducted to isolate relevant articles from 2016–2020. In total, 165 peer-reviewed articles met inclusion criteria and data extraction linked to four research questions was applied by one individual and the accuracy was confirmed by a second individual. A secondary analysis was performed to describe what existing approaches for simulation IPE in simulation center settings have been used to explicitly achieve interprofessional communication competencies in undergraduate medical education. A sub-dataset was developed from the original scoping review and identified 21 studies describing simulation IPE activities that took place in dedicated simulation centers, targeted the IPEC interprofessional communication domain, and involved undergraduate medical students. Results Though diverse, the majority of simulation IPE activities described high-fidelity approaches involving standardized patients and utilized assessment tools with established validity evidence in IPE activities to measure learning outcomes. A minority of simulation IPE activities were described as hybrid and utilized more than one resource or equipment for the activity and only two were longitudinal in nature. Learning outcomes were focused predominantly on modification of attitudes/perceptions and few targeted higher levels of assessment. Conclusions Educators charged with developing simulation IPE activities for medical students focused on interprofessional communication should incorporate assessment tools that have validity evidence from similar activities, target higher level learning outcomes, and leverage hybrid models to develop longitudinal simulation IPE activities. Though an ideal environment to achieve higher level learning outcomes, simulation centers are not required for meaningful simulation IPE activities.

To determine the severity of the effects on VMAT dose calculations caused by varying statistical uncertainties (SU) per control point in a Monte Carlo based treatment planning system (TPS) and to assess the impact of the uncertainty during dose volume histogram (DVH) evaluation.For this study, 13 archived patient plans were selected for recalculation. Treatment sites included prostate, lung, and head and neck. These plans were each recalculated five times with varying uncertainty levels using Elekta's Monaco Version 5.11.00 Monte Carlo Gold Standard XVMC dose calculation algorithm. The statistical uncertainty per control point ranged from 2 to 10% at intervals of 2%, while the grid spacing was set at 3 mm for all calculations. Indices defined by the RTOG describing conformity, coverage, and homogeneity were recorded for each recalculation.For all indices tested, one-way ANOVA tests failed to reject the null hypothesis that there is no significant difference between SU levels (p0.05). Using the Bland-Altman analysis method, it was determined that we can expect the indices (with the exception of CIRTOG) to be within 1% of the lowest uncertainty calculation when calculating at 4% SU per control point. Beyond that, we can expect the indices to be within 3% of the lowest uncertainty calculation.Increasing the SU per control point exponentially decreased the amount of time required for dose calculations, while creating minimal observable differences in DVHs and isodose lines.

Purpose The Brainlab Elements treatment planning system utilizes distinct modules for treatment planning specific to stereotactic treatment sites including single or multiple brain lesions as well as spine. This work investigates the hypothesis that an optimization tailored specifically to spine can in fact create dosimetrically superior plans to those created in more general use treatment planning systems (TPS). Methods Ten spine patients at our institution were replanned in Brainlab Elements, Phillips Pinnacle3, and Elekta Monaco. The planning target volume (PTV) included the vertebral body (in either the thoracic or lumbar spine), pedicles, and transverse processes. In all plans, the target was prescribed 20 Gy to 95% of the PTV. Objectives for the study included D5%

To compare the accuracy of two separate models when calculating dose distributions in patients undergoing stereotactic radiosurgery (SRS) treatment for brain cancer.For this comparison, two dose calculation algorithms were evaluated on two different treatment planning systems (TPS): Elekta's Monaco Version 5.11.00 Monte Carlo Gold Standard XVMC algorithm and Brainlab's iPlan Pencil Beam algorithm. The DICOM files of 11 patients with a total of 19 targets were exported from iPlan and then imported into Monaco to be recalculated. Using the dose distributions of the original (pencil beam/PB) and recalculated (Monte Carlo/MC) plans, four indices for plan quality were evaluated: coverage (Q), conformity index (CIRTOG), homogeneity index (HI), and gradient index (GI).There was a significant difference in the CIRTOG and HI between the two TPS calculations. However, the magnitude of these differences is often not substantial enough to cause the plan to fall outside of RTOG protocol deviation limits. Only 3 of the 19 targets had CIRTOG values which moved to a new level of deviation, and these targets were unique in terms of size (0.1 cm3).It was found that the difference between systems is often not enough to cause the plan to fall outside of RTOG protocol deviation limits. This is an indication that a PB-based treatment planning system is sufficient for the mostly homogeneous conditions of intracranial SRS planning when the target is larger than 0.1 cm3. If below 0.1 cm3, the prescribing physician may need to evaluate TPS differences.

Background The accuracy of stereotactic radiosurgery to multiple brain metastases with a single isocenter using high definition dynamic radiosurgery (HDRS) was evaluated to assess robustness, repeatability, and possibility of inter-institutional quality assurance amongst multiple institutions. Methods A CT simulation scan obtained from a previously treated patient was used as the data set for targeting seven brain lesions. A VMAT treatment plan was generated using Monaco and was replicated at six HDRS-capable institutions using a plan template. All institutions subsequently irradiated 3D-printed head anthropomorphic phantoms mimicking the patient’s anatomy. Three different phantoms with a point dosimeter insert, film insert, and a gel dosimeter were used. Absolute dosimetry end-to-end dosimetric accuracy as well as gamma analysis for relative dose distribution agreement analysis was used to evaluate measurement agreement with calculation. Results Point measurements averaged across all institutions using six-degree-of-freedom treatment positioning correction were within 1.2±0.5%. The average gamma passing rate in the film plane using 3D global 3D gamma analysis was 96.6±2.2% (3%/2 mm). For all targets within 4 cm of the isocenter, the 3D dosimetric gel gamma passing rate averaged across institutions was >90% (3%/2 mm). 88.0% average gamma passing rate was found for targets beyond 4 cm. The targeting accuracy of high definition dynamic radiosurgery assessed by geometrical offset of the center of dose distributions was established across multiple institutions in this study to be within 1 mm for targets within 4 cm of isocenter. Conclusions Across variations in clinical practice, comparable dosimetry and localization is possible with this treatment planning and delivery technique.

The assembly of local communities is likely to reflect the effects of local environmental factors associated with filters that act at larger spatial scales. Dissecting these multiscale effects remains a timely challenge that is particularly important for host-associated microbiomes. We investigated the relative roles of local selection (due to host species identity) and regional effects (due to water body identity) on the community structure of bacteria in the gut of tadpoles from three biogeographic areas and used graph theory and metanetwork approaches to explore and illustrate the distribution of bacteria across different ponds. The pond of origin, which represents a regional species pool of bacteria, was in general more important in shaping the gut microbiome of tadpoles than host species identity. The resulting metanetworks are modular and indicate relatively few species of bacteria occurring in more than one pond. Thus, each pond represents a relatively distinct species pool of bacteria available for community assembly of the tadpole microbiomes. Our findings indicate that microbiome community assembly in amphibian larvae, as in many other communities, is a multiscale process with important regional effects that constrain how local (i.e. host-dependent) filters act to influence microbiome community composition.

Purpose While external beam radiotherapy treatment planning determines nearly every mechanical and dosimetric parameter of the linear accelerator (LINAC), the table coordinates in all three dimensions are generally unknown until initial patient setup at the LINAC. Knowing these parameters in advance could help verify the direction of patient shifts and prevent wrong‐site errors. This study aims to determine the feasibility and accuracy of table coordinate prediction for indexed immobilization devices. Methods A total of 303 table coordinates were predicted for patients on Varian and Elekta linear accelerators with immobilization devices including Orfit mask with baseplate, wingboard, breastboard and BodyFix. Predictions were made for all three spatial dimensions except for Body Fix setups due to the lack of a radiographically apparent indexing‐related landmark. Coordinates were predicted by measuring baseline table coordinates in all dimensions at specified landmark positions. Results Predictions were accurate within 2 cm for 86% of coordinates (71% within 1 cm). Table coordinates were predicted most accurately for head and neck patients with a base plate and the most difficult prediction was in the lateral direction for breastboard patients. Conclusions With proper indexing, table coordinates can be predicted with reasonable accuracy. The data suggest an action of level of 2 cm with certain exceptions for specific immobilization devices and directions.

Picoides borealis (Red-cockaded Woodpecker) is an endangered bird endemic to the Pinus (pine) ecosystems of the southeastern US. Mature pine savannahs with a minimal midstory and lush herbaceous groundcover represent high-quality habitat. This study examines the foraging-habitat patterns of Red-cockaded Woodpeckers in East Texas. We present a logistic regression model that best differentiates between foraged and non-foraged habitat. Increases in hardwood-midstory basal area have the greatest negative impact on the probability of Red-cockaded Woodpeckers selecting a habitat patch for foraging. Five additional variables negatively impact foraging probability: shrub height, diameter at breast height (DBH) of pine midstory, canopy closure, density of pine midstory, and density of hardwood midstory. Our model shows a high degree of accuracy as to the probability of habitat-patch selection for Red-cockaded Woodpeckers foraging in East Texas forests composed of different pine species.

The Daily QATM3 phantom from Sun Nuclear Corporation has been a popular daily quality assurance (QA) tool for many institutions. PTW has recently introduced the QUICKCHECKwebline phantom as an alternative. The goal of this study was to compare these two commercially available devices for daily quality assurance measurements of a linear accelerator and assess the overall performance of the new phantom.Two daily QA phantoms (PTW QUICKCHECKwebline and Sun Nuclear Corporation Daily QATM3) were measured over a 4-month period using a 20x20cm² field size and delivering 150 MU. Photon energies of 6 and 18 MV were measured on a daily basis, and electron energies of 6, 9, 12, 15, and 18 MeV were measured weekly on a 23EX Varian Linear Accelerator. Consistency of the dose output, beam flatness, in-plane and cross-plane symmetry, and beam quality were evaluated.The QUICKCHECKwebline and Daily QATM3 performed with maximum percent differences from baseline of -0.97% and 1.12% for output, 1.36% and 0.82% for flatness, 0.86% and -1.36% for in-plane symmetry, -1.41% and 1.00% for cross-plane symmetry, and -0.91% and 1.29% for beam quality respectively over all energies.Consistent and accurate measurements over a 4-month period, a user-friendly interface, and wireless features prove the QUICKCHECKwebline would be a suitable phantom for daily quality assurance use.

IMPACT: This work assesses clinical implementation of a surface guided imaging system to improve the accuracy radiation delivery for treatment of brain lesions using a patient CT derived head phantom. OBJECTIVES/GOALS: Advancements in radiotherapy design have made clinical demand for efficient and accurate methods to deliver stereotactic radiosurgery (SRS) for treatment of intracranial lesions. This study assesses the potential of using surface guided imaging for setup using a 3D patient specific head phantom. METHODS/STUDY POPULATION: A single isocenter, multiple metastases SRS plan was generated on a CT derived RTsafe Prime phantom made of tissue equivalent materials and a polymer gel insert. Five targets of varying diameters were treated with 8Gy of radiation using two different positioning techniques. The first gel insert was irradiated within the phantom according to internal alignment with standard orthogonal x-ray imaging while the second setup used surface guided imaging, based on external anatomy. 42 hours after irradiation, the phantom was scanned in a head coil using a 1.5T MRI. MR images were fused with the patient CT data and structure set to further evaluate calculated and measured dose distributions. RESULTS/ANTICIPATED RESULTS: Discrepancies in phantom setup according to standard orthogonal x-ray imaging compared to surface guided imaging demonstrated to be 94% (5%/2mm) and >87% (3%/2mm). Finally, 3 of 5 targets showed better 3D GI passing rates and less geometric offset for positioning with the surface guided imaging. DISCUSSION/SIGNIFICANCE OF FINDINGS: 3D spatial analysis of human like phantoms demonstrated that patient positioning according to external anatomy performed comparable to standard methods aligning to the internal anatomy, for a multiple met SRS treatment.

A DNA dosimeter (DNAd) was previously developed that uses double-strand breaks (DSB) to measure dose. This dosimeter has been tested to measure dose in scenarios where transient-charged particle equilibrium (TCPE) has been established. The probability of double strand break (PDSB(o)), which is the ratio of broken double-stranded DNA (dsDNA) to the initial unbroken dsDNA in the dosimeter, was used to quantify DSBs and related to dose. The goal of this work is to produce a new technique to process and analyze the DNAd and quantify DNA-DSBs. This technique included simultaneously processing multiple DNAds and also establishing a new form to the probability of double strand break (PDSB(n)), which was then used to test the DNAd in a non-TCPE condition by taking beam penumbra measurements. The technique utilized a 384-well plate, and the measurements were made at the edge of a 10 × 10 cm field and compared to film measurements. During these penumbra measurements, while observing the positional differences in the higher gradient region at 4.1 and 4.55 cm from the center of the radiation field, the distance to agreement of PDSB(o) to film were 0.38 cm and 0.26cm while the distance to agreement of PDSB(n) to film were 0.11 cm and 0.06 cm, respectively. Finally, the developed new separation technique reduced the time needed for the analysis of 25 samples from 200 minutes to 30 minutes.

Our institution performs in vivo verification measurement for each of our total body irradiation (TBI) patients with optically stimulated luminescent dosimeters (OSLD). The lung block verification measurements were commonly higher than expected. The aim of this work is to understand this discrepancy and improve the accuracy of these lung block verification measurements. Initially, the thickness of the lung block was increased to provide adequate lung sparing. Further tests revealed the increase was due to electron contamination dose emanating from the lung block. The thickness of the bolus material covering the OSLD behind the lung block was increased to offset the electron contamination. In addition, the distance from the lung block to the dosimeter was evaluated for its effect on the OSLD reading and found to be clinically insignificant over the range of variability in our clinic. The results show that the improved TBI treatment technique provides for better accuracy of measured dose in vivo and consistency of patient setup. PACS number(s): 87.53.Bn, 87.53.Kn, 87.55.N‐, 87.55.Qr

The impact of roads on the flora and fauna of Neotropical rainforest is perhaps the single biggest driver of habitat modification and population declines in these ecosystems. We investigated the road-edge effect of a low-use dirt road on amphibian and reptile abundance, diversity, and composition within adjacent lowland Amazonian rainforest at San Jose de Payamino, Ecuador. The road has been closed to vehicle traffic since its construction in 2010. Thus, effects from vehicle mortality, vehicle-related pollution, and road noise were not confounding factors. Herpetofauna were surveyed using both visual encounter surveys and drift fences with pitfall and funnel traps at varying distances from the road. Structural and microclimate features of the forest were measured at each sampling distance. Several habitat variables were found to differ at intermediate and interior sampling distances from the road compared to forest edge conditions, suggesting the road-edge effect began to attenuate by the intermediate sam...

The purpose of this study is to report the dosimetric aspects of commissioning performed on an Elekta Versa HD linear accelerator (linac) with high‐dose‐rate flattening filter‐free (FFF) photon modes and electron modes. Acceptance and commissioning was performed on the Elekta Versa HD linac with five photon energies (6 MV, 10 MV, 18 MV, 6 MV FFF, 10 MV FFF), four electron energies (6 MeV, 9 MeV, 12 MeV, 15 MeV) and 160‐leaf (5 mm wide) multileaf collimators (MLCs). Mechanical and dosimetric data were measured and evaluated. The measurements include percent depth doses (PDDs), in‐plane and cross‐plane profiles, head scatter factor (Sc), relative photon output factors (Scp), universal wedge transmission factor, MLC transmission factors, and electron cone factors. Gantry, collimator, and couch isocentricity measurements were within 1 mm, 0.7 mm, and 0.7 mm diameter, respectively. The PDDs of 6 MV FFF and 10 MV FFF beams show deeper dmax and steeper falloff with depth than the corresponding flattened beams. While flatness values of 6 MV FFF and 10 MV FFF normalized profiles were expectedly higher than the corresponding flattened beams, the symmetry values were almost identical. The cross‐plane penumbra values were higher than the in‐plane penumbra values for all the energies. The MLC transmission values were 0.5%, 0.6%, and 0.6% for 6 MV, 10 MV, and 18 MV photon beams, respectively. The electron PDDs, profiles, and cone factors agree well with the literature. The outcome of radiation treatment is directly related to the accuracy in the dose modeled in the treatment planning system, which is based on the commissioned data. Commissioning data provided us a valuable insight into the dosimetric characteristics of the beam. This set of commissioning data can provide comparison data to others performing Versa HD commissioning, thereby improving patient safety. PACS number(s): 87.56.bd

The Elekta Versa HD incorporates a variety of upgrades to the line of Elekta linear accelerators, primarily including the Agility head and flattening filter‐free (FFF) photon beam delivery. The completely distinct dosimetric output of the head from its predecessors, combined with the FFF beams, requires a new investigation of modeling in treatment planning systems. A model was created in Pinnacle3 v9.8 with the commissioned beam data. A phantom consisting of several plastic water and Styrofoam slabs was scanned and imported into Pinnacle3, where beams of different field sizes, source‐to‐surface distances (SSDs), wedges, and gantry angles were devised. Beams included all of the available photon energies (6, 10, 18, 6 FFF, and 10 FFF MV), as well as the four electron energies commissioned for clinical use (6, 9, 12, and 15 MeV). The plans were verified at calculation points by measurement with a calibrated ionization chamber. Homogeneous and heterogeneous point‐dose measurements agreed within 2% relative to maximum dose for all photon and electron beams. AP photon open field measurements along the central axis at 100 cm SSD passed within 1%. In addition, IMRT testing was also performed with three standard plans (step and shoot IMRT, as well as a small‐ and large‐field VMAT plan). The IMRT plans were delivered on the Delta4 IMRT QA phantom, for which a gamma passing rate was >99.5% for all plans with a 3% dose deviation, 3 mm distance‐to‐agreement, and 10% dose threshold. The IMRT QA results for the first 23 patients yielded gamma passing rates of 97.4%±2.3%. Such testing ensures confidence in the ability of Pinnacle3 to model photon and electron beams with the Agility head. PACS numbers: 87.55.D, 87.56.bd

ViewRay is a novel MR-guided radiotherapy system capable of imaging in near real-time at four frames per second during treatment using 0.35T field strength. It allows for improved gating techniques and adaptive radiotherapy. Three cobalt-60 sources (~ 15,000 Curies) permit multiple-beam, intensity-modulated radiation therapy. The primary aim of this study is to assess the imaging stability, accuracy, and automatic segmentation algorithm capability to track motion in simulated and in vivo targets. Magnetic resonance imaging (MRI) characteristics of the system were assessed using the American College of Radiology (ACR)-recommended phantom and accreditation protocol. Images of the ACR phantom were acquired using a head coil following the ACR scanning instructions. ACR recommended T1- and T2-weighted sequences were evaluated. Nine measurements were performed over a period of seven months, on just over a monthly basis, to establish consistency. A silicon dielectric gel target was attached to the motor via a rod. 40 mm total amplitude was used with cycles of 3 to 9 s in length in a sinusoidal trajectory. Trajectories of six moving clinical targets in four canine patients were quantified and tracked. ACR phantom images were analyzed, and the results were compared with the ACR acceptance levels. Measured slice thickness accuracies were within the acceptance limits. In the 0.35 T system, the image intensity uniformity was also within the ACR acceptance limit. Over the range of cycle lengths, representing a wide range of breathing rates in patients imaged at four frames/s, excellent agreement was observed between the expected and measured target trajectories. In vivo canine targets, including the gross target volume (GTV), as well as other abdominal soft tissue structures, were visualized with inherent MR contrast, allowing for preliminary results of target tracking.

Changing climate will impact species' ranges only when environmental variability directly impacts the demography of local populations. However, measurement of demographic responses to climate change has largely been limited to single species and locations. Here we show that amphibian communities are responsive to climatic variability, using >500,000 time-series observations for 81 species across 86 North American study areas. The effect of climate on local colonization and persistence probabilities varies among eco-regions and depends on local climate, species life-histories, and taxonomic classification. We found that local species richness is most sensitive to changes in water availability during breeding and changes in winter conditions. Based on the relationships we measure, recent changes in climate cannot explain why local species richness of North American amphibians has rapidly declined. However, changing climate does explain why some populations are declining faster than others. Our results provide important insights into how amphibians respond to climate and a general framework for measuring climate impacts on species richness. John Wesley Powell Center for Analysis and Synthesis - US Geological Survey U.S. Geological Survey-Amphibian Research and Monitoring Initiative (ARMI) U.S. Fish and Wildlife Service National Park Service U.S. Forest Service National Science Foundation [DEB-0841758, DEB-1149308] National Institutes of Health [R01GM109499] National Geographic Society Morris Animal Foundation David and Lucille Packard Foundation This work was conducted as part of the Amphibian Decline Working Group supported by the John Wesley Powell Center for Analysis and Synthesis, funded by the US Geological Survey. Funding and logistical support for field data collection came from a range of sources including the U.S. Geological Survey-Amphibian Research and Monitoring Initiative (ARMI), U.S. Fish and Wildlife Service, National Park Service, U.S. Forest Service, National Science Foundation (DEB-0841758, DEB-1149308), National Institutes of Health (R01GM109499), National Geographic Society, Morris Animal Foundation, and David and Lucille Packard Foundation. Data are deposited at the U.S. Geological Survey's John Wesley Powell Center for Analysis and Synthesis. This manuscript is contribution 654 of USGS ARMI. Any use of trade, firm, or product names is for descriptive purposes only and does not imply endorsement by the U.S. Government.

Temporal variation represents an important component in understanding the structure of ecological communities and species coexistence. We examined calling phenology of an assemblage of anurans in the Gran Chaco ecoregion of Bolivia by deploying automated recording devices to document nocturnally vocalizing amphibians nightly at seven ponds from 20 January 2011 until 31 October 2011. Using logistic regression, we modelled the relationships between temperature, rainfall and photoperiod with calling activity. There was a distinct seasonal effect with calling activity concentrated in the rainy season with no species detected during the dry season from June until the end of October. Calling activity was positively and significantly correlated with photoperiod in 9 of the 10 species analyzed, but there were distinct species-specific relationships associated with rainfall and temperature. All of these species utilize ephemeral ponds as breeding sites, which can account for their reliance on rainfall as an important driver in calling activity. Two prolonged breeders exhibited similar seasonal breeding patterns across the rainy season, but differed in their response to daily abiotic factors, which might be attributed to the constraints imposed by their reproductive mode. Explosive breeders needed several days of rain to elicit calling. Two pairs of congeners had distinct species-specific relationships between their calling activity and abiotic factors, even though the congeners shared the same reproductive mode, suggesting that the reproductive modes vary in the constraints imposed on calling activity. The patterns observed suggest that calling phenology of tropical anurans is determined by the interaction of exogenous factors (i.e. climatic variables) and endogenous factors (i.e. reproductive modes).

Divergent natural selection drives a considerable amount of the phenotypic and genetic variation observed in natural populations. For example, variation in the predator community can generate conflicting selection on behavioral, life-history, morphological, and performance traits. Differences in predator regime can subsequently increase phenotypic and genetic variations in the population and result in the evolution of reproductive barriers (ecological speciation) or phenotypic plasticity. We evaluated morphology and swimming performance in field collected Bronze Frog larvae (Lithobates clamitans) in ponds dominated by predatory fish and those dominated by invertebrate predators. Based on previous experimental findings, we hypothesized that tadpoles from fish-dominated ponds would have small bodies, long tails, and large tail muscles and that these features would facilitate fast-start speed. We also expected to see increased tail fin depth (i.e., the tail-lure morphology) in tadpoles from invertebrate-dominated ponds. Our results support our expectations with respect to morphology in affecting swimming performance of tadpoles in fish-dominated ponds. Furthermore, it is likely that divergent natural selection is playing a role in the diversification on morphology and locomotor performance in this system.

Climate change has changed the phenologies of species worldwide, but it remains unclear how these phenological changes will affect species interactions and the structure of natural communities. Using a novel approach to analyse long-term data of 66 amphibian species pairs across eight communities, we demonstrate that phenological shifts can significantly alter the interaction potential of coexisting competitors. Importantly, these changes in interaction potential were mediated by non-uniform, species-specific shifts in entire phenological distributions and consequently could not be captured by metrics traditionally used to quantify phenological shifts. Ultimately, these non-uniform shifts in phenological distributions increased the interaction potential for 25% of species pairs (and did not reduce interaction potential for any species pair), altering temporal community structure and potentially increasing interspecific competition. These results demonstrate the potential of phenological shifts to reshape temporal structure of natural communities, emphasising the importance of considering entire phenological distributions of natural populations.

The purpose of this study is to perform dosimetric validation of Monaco treatment planning system version 5.1. The Elekta VersaHD linear accelerator with high dose rate flattening filter‐free photon modes and electron energies was used in this study. The dosimetric output of the new Agility head combined with the FFF photon modes warranted this investigation into the dosimetric accuracy prior to clinical usage. A model of the VersaHD linac was created in Monaco TPS by Elekta using commissioned beam data including percent depth dose curves, beam profiles, and output factors. A variety of 3D conformal fields were created in Monaco TPS on a combined Plastic water/Styrofoam phantom and validated against measurements with a calibrated ion chamber. Some of the parameters varied including source to surface distance, field size, wedges, gantry angle, and depth for all photon and electron energies. In addition, a series of step and shoot IMRT, VMAT test plans, and patient plans on various anatomical sites were verified against measurements on a Delta4 diode array. The agreement in point dose measurements was within 2% for all photon and electron energies in the homogeneous phantom and within 3% for photon energies in the heterogeneous phantom. The mean ± SD gamma passing rates of IMRT test fields yielded 93.8 ± 4.7% based on 2% dose difference and 2 mm distance‐to‐agreement criteria. Eight previously treated IMRT patient plans were replanned in Monaco TPS and five measurements on each yielded an average gamma passing rate of 95% with 6.7% confidence limit based on 3%, 3 mm gamma criteria. This investigation on dosimetric validation ensures accuracy of modeling VersaHD linac in Monaco TPS thereby improving patient safety.

Changes in climate and the introduction of invasive species are two major stressors to amphibians, although little is known about the interaction between these two factors with regard to impacts on amphibians. We focused our study on an invasive tree species, the Chinese tallow (Triadica sebifera), that annually sheds its leaves and produces leaf litter that is known to negatively impact aquatic amphibian survival. The purpose of our research was to determine whether the timing of leaf fall from Chinese tallow and the timing of amphibian breeding (determined by weather) influence survival of amphibian larvae. We simulated a range of winter weather scenarios, ranging from cold to warm, by altering the relative timing of when leaf litter and amphibian larvae were introduced into aquatic mesocosms. Our results indicate that amphibian larvae survival was greatly affected by the length of time Chinese tallow leaf litter decomposes in water prior to the introduction of the larvae. Larvae in treatments simulating warm winters (early amphibian breeding) were introduced to the mesocosms early in the aquatic decomposition process of the leaf litter and had significantly lower survival compared with cold winters (late amphibian breeding), likely due to significantly lower dissolved oxygen levels. Shifts to earlier breeding phenology, linked to warming climate, have already been observed in many amphibian taxa, and with most climate models predicting a significant warming trend over the next century, the trend toward earlier breeding should continue if not increase. Our results strongly suggest that a warming climate can interact with the effects of invasive plant species, in ways we have not previously considered, to reduce the survival of an already declining group of organisms.

Since amphibian declines were first proposed as a global phenomenon over a quarter century ago, the conservation community has made little progress in halting or reversing these trends. The early search for a "smoking gun" was replaced with the expectation that declines are caused by multiple drivers. While field observations and experiments have identified factors leading to increased local extinction risk, evidence for effects of these drivers is lacking at large spatial scales. Here, we use observations of 389 time-series of 83 species and complexes from 61 study areas across North America to test the effects of 4 of the major hypothesized drivers of declines. While we find that local amphibian populations are being lost from metapopulations at an average rate of 3.79% per year, these declines are not related to any particular threat at the continental scale; likewise the effect of each stressor is variable at regional scales. This result - that exposure to threats varies spatially, and populations vary in their response - provides little generality in the development of conservation strategies. Greater emphasis on local solutions to this globally shared phenomenon is needed. US Geological Survey This work was conducted as part of the Amphibian Decline Working Group supported by the John Wesley Powell Center for Analysis and Synthesis, funded by the US Geological Survey. Data deposited at the US Geological Survey's John Wesley Powell Center for Analysis and Synthesis. The authors declare no competing financial interests. This manuscript is contribution #541 of the USGS Amphibian Research and Monitoring Initiative. Any use of trade, firm, or product names is for descriptive purposes only and does not imply endorsement by the U.S. Government. Comments from D. Hocking, P. Toschik and three anonymous reviewers improved the manuscript.