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The correct quantification of the dose released in charged particle therapy treatments requires the knowledge of the double differential fragmentation cross section of particles composing both the beam and the target. The FragmentatiOn Of Target (FOOT) experiment aims at measuring these cross sections for ions of interest for charged particle therapy applications. This article describes the performance of the time-of-flight (TOF)-wall detector of the experiment. The detector is composed of two layers of 44 cm $\times 2$ cm $\times 3$ mm plastic scintillator bars (20 for each layer), arranged orthogonally and read-out by silicon photomultipliers. The detector is designed to identify the charge of fragments ranging from protons to oxygen ions, with a maximum energy of 700 MeV/u, by measuring the energy released in the scintillators and the TOF with respect to a start counter. In this study, the detector was scanned with carbon ions of energy between 115 and 400 MeV/u and with a 60-MeV proton beam. The measurements show an energy resolution ( $\sigma _{E}/\mu _{E}$ ) between 6% and 4% and a contribution of the detector to the TOF system time resolution between 25 and 20 ps (standard deviation) for carbon ions and between 100 and 80 ps for protons.

In this paper, we investigate the use of a positron emission tomography (PET) system to monitor the proton therapy. The monitoring procedure is based on the comparison between the ${ \beta }+$ activity generated in the irradiated volume during the treatment, with the ${ \beta }+$ activity distribution obtained with Monte Carlo (MC) simulation. The dedicated PET system is a dual head detection system; each head is composed of nine scintillating LYSO crystal matrices read out independently with a custom modularized acquisition system. Our experimental data were acquired at the Cyclotron Centre Bronowice, Institute Nuclear Physics in Krakow, Poland, and were simulated with the FLUKA MC code. Homogeneous and heterogeneous plastic phantoms were irradiated with monoenergetic 130 MeV protons. The capabilities of our PET system to distinguish different irradiated materials were investigated, and the proton pencil-beams were used as probes. Our focus was to analyze the activity width and the total activity event number in several cases. Irradiations were performed using either single pencil-beams one at a time, or two pencil-beams during the same data taking. The comparison of 1-D activity profile for experimental data and MC simulation were always in good agreement showing that, the treatment quality assessment in proton therapy can be based on ${ \beta }+$ activity measurements.

The International Paralympic Committee mandates the development of an evidence-based classification system, which requires a measure of performance. Performance in cross-country sit-skiing is mainly dependent on force generated during the poling phase and is enhanced by trunk flexion–extension movements. Since all sit-skiers have neuromuscular impairment, but different ability to control the trunk, this study aimed to verify if simulated action of poling on an adapted ergometer, together with a cluster analysis, could be used for grouping participants with different impairments according to their performance. On the ergometer, eight male and five female participants performed seven poling cycles at maximal speed, while sitting on personal sit-ski. Based on maximal speed, generated force, cycle characteristics, and trunk kinematics, cluster analysis divided participants into three groups showing good accuracy, sensitivity, and precision. Although a validation of this exploratory study is necessary, skiing on the ergometer could be considered as sport-specific measure of performance and may become an interesting tool in the development of an evidence-based classification system for cross-country sit-skiing.

Computational modelling is a powerful tool in biomechanical studies. Open-source software OpenSim provides different musculoskeletal models. However, existing upper body models consider only one limb, which could be a limitation in reproducing two-handed tasks. The purpose of this research was to develop a two upper limbs model that can be customized with subject’s anthropometry and muscles properties. The proposed model was composed of thorax, left and right upper limbs. Each limb presents 3 degrees of freedom (shoulder flexion-extension, elbow flexion-extension and prono-supination), 4 flexor and 3 extensor muscles. A preliminary model assessment was done. A subject was asked to execute isometric tests at three elbow angles, holding different loads, while EMG muscle activation was recorded. Simulated and experimental muscles activation were compared considering the right upper limb. Very good results were obtained without external load, whereas differences were observed when increasing the load; but, overall, model performance remained acceptable.

Purpose To biomechanically profile force generation connected to the complex role of the trunk in double poling in a representative sample of Para-Nordic sit-skiers. Methods Twelve male World Cup Para-Nordic sit-skiers (sport classes: LW10–12) were skiing on flat snow terrain at submaximal speed of 4.5 m/s (~ 73% maximum speed). 2D video (50 Hz) and pole force analyses (1000 Hz) were performed synchronously, examining angle, force and cycle characteristics to analyse the role of the trunk in generating propulsion. Results LW10–11.5 skiers lost between 21% and 4% propulsive force versus LW12 athletes only due to different geometrics of the trunk and pole angle at an equal axial pole force. While LW10–11 skiers indicated trunk extension or position maintenance during pole thrust, LW11.5–12 skiers showed strong trunk flexion combined with smaller pole angles to the ground. Hence, LW11.5–12 skiers could create larger propulsive forces and therefore greater cycle lengths at lower cycle rates at the same speed. Maximum speed increased from LW10 to LW12 and was significantly correlated to trunk flexion range of motion (r = 0.63) and cycle length (r = 0.59). Trunk flexion ROM showed a significant relationship to the impulse of propulsive force (r = 0.63) and pole angle to the ground (r = − 0.76) (all P Conclusion The impact of impairment on the force production profiles and its physiological-biomechanical consequences need further investigation also in other terrains and at wider spectrums of skiing speeds. The evident problem of low numbers of LW10–11 skiers in World Cup needs creative future solutions for research.

In Paralympic cross-country sit skiing, athlete classification is performed by an expert panel, so it may be affected by subjectivity. An evidence-based classification is required, in which objective measures of impairment must be identified. The purposes of this study were: (i) to evaluate the reliability of 5 trunk strength measures and 18 trunk control measures developed for the purposes of classification; (ii) to rank the objective measures, according to the largest effects on performance. Using a new testing device, 14 elite sit-skiers performed two upright seated press tests and one simulated poling test to evaluate trunk strength. They were also subjected to unpredictable balance perturbations to measure trunk control. Tests were repeated on two separate days and test–retest reliability of trunk strength and trunk control measures was evaluated. A cluster analysis was run and correlation was evaluated, including all strength and control measures, to identify the measures that contributed most to clustering participants. Intraclass correlations coefficients (ICC) were 0.71 r

PURPOSE In-beam Positron Emission Tomography (PET) is one of the modalities that can be used for in-vivo non-invasive treatment monitoring in proton therapy. Although PET monitoring has been frequently applied for this purpose, there is still no straightforward method to translate the information obtained from the PET images into easy to interpret information for clinical personnel. The purpose of this work is to propose a statistical method for analyzing in-beam PET monitoring images that can be used to locate, quantify and visualize regions with possible morphological changes occurring over the course of treatment. MATERIALS AND METHODS We selected a patient treated for Squamous Cell Carcinoma (SCC) with proton therapy, to perform multiple Monte Carlo (MC) simulations of the expected PET signal at the start of treatment, and to study how the PET signal may change along the treatment course due to morphological changes. We performed voxel-wise two-tailed statistical tests of the simulated PET images, resembling the Voxel-Based Morphometry (VBM) method commonly used in neuroimaging data analysis, to locate regions with significant morphological changes and to quantify the change. RESULTS The VBM resembling method has been successfully applied to the simulated in-beam PET images, despite the fact that such images suffer from image artifacts and limited statistics. Three dimensional probability maps were obtained, that allowed to identify inter-fractional morphological changes and to visualize them superimposed on the Computed Tomography (CT) scan. In particular, the characteristic color patterns resulting from the two-tailed statistical tests lend themselves to trigger alarms in case of morphological changes along the course of treatment. CONCLUSIONS The statistical method presented in this work is a promising method to apply to PET monitoring data to reveal inter-fractional morphological changes in patients, occurring over the course of treatment. Based on simulated in-beam PET treatment monitoring images, we showed that with our method it was possible to correctly identify the regions that changed. Moreover we could quantify the changes, and visualize them superimposed on the CT scan. The proposed method can possibly help clinical personnel in the replanning procedure in adaptive proton therapy treatments. This article is protected by copyright. All rights reserved.

Open physics 19(1), 383 - 394 (2021). doi:10.1515/phys-2021-0032, Published by de Gruyter, Berlin

Objective. Monolithic scintillator crystals coupled to silicon photomultiplier (SiPM) arrays are promising detectors for PET applications, offering spatial resolution around 1 mm and depth-of-interaction information. However, their timing resolution has always been inferior to that of pixellated crystals, while the best results on spatial resolution have been obtained with algorithms that cannot operate in real-time in a PET detector. In this study, we explore the capabilities of monolithic crystals with respect to spatial and timing resolution, presenting new algorithms that overcome the mentioned problems. Approach. Our algorithms were tested first using a simulation framework, then on experimentally acquired data. We tested an event timestamping algorithm based on neural networks which was then integrated into a second neural network for simultaneous estimation of the event position and timestamp. Both algorithms are implemented in a low-cost field-programmable gate array that can be integrated in the detector and can process more than 1 million events per second in real-time. Results. Testing the neural network for the simultaneous estimation of the event position and timestamp on experimental data we obtain 0.78 2D FWHM on the (x, y) plane, 1.2 depth-of-interaction FWHM and 156 coincidence time resolution on a 25 mm × 25 mm × 8 mm × LYSO monolith read-out by 64 3 mm × 3 mm Hamamatsu SiPMs. Significance. Our results show that monolithic crystals combined with artificial intelligence can rival pixellated crystals performance for time-of-flight PET applications, while having better spatial resolution and DOI resolution. Thanks to the use of very light neural networks, event characterization can be done on-line directly in the detector, solving the issues of scalability and computational complexity that up to now were preventing the use of monolithic crystals in clinical PET scanners.

Objective To compare the analgesic effects of oral administration of cimicoxib and tramadol over a 30 day period following Tibial Plateau Leveling Osteotomy and partial menisectomy in dogs. Design Randomized, double blinded, prospective clinical trial. Animals 42 adult client-owned dogs with unilateral cranial cruciate ligament disease and partial meniscal tears. Methods Dogs were allocated into 2 treatment groups (cimicoxib or tramadol). Weight bearing while standing, thigh circumference, flexion and extension range of motions, wound classification, adverse effects, Visual Analogue Scale (VAS), Glasgow Composite Measure Pain Scale (CMPS-SF) and Helsinki Chronic Pain Index (HCPI) questionnaire and limb function by means of pressure platform gait analysis were recorded before surgery and at several time points after surgery for 30 days. Outcome measures were compared at each time point among groups. Results A significant improvement in two objective measures of gait of the cimicoxib group: the vertical impulse on day 1 and day 20 and the peak vertical force on day 20 were significantly improved when compared to the tramadol group. However, no difference was seen for the VI or PVF of dogs on the other days compared. In addiction there was no difference in the weight bearing while standing, thigh circumference, wound classification, adverse effects, VAS, CMPS-SF and HCPI. We did not observe a difference in the number of adverse effects measured in this study with the exception of hock edaema. Conclusions and clinical relevance A significant difference was not found in long-term postoperative analgesia provided by cimicoxib or tramadol in dogs undergoing TPLO when subjective parameters (with the exception of knee joint range of motion) were evaluated, but use of the force plate analysis revealed a significant difference between groups at T20 for both PVF and VI. The use of cimicoxib improved the limb function and ROM and reduced the occurrence of hock edema, in the first 20 days after surgery, without any additional side effects, compared to tramadol. Thus, the use of cimicoxib should be preferred to tramadol alone in clinical cases similar to the ones included in this study.

Paralympic Winter Games (PWG) born in 1976. Across Games, media personnel has increased suggesting an increase in PWG size. However, the growth of PWG from Örnsköldsvik 1976 to PyeongChang 2018 in terms of participating data has not been discussed. This work aims to find if the growth in media coverage comes together with an increase in PWG size in terms of National Paralympic Committee, sports, medal events, and athletes. The presence of trend over PWG editions is evaluated with Mann-Kendall Trend Test and differences among sports and continents with Kruskal Wallis test. Showing a significant monotonic trend, the number of countries (p < .001, β = 0.81) and the number of participating athletes (p < .001, β = 7.40) seem to be good indicators of PWG. These two indicators are good descriptors of PWG size because related to sociocultural and political aspects. In contrast, number of medal events being related to many factors did not show statistically significant trend (p = .95); therefore, this indicator seems to be less appropriate to describe PWG size. If the whole history is considered, slow but significant changes in number of sports (p < .001, β = 0.08) suggest this indicator could be considered in describing Games size.

Judo is a combat sport that involves throwing the opponent onto the back. When being thrown, head biomechanics may be related to head injury risk. This study aimed to assess head injury risks associated with four Judo techniques in children and adolescents with different experience levels. Twenty children (

In a carbon ion treatment the nuclear fragmentationof both target and beam projectiles impacts on the dose releasedon the tumor and on the surrounding healthy tissues. Carbon ionfragmentation occurring inside the patient body has to be stud-ied in order to take into account this contribution. These dataare also important for the development of the range monitoringtechniques with charged particles. The production of chargedfragments generated by carbon ion beams of 115-353 MeV/ukinetic energy impinging on carbon, oxygen, and hydrogen tar-gets has been measured at the CNAO particle therapy center(Pavia, Italy). The use of thin targets of graphite (C), PMMA(C2O5H8) and polyvinyl-toluene [plastic scintillator (PS), CbHa]allowed to measure fragments production cross sections, exploit-ing a time-of-flight (ToF) technique. PS detectors have been usedto perform the ToF measurements, while LYSO crystals havebeen used for the deposited energy measurement and to performparticle identification. Cross sections have been measured at 90◦and 60◦with respect to the beam direction. The measured pro-ton, deuteron, and triton differential production cross sectionson C, O, and H, obtained exploiting the target subtraction strat-egy, are presented here as a function of the fragment kineticenergy.

Spectroscopy-based photon-counting detector systems, Medipix, have many applications in medicine. Medipix detectors benefit from providing energy information as well as high spatial resolution. In this article, a review of Medipix detector technology applied to medicine and imaging techniques are presented. The technology has been used to develop quality assurance (QA) measurement devices in radiation-based treatments. A gamma camera system for radiotherapy has been developed to measure dose delivered to prostate treatments in real-time. The advantage of a high-resolution detector has been utilized in proton and heavy ion therapy for dose QA, measuring the charge particle spectra, and beam geometry for mini-beams. Applications in medical imaging using helium ion beams have been investigated to replace CT for ion beam radiotherapy. This technique provides many advantages over conventional CT such as high-resolution imaging and spectroscopy-based information for planning in helium ion treatments. The Medipix technology has shown it can be broadly applied in radiation and particle therapy applications for accurate QA as well as proving high-resolution imaging in medicine.

The purpose of this study was to investigate the biomechanics of cross-country sit-skiing in simulated and natural skiing. Thirteen international level athletes participated in a ski ergometer test (simulated conditions) and a test on snow in a ski-tunnel (natural conditions) using their personal sit-ski. Tests in both conditions were performed at individual maximal speed. When comparing the two conditions the main results were: (1) maximal speed in simulated conditions was lower (p < 0.05) but correlated well with the natural condition (r = 0.79, p < 0.001); (2) no differences in pole force variables were found; peak force (r = 0.77, p < 0.01) and average force (r = 0.78, p < 0.01) correlated well; (3) recovery time and time to peak did not differ and time to impact correlated with each other (r = 0.88, p < 0.01); (4) no differences were found in peak electromyography (EMG) and average EMG for Triceps, Pectoralis, and Erector Spinae; Rectus Abdominis did not differ in peak. EMG peak and average EMG of all muscles were correlated between the two conditions (r = 0.65–0.94; p < 0.05–0.01). Although some differences were observed, this study demonstrated that technical skill proficiency in natural and simulated cross-country skiing is comparable from a force production and muscle activation perspective. peerReviewed

Quantitative performance analysis is of great importance, especially to increase personalized training and to reduce injuries. The use of inertial sensors has given many possibilities and has been largely used in analysing technical capabilities of athletes. With respect to combat sports, judo has many issues resulting from the great number of variables involved in the techniques and due to the critical measurement environment. The aim of this study was to propose a method for measuring and quantifying motor abilities objectively.Four inertial sensors were fixed to the lower limbs and one on the sternum of five male and five female elite judo athletes. Accelerations and angular velocities of the lower limbs were measured in 480 judo techniques. Regression lines of accelerations and angular velocities have been analysed to obtain 5 single technique indices and 1 overall technique index representing the motor abilities connected, respectively to force expressions and coordination capabilities.Correlations of motor abilities (force expression and coordination capabilities) and athletes' weight and height were found in only 6.7% of pairs. Results of force expression and coordination capabilities for most of the athletes are in line with their level of technical and combat experience.This method allowed to "photograph" athlete's technical level and to compare it in time through subsequent trials. With this innovative way, motor abilities could become evaluable and measurable, highlighting the importance of their objective quantification in order to evaluate effectiveness and efficiency of the sport technique.

Summary: Charged particle therapy exploits proton or 12C beams to treat deep-seated solid tumors. Due to the advantageous characteristics of charged particles energy deposition in matter, the maximum of the dose is released to the tumor at the end of the beam range, in the Bragg peak region. However, the beam nuclear interactions with the patient tissues induces fragmentation both of projectile and target nuclei and needs to be carefully taken into account. In proton treatments, target fragmentation produces low energy, short range fragments along all the beam range, which deposit a non negligible dose in the entry channel. In 12C treatments the main concern is represented by long range fragments due to beam fragmentation that release their dose in the healthy tissues beyond the tumor. The FOOT experiment (FragmentatiOn Of Target) of INFN is designed to study these processes, in order to improve the nuclear fragmentation description in next generation Treatment Planning Systems and the treatment plans quality. Target (16O and 12C nuclei) fragmentation induced by –proton beams at therapeutic energies will be studied via an inverse kinematic approach, where 16O and 12C therapeutic beams impinge on graphite and hydrocarbon targets to provide the nuclear fragmentation cross section on hydrogen. Projectile fragmentation of 16O and 12C beams will be explored as well. The FOOT detector includes a magnetic spectrometer for the fragments momentum measurement, a plastic scintillator for ΔE and time of flight measurements and a crystal calorimeter to measure the fragments kinetic energy. These measurements will be combined in order to make an accurate fragment charge and isotopic identification. Keywords: Hadrontherapy, Nuclear fragmentation cross sections, Tracking detectors, Scintillating detectors

Positron emission tomography (PET) is one of the most mature techniques for monitoring in ion beam therapy. PET allows to reconstruct the β + activity generated in the patient by the nuclear interaction of the ions. Taking advantage of the spatial correlation between positron emitters created along the ions path and the dose distribution, it is possible to perform a quality control of the treatment. Usually, to reconstruct the activity generated within the irradiated volume, standard 3D PET reconstruction techniques are implemented. In this work, we explore a new reconstruction method (Straight Forward Reconstruction) particularly useful for reconstructing activity distribution generated by mono-energetic pencil beams. The method was validated by measuring the produced activity distribution with the DoPET system. Irradiations performed with mono-energetic pencil beams on phantoms mimicking human tissues were used for this study. Both reconstruction methods reach an accuracy in the reconstruction of the activity distribution width of the order of 1.5 mm for 2 ⋅ 1 0 8 primaries.

In cross-country sit-skiing, the trunk plays a crucial role in propulsion generation and balance maintenance. Trunk stability is evaluated by automatic responses to unpredictable perturbations; however, electromyography is challenging. The aim of this study was to identify a measure to group sit-skiers according to their ability to control the trunk. Seated in their competitive sit-ski, 10 male and 5 female Paralympic sit-skiers received 6 forward and 6 backward unpredictable perturbations in random order. k-means clustered trunk position at rest, delay to invert the trunk motion, and trunk range of motion significantly into 2 groups. In conclusion, unpredictable perturbations might quantify trunk impairment and may become an important tool in the development of an evidence-based classification system for cross-country sit-skiers. peerReviewed

This paper describes the development and characterization of a Δ E-TOF detector composed of a plastic scintillator bar coupled at both ends to silicon photomultipliers. This detector is a prototype of a larger version which will be used in the FOOT (FragmentatiOn Of Target) experiment to identify the fragments produced by ion beams accelerated onto a hydrogen-enriched target. The final Δ E-TOF detector will be composed of two layers of plastic scintillator bars with orthogonal orientation and will measure, for each crossing fragment, the energy deposited in the plastic scintillator ( Δ E), the time of flight (TOF), and the coordinates of the interaction position in the scintillator. To meet the FOOT experimental requirements, the detector should have energy resolution of a few percents and time resolution of 70 ps, and it should allow to discriminate multiple fragments belonging to the same event. To evaluate the achievable performances, the detector prototype was irradiated with protons of kinetic energy in the 70–230 MeV range and interacting at several positions along the bar. The measured energy resolution σ Δ E ∕ Δ E was 6–14%, after subtracting the fluctuations of the deposited energy. A time resolution σ between 120 and 180 ps was obtained with respect to a trigger detector. A spatial resolution σ of 1.9 cm was obtained for protons interacting at the center of the bar.

Charged Particle Therapy (CPT) is a powerful radiotherapy technique for the treatment of deep-seated tumours characterized by a large dose released in the Bragg peak area (corresponding to the tumour region) and a small dose delivered to the surrounding healthy tissues. The precise measurement of the fragments produced in the nuclear interactions of charged particle beams with patient tissues is a crucial task to improve the clinical treatment plans. The FOOT (FragmentatiOn Of Target) experiment is an international project, funded by the Istituto Nazionale di Fisica Nucleare (INFN), aimed to study the dose released by the tissues and particle beams fragmentation. The target (16O, 12C) fragmentation induced by 150-400 MeV/n proton beams will be studied via the inverse kinematic approach, where 16O and 12C therapeutic beams collide on graphite and hydrocarbon target to provide the cross section on Hydrogen. A table-top detector is being developed and it includes a drift chamber as a beam monitor upstream of the target to measure the beam direction, a magnetic spectrometer based on silicon pixel and strip detectors, a scintillating crystal calorimeter able to stop the heavier produced fragments, and a ΔE detector, with TOF capability, for the particle identification. A setup based on the concept of the “Emulsion Cloud Chamber”, coupled with the interaction region of the electronic FOOT setup, will complement the physics program by measuring lighter charged fragments to extend the angular acceptance up to about 70 degrees. In this work, the experimental design and the requirements of the FOOT experiment will be discussed and preliminary results on the emulsion spectrometer tests will be presented.

FOOT (FragmentatiOn On Target) is an applied nuclear physics experiment aimed at measuring the production cross sections of fragments for energies, beams and targets relevant in particle therapy and radioprotection in space. The Δ E-TOF detector will measure the energy deposited by the fragments in a wall of plastic scintillators and the time of flight with respect to a start detector. These two quantities allow to determine the charge Z of the fragment. In this work, we summarize the charge identification procedure of a detector prototype with two scintillator modules.

In hadron therapy, the accelerated ions, interacting with the body of the patient, cause the fragmentation of both projectile and target nuclei. The fragments interact with the human tissues depositing energy both in the entrance channel and in the volume surrounding the tumor. The knowledge of the fragments features is crucial to determine the energy amount deposited in the human body, and - hence - the damage to the organs and to the tissues around the tumor target. The FOOT (FragmentatiOn Of Target) experiment aims at studying the fragmentation induced by the interaction of a proton beam (150-250 MeV/n) inside the human body. The FOOT detector includes an electronic setup for the identification of Z ≥ 3 fragments integrated with an emulsion spectrometer to measure Z ≤ 3 fragments. Charge identification by nuclear emulsions is based on the development of techniques of controlled fading of the particle tracks inside the nuclear emulsion, that extend the dynamical range of the films developed for the tracking of minimum ionising particles. The controlled fading strongly depends on temperature, relative humidity and treatment duration. In this study the performances in terms of charge separation of proton, helium and carbon particles, obtained on a batch of new emulsion films produced in Japan are reported.

Nuclear physics processes are an important source of uncertainty in dose calculations in particle therapy and radioprotection in space. Accurate cross section measurements are a crucial ingredient in improving the understanding of these processes. The FOOT (FragmentatiOn Of Target) experiment aims at measuring the production cross sections of fragments for energies, beams and targets that are relevant in particle therapy and radioprotection in space. An experimental apparatus composed of several sub-detectors will provide the mass, charge, velocity and energy of fragments produced in nuclear interactions in a thin target. A crucial component of the FOOT apparatus will be the Δ E-TOF detector, designed to identify the charge of the fragments using plastic scintillators to measure the energy deposited and the time of flight with respect to a start counter. In this work, we present a charge reconstruction procedure of produced fragments at particle therapy energies. We validate it by measuring the charges of various fragments at an angle of 3.2°and 8.3°with respect the beam-axis, using a small-scale detector and clinical beams of carbon ions at the CNAO oncology center. Experimental results agree well with FLUKA Monte Carlo simulations.

Overweight/obesity is a physical condition that affects daily activities, including walking. The main purpose of this study was to identify if there is a relationship between body mass index (BMI) and gait characteristics in young adults. 12 normal weight (NW) and 10 overweight/obese (OW) individuals walked at a self-selected speed along a 14 m indoor path. H-Gait system, combining seven inertial sensors (fixed on pelvis and lower limbs), was used to record gait data. Walking speed, spatio-temporal parameters and joint kinematics in 3D were analyzed. Differences between NW and OW and correlations between BMI and gait parameters were evaluated. Conventional spatio-temporal parameters did not show statistical differences between the two groups or correlations with the BMI. However, significant results were pointed out for the joint kinematics. OW showed greater hip joint angles in frontal and transverse planes, with respect to NW. In the transverse plane, OW showed a greater knee opening angle and a shorter length of knee and ankle trajectories. Correlations were found between BMI and kinematic parameters in the frontal and transverse planes. Despite some phenomena such as soft tissue artifact and kinematics cross-talk, which have to be more deeply assessed, current results show a relationship between BMI and gait characteristics in young adults that should be looked at in osteoarthritis prevention.

Hadrontherapy is a method for treating cancer with very targeted dose distributions and enhanced radiobiological effects. To fully exploit these advantages, in vivo range monitoring systems are required. These devices measure, preferably during the treatment, the secondary radiation generated by the beam-tissue interactions. However, since correlation of the secondary radiation distribution with the dose is not straightforward, Monte Carlo (MC) simulations are very important for treatment quality assessment. The INSIDE project constructed an in-beam PET scanner to detect signals generated by the positron-emitting isotopes resulting from projectile-target fragmentation. In addition, a FLUKA-based simulation tool was developed to predict the corresponding reference PET images using a detailed scanner model. The INSIDE in-beam PET was used to monitor two consecutive proton treatment sessions on a patient at the Italian Center for Oncological Hadrontherapy (CNAO). The reconstructed PET images were updated every 10 s providing a near real-time quality assessment. By half-way through the treatment, the statistics of the measured PET images were already significant enough to be compared with the simulations with average differences in the activity range less than 2.5 mm along the beam direction. Without taking into account any preferential direction, differences within 1 mm were found. In this paper, the INSIDE MC simulation tool is described and the results of the first in vivo agreement evaluation are reported. These results have justified a clinical trial, in which the MC simulation tool will be used on a daily basis to study the compliance tolerances between the measured and simulated PET images.

Particle therapy exploits the energy deposition pattern of hadron beams. The narrow Bragg Peak at the end of range is a major advantage but range uncertainties can cause severe damage and require online verification to maximise the effectiveness in clinics. In-beam Positron Emission Tomography (PET) is a non-invasive, promising in-vivo technique, which consists in the measurement of the β+ activity induced by beam-tissue interactions during treatment, and presents the highest correlation of the measured activity distribution with the deposited dose, since it is not much influenced by biological washout. Here we report the first clinical results obtained with a state-of-the-art in-beam PET scanner, with on-the-fly reconstruction of the activity distribution during irradiation. An automated time-resolved quantitative analysis was tested on a lacrimal gland carcinoma case, monitored during two consecutive treatment sessions. The 3D activity map was reconstructed every 10 s, with an average delay between beam delivery and image availability of about 6 s. The correlation coefficient of 3D activity maps for the two sessions (above 0.9 after 120 s) and the range agreement (within 1 mm) prove the suitability of in-beam PET for online range verification during treatment, a crucial step towards adaptive strategies in particle therapy.

The FOOT experiment aims at identifying the fragments produced in the human body during hadrontherapy and at measuring their cross sections. The apparatus is composed of several detectors which allow a complete reconstruction of the tracks of the fragments. In particular, the Δ E-TOF detector measures the energy released in a thin plastic scintillator and the time of flight of the fragments. In this work, we report the energy and time resolution of a Δ E-TOF detector prototype with proton and carbon irradiations, and we compare the results with a Monte Carlo simulation of the optical transport in the detector. With carbon ions, we measured time resolutions of ∼ 50 ps and energy resolutions of ∼ 6%. The Monte Carlo simulation was able to model the dependence of the number of detected photons on the proton interaction position.

Particle therapy uses protons or $^{12}$C beams for the treatment of deep-seated solid tumors. Due to the features of the energy deposition of charged particles in matter, a limited amount of dose is released to the healthy tissue in the beam entrance region, while the maximum of the dose is released to the tumor at the end of the beam range, in the Bragg peak region. However nuclear interactions between beam and patient tissues induce fragmentation both of projectile and target. This has to be carefully taken into account since different ions have different effectiveness in producing a biological damage. par In $^{12}$C treatments the main concern are long range forward emitted secondary ions produced in projectile fragmentation that release dose in the healthy tissue after the tumor. Instead, in a proton treatment, the target fragmentation produces low energy, short range fragments along all the beam range. The FOOT experiment (FragmentatiOn Of Target) is designed to study these processes. Target nuclei ($^{16}$O, $^{12}$C) fragmentation induced by 150-250 MeV proton beam will be studied by means of the inverse kinematic approach: $^{16}$O,$^{12}$C therapeutic beams, at the quoted kinetic energy per nucleon, collide on graphite and hydrocarbons target. The cross section on Hydrogen can be then extracted by subtraction. This configuration explores also the projectile fragmentation of these O and C beams, or other ions of therapeutic interest, such as $^4$He for instance. The detector includes a magnetic spectrometer based on silicon pixel and strip detectors, a scintillating crystal calorimeter able to stop the heavier produced fragments, and a $\Delta E$ detector, with TOF capability, to achieve the needed energy resolution and particle identification. In addition to the electronic apparatus, an alternative setup based on the concept of the "Emulsion Cloud Chamber", coupled with the interaction region of the electronic FOOT setup, will provide the measurement of lighter charged fragments: protons, deuterons, tritons and Helium nuclei. The FOOT data taking is foreseen in the available experimental rooms existing in the presently operational charged particle therapy facilities in Europe, and possibly at GSI. An initial phase with the emulsion setup will start in early 2018, while the complete electronic detector will take data starting in 2019. In this work a general description of the FOOT experiment and of its expected performances is presented.

3D gait analysis comprises the study of kinematics in the sagittal, coronal, and transverse planes. The transverse plane measurements are usually less used and generally show the lowest reliability. Nevertheless, the knee and ankle joint center trajectories, in the transverse plane, provide new parameters that may be important in clinical gait analysis. The aim of this study is to analyze the test-retest variability of these parameters. Gait measurements were performed using H-Gait, a wearable system based on magnetic and inertial sensors. A normal weight and an overweight subject were recruited and were asked to walk at their preferred speed for 6 trials. For both of them, the angle between the right and left knee and ankle joint center trajectories were analyzed. Overall, results showed a standard deviation across trials always lower than 2°. This small standard deviation was found also in the overweight subject, for whom it is usually challenging to obtain reliable gait measurements. In addition, a greater knee angle between the right and left joint center trajectories was found in the overweight subject compared to the normal weight. The promising results of this study suggest that the new parameters introduced might be suitable to assess gait of subjects with different anthropometric characteristics.

The quality assurance of particle therapy treatment is a fundamental issue that can be addressed by developing reliable monitoring techniques and indicators of the treatment plan correctness. Among the available imaging techniques, positron emission tomography (PET) has long been investigated and then clinically applied to proton and carbon beams. In 2013, the Innovative Solutions for Dosimetry in Hadrontherapy (INSIDE) collaboration proposed an innovative bimodal imaging concept that combines an in-beam PET scanner with a tracking system for charged particle imaging. This paper presents the general architecture of the INSIDE project but focuses on the in-beam PET scanner that has been designed to reconstruct the particles range with millimetric resolution within a fraction of the dose delivered in a treatment of head and neck tumors. The in-beam PET scanner has been recently installed at the Italian National Center of Oncologic Hadrontherapy (CNAO) in Pavia, Italy, and the commissioning phase has just started. The results of the first beam test with clinical proton beams on phantoms clearly show the capability of the in-beam PET to operate during the irradiation delivery and to reconstruct on-line the beam-induced activity map. The accuracy in the activity distal fall-off determination is millimetric for therapeutic doses.

Monitoring surface electromyographic (EMG) signals can provide useful insights for characterizing muscle fatigue, which is defined as an exercise-induced strength loss. This experiment investigated the muscle fiber conduction velocity (CV) changes induced by an endurance run. The day before and immediately after a half-marathon run (21.097 km) 11 amateur runners performed maximum voluntary contractions (MVCs) of knee extensor muscles. During the MVC, multichannel EMG was recorded from the vastus lateralis and EMG amplitude and CV were calculated. After the run, knee extensors showed a decreased strength (-13 ± 9%, p = 0.001) together with a reduction in EMG amplitude (-13 ± 10%, p = 0.003) and in CV (-6 ± 8%, p = 0.032). Knee extensor strength loss positively correlated with vastus lateralis CV differences (r = 0.76, p = 0.006). Thus, the exercises-induced muscle fatigue was associated not only with a decrease in EMG amplitude, but also with a reduction in CV. This finding suggests that muscle fibers with higher CV (i.e. those with greater fiber size) were the most impaired during strength production after an endurance run.

In this study the possibility of retrieving composition information in proton therapy with a planar in-beam PET scanner is investigated. The analysis focuses both on spatial activity distributions and time dependence of the recorded signal. The experimental data taking was performed at the Trento Proton Therapy Center (IT) by irradiating three different phantoms. We show that different phantom compositions reflect into different activity profile shapes. We demonstrate that the analysis of the event rate can provide significant information on the phantom elemental composition, suggesting that elemental analysis could be used along with activity profile analysis to achieve a more accurate treatment monitoring.

The aim of this mini-review is to describe the potential application of surface electromyography (sEMG) techniques in aging studies. Aging is characterized by multiple changes of the musculoskeletal system physiology and function. This paper will examine some of the innovative methods used to monitor age-related alterations of the neuromuscular system from sEMG signals. A description of critical assumptions which underlie some of these approaches is emphasized. The first part focuses on the evolution of the recording techniques and describes some methodological issues. The second part focuses on how to use the following techniques to characterize aging: amplitude and spectral sEMG signal analysis, muscle fiber conduction velocity estimation, and myoelectric fatigue assessment. The last part describes a number of advanced sEMG approaches which seem promising in the geriatric population to estimate motor unit number, size, recruitment thresholds, and firing rates.