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A multiscale model for glioma spread in brain tissue under the influence of vascularization and vascular endothelial growth factors is proposed. It accounts for the interplay between the different components of the neoplasm and the healthy tissue and it investigates and compares various therapy approaches. Precisely, these involve radiotherapy and chemotherapy in a concurrent or adjuvant manner together with anti-angiogenic therapy affecting the vascular component of the system. We assess tumor growth and spread on the basis of diffusion tensor imaging (DTI) data, which allows us to reconstruct a realistic brain geometry and tissue structure, and we apply our model to real glioma patient data. In this latter case, a space-dependent radiotherapy description is considered using data about the corresponding isodose curves.

Background Navigated transcranial magnetic stimulation (nTMS) is an established, noninvasive tool to preoperatively map the motor cortex. Despite encouraging reports from few academic centers with vast nTMS experience, its value for motor-eloquent brain surgery still requires further exploration. Objective To further elucidate the role of preoperative nTMS in motor-eloquent brain surgery. Methods Patients who underwent surgery for a motor-eloquent supratentorial glioma or metastasis guided by preoperative nTMS were retrospectively reviewed. The nTMS group (n = 105) was pair-matched to controls (non-nTMS group, n = 105). Gross total resection (GTR) and motor outcome were evaluated. Subgroup analyses including survival analysis for WHO III/IV glioma were performed. Results GTR was significantly more frequently achieved in the entire nTMS group compared to the non-nTMS group (P = .02). Motor outcome did not differ (P = .344). Bootstrap analysis confirmed these findings. In the metastases subgroup, GTR rates and motor outcomes were equal. In the WHO III/IV glioma subgroup, however, GTR was achieved more frequently in the nTMS group (72.3%) compared to non-nTMS group (53.2%) (P = .049), whereas motor outcomes did not differ (P = .521). In multivariable Cox-regression analysis, prolonged survival in WHO III/IV glioma was significantly associated with achievement of GTR and younger patient age but not nTMS mapping. Conclusion Preoperative nTMS improves GTR rates without jeopardizing neurological function. In WHO III/IV glioma surgery, nTMS increases GTR rates that might translate into a beneficial overall survival. The value of nTMS in the setting of a potential survival benefit remains to be determined.

Purpose Randomized comparison of the effect of radiotherapy on painful osteoarthritis (OA) applying a standard-dose vs. a very-low-dose regime Patients and methods Patients with OA of the hand and knee joints were included. Further inclusion criteria: symptoms for more than 3 months, favorable general health status, age above 40 years. Patients with prior local radiotherapy, trauma, rheumatoid arthritis, or vascular diseases were excluded. After randomization (every joint was randomized separately), the following protocols were applied: standard arm: total dose 3.0 Gy, single fractions of 0.5 Gy twice weekly; experimental arm: total dose 0.3 Gy, single fractions of 0.05 Gy twice weekly. The dosage was not known to the patients. The patients were examined 3 and 12 months after radiotherapy. Scores like VAS (visual analogue scale), KOOS-SF (the knee injugy and osteoarthritis outcome score), SF-SACRAH (short form score for the assessment and quantification of chronic rheumatic affections of the hands), and SF-12 (short form 12) were used. Results A total of 64 knees and 172 hands were randomized. 3.0 Gy was applied to 87 hands and 34 knees, 0.3 Gy was given to 85 hands and 30 knees. After 3 months, we observed good pain relief after 3 Gy and after 0.3 Gy, there was no statistically significant difference. Side effects were not recorded. The trial was closed prematurely due to slow recruitment. Conclusion We found favorable pain relief and a limited response in the functional and quality of life scores in both arms. The effect of low doses such as 0.3 Gy on pain is widely unknown. Further trials are necessary to compare a conventional dose to placebo and to further explore the effect of low doses on inflammatory disorders.

Microcomputed tomography (micro-CT) is a frequently used imaging tool for a wide spectrum of in-vivo mouse models in basic and translational research. To allow an accurate interpretation of micro-CT images, high spatial resolution is necessary. However, this may also lead to a high radiation exposure of the animals. Therefore, animal welfare requires exact information about the expected radiation doses for experimental planning. To gain this, a mouse cadaver was herein used for micro-CT analyses under different conditions. For each radiation dose measurement, the cadaver was labeled with thermoluminescent dosimeter chips around the thoracic skin surface. Micro-CT scans of the thorax were performed with spatial resolutions of 35 µm, 18 µm and 9 µm in combination with Al0.5, Al1.0, CuAl and Cu filters. As a surrogate of image quality, the number of identifiable lung vessels was counted on a transversal micro-CT slice. Measured radiation doses varied from 0.09 Gy up to 5.18 Gy dependent on resolution and filter settings. A significant dose reduction of > 75% was achieved by a Cu filter when compared to an Al0.5 filter. However, this resulted in a markedly reduced image quality and interpretability of microstructures due to higher radiation shielding and lower spatial resolution. Thus, the right combination of distinct filters and several scan protocol settings adjusted to the individual requirements can significantly reduce the radiation dose of micro-CT leading to a higher animal welfare standard.

PURPOSE Rhabdoid tumor of the kidney (RTK) is one of the most aggressive childhood renal tumors. Overall survival ranges from 22% to 47%. The indication for radiation therapy (RT) in usually very young patients is an ongoing discussion. Recent protocols recommend RT independent of local stage, the latter being a good discriminator in other childhood kidney tumors. In this study, we analyze the evidence for RT in regard to risk factors, including tumor stage. METHODS AND MATERIALS This study analyzed 58 patients with RTK from Austria, Switzerland, and Germany treated in the framework of 4 consecutive, prospective renal/rhabdoid tumor studies from 1991 to 2014. All treatment protocols included multimodality treatment, including high-intensity chemotherapy, surgery, and RT. RESULTS Local stage distribution was not applicable, I, II, and III in 1, 6, 11, and 40, respectively. Twenty-nine (50%) patients had stage IV disease at diagnosis. Thirty-seven patients (64%) achieved complete remission, and 49% (18/37) relapsed. Thirty-four patients (60%) patients had progressive disease and died, 17 had local disease, 10 had combined disease, and 7 had distant disease; 2 treatment-related deaths were reported (3%). Twenty-one patients received RT during first-line treatment, 18 of them to all involved sites. Eight of the 34 cases of progressive disease occurred in irradiated patients. The local failure rate of treated patients with local stage II or III disease was 29% (6/18) in patients irradiated to all sites compared with 68% (15/22) in nonirradiated patients. One of 6 stage I patients received RT, and 1 patient experienced distant relapse (2-year progression-free and overall survival both 83% ± 15%). Progression-free survival for local stage II and III disease treated with RT, adjusted for early relapse or treatment abandonment, was 67% ± 11%, compared with 15% ± 7% without RT (P < .0001). CONCLUSION The 68% local failure rate in nonirradiated patients underlines the importance of local treatment. Our experience supports the use of RT for local control in higher stage disease. In contrast, no local relapse in 6 local stage I patients, including 5 nonirradiated patients, suggests omission of RT in this favorable subset of usually infant patients with RTK.

Gliomas are the most prevalent, aggressive, and invasive subtype of primary brain tumors, characterized by fast cell growth, strong invasion capability, and well-developed tumor vasculature. Although the research advances and the clinical trials testing the efficacy of novel combined therapies have allowed significant progress in the comprehension and treatment of gliomas, these tumors are characterized by a poor prognosis, and recurrence remains the main cause of mortality. The growth and migration of tumor cells inside the brain is a highly complex phenomenon, influenced by a multitude of intrinsic and extrinsic factors at different spatial and temporal scales. The high complexity of this invasion process remains a challenge to face and several important questions are still unanswered. In this context, mathematical models emerge as powerful tools to face these challenges. Here, we propose a multiscale approach for the description of glioma progression under the influence of vascularization. Precisely, we firstly focus on the effects of (hypoxia-driven) acidity and phenotypic heterogeneity on tumor progression. Then, we extend the setting to include vascular endothelial growth factor evolution and compare various therapeutic approaches. Starting from a microscopic description of the interactions between specific cell membrane receptors and the extracellular microenvironment, we define two different coupled systems for endothelial and tumor cell evolution. The analysis of these systems allows us to assess tumor growth and spread on the basis of DTI and glioma patient data. In particular, we perform several data-driven numerical tests aimed at assessing the role of vasculature and phenotypic heterogeneity on tumor progression and comparing the effect of different combinations of radio-, chemo-, and anti-angiogenic therapy on it.

Patienten mit komplexen Tumorprothesen bedurfen zur Behandlung ihres Tumorleidens vielfach einer Radiotherapie oder Radiochemotherapie. Tumordiagnosen, Indikation, Planung, Durchfuhrung und Prognose der Strahlentherapie im Rahmen einer interdisziplinaren Behandlung von Knochensarkomen sowie mogliche Interaktionen zwischen der Strahlung und den einliegenden Prothesen sowie damit potenziell verbundene Komplikationen werden erlautert. Literatursuche, Zusammenfassung eigener Erfahrungen. Komplexe prothetische Verfahren werden uberwiegend bei Patienten mit Knochensarkomen, also Ewing- oder Osteosarkomen angewandt. Bei Ewing-Sarkomen ist die Strahlentherapie integraler Bestandteil des multimodalen Therapiekonzeptes, bei Osteosarkomen ist sie in speziellen Situationen indiziert. Planung und Durchfuhrung der Radiatio werden durch die metallischen Implantate erschwert (Artefakte in der Planungs-CT, Beeinflussung der Dosisverteilung). Es wird diskutiert, ob die Einheilung einer Prothese durch die anschliesende Strahlentherapie beeintrachtigt wurde – bei Einbau einer Prothese nach einer durchgefuhrten Strahlentherapie ist eine erhohte Komplikationsrate durchaus bekannt. Die Prognose dieser Knochensarkome wird durch die multimodale Behandlung deutlich verbessert. Patienten mit Knochensarkomen, die einer multimodalen Therapie aus Operation, Strahlentherapie und Chemotherapie zugefuhrt werden, haben inzwischen eine gute Tumorprognose bei akzeptabler Funktionalitat.

Brain metastases can effectively be treated with surgical resection and adjuvant stereotactic radiotherapy (SRT). Navigated transcranial magnetic stimulation (nTMS) has been used to non-invasively map the motor cortex prior to surgery of motor eloquent brain lesions. To date, few studies have reported the integration of such motor maps into radiotherapy planning. The hippocampus has been identified as an additional critical structure of radiation-induced deficits. The aim of this study is to assess the feasibility of selective dose reduction to both the nTMS-based motor cortex and the hippocampi in SRT of motor-eloquent brain metastases. Patients with motor-eloquent brain metastases undergoing surgical resection and adjuvant SRT between 07/2014 and 12/2018 were retrospectively analyzed. The radiotherapy treatment plans were retrieved from the treatment planning system (“original” plan). For each case, two intensity-modulated treatment plans were created: the “motor” plan aimed to reduce the dose to the motor cortex, the “motor & hipp” plan additionally reduce the dose to the hippocampus. The optimized plans were compared with the “original” plan regarding plan quality, planning target volume (PTV) coverage, and sparing of organs at risk (OAR). 69 plans were analyzed, all of which were clinically acceptable with no significant differences for PTV coverage. All OAR were protected according to standard protocols. Sparing of the nTMS motor map was feasible: mean dose 9.66 ± 5.97 Gy (original) to 6.32 ± 3.60 Gy (motor) and 6.49 ± 3.78 Gy (motor & hipp), p

OBJECTIVE. The purpose of this study was to evaluate radiation dose, effective dose, and image quality of different low-dose abdominal CT protocols in a swine model and an anthropomorphic phantom u...

Background In order to consider potential positioning errors there are different recipes for safety-margins for CTV-to-PTV expansion. The aim of this study is to simulate the effect of positioning inaccuracy with clinically realistic patient treatment plans. Methods For a collective of 40 prostate patients, the isocenter was shifted back appropriately to the applied table shifts after positioning verification, simulating that no positioning correction had been performed and the treatment plans were recalculated. All the treatment fractions with the appropriate isocenter-shifts were added to yield a new plan considering two scenarios: 1) Extreme scenario: summation of only shifted plans. 2) Realistic scenario: consideration of the original treatment plan for the fractions with verification imaging. Afterwards all plans were analysed and compared with each other regarding target coverage, sparing of organs at risk (OAR) and normal tissue complication probability (NTCP). Results Dose distributions and especially DVH show a deterioration of the target-coverage caused by the positioning inaccuracy. Deviations in dose at a single point can reach values of over 10 Gy. In single cases minimum plan agreement only achieved 66% pass within 3% local dose for the realistic case. Organs at risk and NTCP analysis result in a slightly better sparing of the rectum. Measures of quality like homogeneity and conformity differ just minimally regarding the different scenarios. Conclusion PTV-coverage suffers markedly by the positioning uncertainties, the shifted plans are in large parts clinically not acceptable. Surprisingly sparing of the OAR is not negatively affected by potential positioning errors for this prostate collective.

BACKGROUND The net benefit from local ablative therapy for pulmonary oligometastases remains unknown. The outcomes of stereotactic ablative radiotherapy (SABR) for metastatic lung lesions (MLLs) were analyzed retrospectively and compared with those of SABR for primary lung lesions (PLLs). METHODS Medical records of patients treated with lung SABR between 2011 and 2014 were retrospectively reviewed. Basic patient, lesion and treatment characteristics were compared using the Pearson chi-square test for categorical and Mann-Whitney U test for continuous variables. To estimate the rates of local control (LC), progression-free survival (PFS), survival after the first progression post-SABR (SAPF) and overall survival (OS), the Kaplan-Meier method was used, and the differences between groups were assessed by means of the log rank test. The uni- and multivariate Cox proportional hazards regression model was used to identify predictive factors for these endpoints. RESULTS Twenty-nine MLLs in 18 consecutive patients and 51 PLLs in 42 patients were treated stereotactically and included in the study. Median follow-up was 14 months (range, 4-40 months). Although patients with MLLs had a significantly better cardiopulmonary function (P=0.0001), more conservative dose-fractionation schedules were prescribed (P=0.0001), but this did not result in a significant difference in LC (P=0.98), PFS (P=0.06) and OS (P=0.14). Multivariate analysis revealed that the dose per fraction (≥ or

In this randomized multicenter trial, we compared the effect of a lower single dose of 0.5 Gy vs. a standard single dose of 1 Gy concerning pain relief and quality of life, while maintaining a uniform total dose of 6 Gy. On the basis of laboratory observations, the lower single dose would be expected to be more effective.A total of 127 patients suffering from painful heel spur were randomized: Patients in the standard group were treated with single fractions of 6 × 1 Gy twice a week, while the experimental group was treated with single fractions of 12 × 0.5 Gy three times a week. Patients who did not show satisfactory pain relief after 12 weeks were offered re-irradiation with the standard dose. The study's primary endpoints were pain relief and quality of life. Therapy results were evaluated and compared based on follow-up examinations after 12 and 48 weeks.The data of 117 patients could be evaluated. There was no significant difference between the groups concerning the results of a visual analogue scale (VAS), Calcaneodynia Score (CS), and the somatic scale of the 12-Item Short-Form Health Survey(SF-12). Patients undergoing re-irradiation showed a significant benefit concerning pain relief. Their total outcome was comparable to patients showing a good response from the beginning. No relevant acute or chronic side effects were recorded.Both patient groups showed good results concerning pain relief. A fractionation schedule of 12 × 0.5 Gy was not superior to the current standard dose of 6 × 1 Gy. Further trials are necessary to explore the best fractionation schedule.

Purpose The mARC technique is a hybrid rotational IMRT modality operating in “burst mode”. While it is generally assumed that it will be slower than VMAT, the real limits of operation have not been defined so far. We here present the first systematic study of the technical limits on mARC treatment. Methods The following scenarios are considered: 18, 30, 36 or 45 arclets per rotation (spacing between 20° and 8°), flat and flattening-filter-free (FFF) energy, arclet width 4° or 2°, from 1 MU/arclet to 1000 MU/plan. All scenarios are irradiated, treatment times are measured and treatment parameters reported. Dose linearity was assessed by point dose measurements of the 18 arclet plans with 1-30 MU per arclet. Results Minimum treatment times (no MLC movement, few MUs) depend strongly on the number of arclets per rotation (1 minute for 18 arclets to 1:50 min for 45 arclets), and rise linearly with MU/arclets after a given cut-off value depending on scenario, arclet width and available maximum dose rate. MLC movement adds up to 2 minutes of treatment time, but generally less (ca. 45 seconds in realistic plans). The rules by which irradiation parameters are selected by the firmware can be partly discovered. The choice of dose rate is most clearly defined. For the flat 6 MV energy, the highest available dose rate (300 MU/min) is always applied. For FFF 7 MV dose rate is reduced for arclets with few MUs, so that an arclet is irradiated in no less than 0.3 s. Only for the case of 1 MU/arclet can this constraint not be met (the technical limit on the dose rate if 500 MU/min for FFF 7 MV). In this case, dosimetric linearity is reduced. In all other instances, deviations from linearity at low MU remain below 2%. Conclusions Treatment times of down to 90 seconds are technically achievable for treatment with FFF beams using up to 36 arclets per rotation (arclet spacing every 10°) for up to 900 MU/plan, comparable to VMAT treatment times. The values provided here are meant to serve as a reference for the design of mARC plans (choice of arclets spacing etc.) and as minimum times against which the performance of different treatment planning systems can be evaluated.

Background Daily image-guided radiotherapy (IGRT) can contribute to cover extended body volumes with low radiation dose. The effect of additional imaging dose on secondary cancer development is modelled for a collective of children with Morbus Hodgkin. Methods Eleven radiotherapy treatment plans from pediatric patients with Hodgkin’s lymphoma were retrospectively analyzed, including imaging dose from scenarios using different energies (kV/MV) and planar/cone-beam computed tomography (CBCT) techniques. In addition to assessing the effect of imaging dose on organs at risk, the excess average risk (EAR) for developing a secondary carcinoma of the lung or breast was modelled. Results Although the variability between the patients is relatively large due to the different target volumes, the additional EAR due to imaging can be consistently determined. For daily 6MV CBCT, the EAR for developing a secondary cancer at age 50 is over 3 cases per 104 PY (patient-years) for the female breast and 0.7–0.8 per 104 PY for the lungs. This can be decreased by using only planar images (

The aim of our work is to provide the up-to-now missing information on the Siemens Artiste FFF 7 MV beam line using a Monte-Carlo model fit to the realistic dosimetric measurements at the linear accelerator in clinical use at our department. The main Siemens Artiste 6MV and FFF 7MV beams were simulated using the Geant4 toolkit. The simulations were compared with the measurements with an ionization chamber in a water phantom to verify the validation of simulation and tuning the primary electron parameters. Hereafter, other parameters such as surface dose, spectrum, electron contamination, symmetry, flatness/unflatness, slope, and characteristic off-axis changes were discussed for both Flat and FFF mode. The mean electron energy for the FFF beam was 8.8 MeV and 7.5 MeV for Flat 6 MV, the spread energy and spot size of the selected Gaussian distribution source were 0.4 MeV and 1mm, respectively. The dose rate of the FFF beam was 2.8 (2.96) times higher than for the flattened beam for a field size of 10×10 (20×20) cm2. The electron contamination has significant contribution to the surface dose especially for the flattened beam. The penumbra, surface dose and the mean energy of photons decrease by removing the flattening filter. Finally, the results show that off-axis changes have no strong effect on the mean energy of FFF beams, while this effect was more considerable for the flattened beam.

Purpose The purpose of this work is to compare the positioning accuracy achieved by three different imaging techniques and planar vs. CBCT imaging for two common IGRT indications. Methods A collective of prostate cancer and head-and-neck cancer patients treated at our institution during the year 2013 was retrospectively analyzed. For all treatment fractions (3078 in total), the kind of acquired set-up image and the performed couch shift before treatment were assessed. The distribution of couch corrections was compared for three different imaging systems available at our institution: the treatment beam line operating at 6 MV, a dedicated imaging beam line of nominally 1 MV, and the kVision system at 70–121 kV. Shifts were analyzed for planar and cone-beam CT images. Based on the set-up corrections, CTV to PTV expansion margins were calculated. Results The difference in set-up corrections performed for the three energies and both techniques (planar vs. CBCT) was not significant for head-and-neck cancer patients. For prostate cancer all shifts had equal variance. Averages ranged from −0.7 to +0.7 mm. The set-up margins calculated on the basis of the observed shifts are 4.0 mm (AP) and 3.8 mm (SI, LR) for the head-and-neck PTV and 6.6 mm (SI), 6.7 mm (AP) and 7.9 mm (LR) for the prostate cancer patients. Conclusions For three different linac-based imaging energies and planar/CBCT imaging, no relevant differences in set-up shifts were observed. The suggested set-up margins for these indications are of the order of 4 mm for head-and-neck and 6–8 mm for prostate treatment.

Purpose To compare abdominal imaging dose from 3D imaging in radiology (standard/low-dose/dual-energy CT) and radiotherapy (planning CT, kV cone-beam CT (CBCT)). Methods Dose was measured by thermoluminescent dosimeters (TLD’s) placed at 86 positions in an anthropomorphic phantom. Point, organ and effective dose were assessed, and secondary cancer risk from imaging was estimated. Results Overall dose and mean organ dose comparisons yield significantly lower dose for the optimized radiology protocols (dual-source and care kV), with an average dose of 0.34±0.01 mGy and 0.54±0.01 mGy (average ± standard deviation), respectively. Standard abdominal CT and planning CT involve considerably higher dose (13.58 ± 0.18 mGy and 18.78±0.27 mGy, respectively). The CBCT dose show a dose fall-off near the field edges. On average, dose is reduced as compared with the planning or standard CT (3.79 ± 0.21 mGy for 220° rotation and 7.76 ± 0.37 mGy for 360°), unless the high-quality setting is chosen (20.30 ± 0.96 mGy). The mean organ doses show a similar behavior, which translates to the estimated secondary cancer risk. The modelled risk is in the range between 0.4 cases per million patient years (PY) for the radiological scans dual-energy and care kV, and 300 cases per million PY for the high-quality CBCT setting. Conclusions Modern radiotherapy imaging techniques (while much lower in dose than radiotherapy), involve considerably more dose to the patient than modern radiology techniques. Given the frequency of radiotherapy imaging, a further reduction in radiotherapy imaging dose appears to be both desirable and technically feasible.

Linac-based patient imaging is possible with a variety of techniques using different photon energies. The purpose of this work is to compare three imaging systems operating at 6 MV, flattening free filter (FFF) 1 MV, and 121 kV.The dose distributions of all pretreatment set-up images (over 1,000) were retrospectively calculated on the planning computed tomography (CT) images for all patients with prostate and head-and-neck cancer treated at our institution in 2013. We analyzed the dose distribution and the dose to organs at risk.For head-and-neck cancer patients, the imaging dose from 6-MV cone beam CT (CBCT) reached maximum values at around 8 cGy. The 1-MV CBCT dose was about 63-79 % of the 6-MV CBCT dose for all organs at risk. Planar imaging reduced the imaging dose from CBCT to 30-40 % for both megavoltage modalities. The dose from the kilovoltage CBCT was 4-10 % of the 6-MV CBCT dose. For prostate cancer patients, the maximum dose from 6-MV CBCT reached 13-15 cGy, and was reduced to 66-73 % for 1 MV. Planar imaging reduces the MV CBCT dose to 10-20 %. The kV CBCT dose is 15-20 % of the 6-MV CBCT dose, slightly higher than the dose from MV axes. The dose distributions differ markedly in response to the different beam profiles and dose-depth characteristics.

A seismic network operated from December 2008 to November 2009 in south-central Chile covering the Chile subduction zone from c. 39°S to 40°S. This segment of the subduction zone includes the highly active Villarrica volcano and the maximum slip area of the 1960 Mw 9.5 earthquake. We applied surface wave dispersion analysis to data from a linear array of broadband stations and to records of four areal sub-arrays. Fifty regional and teleseismic events were used to produce dispersion curves of Rayleigh waves. From the dispersion curves, we determined depth functions of the shear-wave velocity for 4 subregions of the subduction zone: the Coastal Range, the Central Valley, the Volcanic Arc and the Back-arc Region in Argentina. The resulting models reveal the structure of the crust and the depth of the Moho discontinuity. Below the volcanic arc, the shear-wave velocities of the continental mantle are reduced by c. 7% with respect to a background value of 4.3 km s−1. This low-velocity zone coincides with a zone of reduced electrical resistivity that was previously determined from magnetotelluric measurements. The combined occurrences of minima in the S-wave velocity and resistivity can be interpreted as an indicator of partial melts.

The modulated arc (mARC) technique has recently been introduced for Siemens ARTISTE linear accelerators. We present the first experiences with the commissioning of the system and first patient treatments.Treatment planning and delivery are presented for the Prowess Panther treatment planning system or, alternatively, an in-house code. Dosimetric verification is performed both by point dose measurements and in 3D dose distribution.Depending on the target volume, one or two arcs can be used to create highly conformal plans. Dosimetric verification of the converted mARC plans with step-and-shoot plans shows deviations below 1 % in absolute point dose; in the 3D dose distribution, over 95 % of the points pass the 3D gamma criteria (3 % deviation in local dose and 3 mm distance to agreement for doses 20 % of the maximum). Patient specific verification of the mARC dose distribution with the calculations has a similar pass rate. Treatment times range between 2 and 5 min for a single arc.To our knowledge, this is the first report of clinical application of the mARC technique. The mARC offers the possibility to save significant amounts of time, with single-arc treatments of only a few minutes achieving comparable dose distribution to IMRT plans taking up to twice as long.

This paper analyzes the style, distribution, mechanics and timing of deformation of the Andean retroarc zone between 39° and 40°S, in the North Patagonian Andes. Field recognition and interpretation of the main structures, constrained by new gravity data allowed establishing a structural control for the main sedimentary successions that coexisted with Andean development. A balanced cross section is constructed, where the westernmost segment is characterized by a thick-skinned structure associated with a deep decollment, over which Late Paleozoic rocks are uplifted on top of Cenozoic successions. To the east, a central segment was formed by Late Miocene inversion of a late Oligocene backarc basin controlled by a shallower decollment. A new K/Ar age of 29 Ma constrains the age of these synextensional deposits. Gravity data show the rhomboedric geometry and depth of these depocenters affecting the basement in the western orogenic front area. Finally, an eastern sector is characterized by the inversion of Late Triassic structures and development of primary faults over a deeper decollment, producing a west-vergent deformational belt. The restoration of the structural profile has yielded a total shortening of less than 10 km produced in more than one contractional stage. The complex structure described in this work results from the interaction of NW structures related to the typical Andean deformation, and ENE structures related to the intraplate Huincul high. Finally, previous works had visualized in seismic tomographies an area of relatively low velocities in the orogenic front area, interpreting it as a mantle-derived magmatic-hydrothermal crustal reservoir. Computed elastic thicknesses performed in this work from gravity data show a good correlation between areas of low flexural rigidity and areas of low seismic velocities. These anomalies coincide at surface with Pliocene to Quaternary retroarc mafic eruptions that could have a connection to slab tearing processes proposed for the last 5–2 Ma from seismic data. Fil: Ramos, Miguel Esteban. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Estudios Andinos "Don Pablo Groeber". Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Estudios Andinos "Don Pablo Groeber"; Argentina Fil: Folguera Telichevsky, Andres. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Estudios Andinos "Don Pablo Groeber". Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Estudios Andinos "Don Pablo Groeber"; Argentina Fil: Fennell, Lucas Martín. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Estudios Andinos "Don Pablo Groeber". Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Estudios Andinos "Don Pablo Groeber"; Argentina Fil: Gimenez, Mario Ernesto. Universidad Nacional de San Juan. Facultad de Ciencias Exactas, Físicas y Naturales. Instituto Geofísico Sismológico Volponi; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Litvak, Vanesa Dafne. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Estudios Andinos "Don Pablo Groeber". Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Estudios Andinos "Don Pablo Groeber"; Argentina Fil: Dzierma, Yvonne. Christian Albrechts University Kiel; Alemania Fil: Ramos, Victor Alberto. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Estudios Andinos "Don Pablo Groeber". Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Estudios Andinos "Don Pablo Groeber"; Argentina

Purpose Flattening filter-free (FFF) beams have recently become available for radiation therapy, offering much higher dose rates but complicating treatment owing to the nonflat profile. Stereotactic treatment is one of the most evident scenarios to investigate the use of FFF beams. Methods and Materials We present a planning study of a FFF 7-MV beam for the treatment of brain metastases using multiple noncoplanar arcs. Plan differences as compared with flat 6 MV photon fields are estimated using different measures of quality. Absolute dosimetry and fluence distribution are verified and the out-of-field dose is measured. Results The FFF 7-MV plans are slightly better than the flat 6-MV plans as evaluated by a number of quality indices, dose to organs at risk, and out-of-field dose, although differences may not be clinically relevant. Verification does not pose any problems. Conclusions The FFF 7-MV treatment plans are marginally superior to the flat-beam 6-MV plans in almost all cases, with greatly reduced treatment times (almost 50%).

Purpose To present the beam properties of the Siemens 70-kV and 121-kV linear accelerator-mounted imaging modalities and commissioning of the 121-kV beam in the Philips Pinnacle treatment planning system (TPS); measurements in an Alderson phantom were performed for verification of the model and to estimate the cone-beam CT (CBCT) imaging dose in the head and neck, thorax, and pelvis. Methods and Materials The beam profiles and depth–dose curve were measured in an acrylic phantom using thermoluminescent dosimeters and a soft x-ray ionization chamber. Measurements were imported into the TPS, modeled, and verified by phantom measurements. Results Modeling of the profiles and the depth–dose curve can be achieved with good quality. Comparison with the measurements in the Alderson phantom is generally good; only very close to bony structures is the dose underestimated by the TPS. For a 200° arc CBCT of the head and neck, a maximum dose of 7 mGy is measured; the thorax and pelvis 360° CBCTs give doses of 4-10 mGy and 7-15 mGy, respectively. Conclusions Dosimetric characteristics of the Siemens kVision imaging modalities are presented and modeled in the Pinnacle TPS. Thermoluminescent dosimeter measurements in the Alderson phantom agree well with the calculated TPS dose, validating the model and providing an estimate of the imaging dose for different protocols.

At the continental margin of north Costa Rica and Nicaragua, the strongly hydrated Cocos Plate subducts beneath the Caribbean Plate. From the downgoing Cocos plate fluids are released through extensional fractures in the overriding plate. At the seafloor, they form fluid seeps, mounds and other types of fluid expulsion. Using an offshore temporary seismic network, we investigated seismicity possibly related to these processes and observed several swarms of earthquakes located on the continental slope trenchward of the seismogenic zone of S Nicaragua. The seismicity occurred within the downgoing plate, near the plate interface and in the overriding plate. We interpret these swarm events as an expression of pore pressure propagation under critical stress conditions driven by fluid release from the downgoing plate. In order to estimate hydraulic diffusivity and permeability values, we applied a theory developed for injection test interpretation to the spatio-temporal development of the swarms. The resulting diffusivity and permeability values are in the ranges of 28–305 m²/s and 3.2 × 10−14 m²–35.1 × 10−14 m², respectively, applying to the continental and oceanic crust near the plate interface. These values are somewhat larger than observed in drill logs on the margin wedge off north Costa Rica, but of comparable magnitude to values estimated for the Antofagasta 1995 earthquake aftershock sequence.

Accurate patient positioning before radiotherapy is often verified using advanced imaging techniques such as cone-beam computed tomography (CBCT). Even for dedicated imaging beam lines, the applied dose is not necessarily negligible with respect to the treatment dose and should be considered in the treatment plan.This study presents measurements of the beam properties of the Siemens kView (Siemens AG, Munich, Germany) image beam line (IBL) and the commissioning in the Philips Pinnacle(3) treatment planning system (TPS; Philips, Amsterdam, Netherlands).The percent depth dose curve reaches its maximum at a depth of 10 mm, with a surface dose of 44 %. The IBL operates in flattening filter-free mode, showing the characteristic dose falloff from the central axis. Stability over several days to months is within less than 2 % dose deviation or 1 mm distance-to-agreement. Modelling of the IBL beam line was performed using the Pinnacle(3) automatic modelling routine, with absolute dosimetric verification and film measurements of the fluence distribution.After commissioning of the IBL beam model, the dose from the imaging IBL CBCT can be calculated. Even if the absolute dose deposited is small, repeated imaging doses may sum up to significant amounts and can shift the position of the dose maximum by several centimetres.

Background Modern radiotherapy offers various possibilities for image guided verification of patient positioning. Different clinically relevant IGRT (image guided radiotherapy) scenarios were considered with regard to their influence on dosimetric plan quality and normal tissue complication probability (NTCP). Methods This study is based on treatment plans of 50 prostate patients. We evaluate the clinically performed IGRT and simulate the influence of different daily IGRT scenarios on plan quality. Imaging doses of planar and cone-beam-CT (CBCT) images for three different energies (6 MV, 1 MV and 121 kV) were added to the treatment plans. The plan quality of the different scenarios was assessed by a visual inspection of the dose distribution and dose-volume-histogram (DVH) and a statistical analysis of DVH criteria. In addition, an assessment of the normal tissue complication probability was performed. Results Daily 1MV-CBCTs result in undesirable high dose regions in the target volume. The DVH shows that the scenarios with actual imaging performed, daily kV-CBCT and daily 6MV imaging (1x CBCT, 4x planar images per week) do not differ exceedingly from the original plan; especially imaging with daily kV-CBCT has little influence to the sparing of organs at risk. In contrast, daily 1MV- CBCT entails an additional dose of up to two fraction doses. Due to the additional dose amount some DVH constraints for plan acceptability could no longer be satisfied, especially for the daily 1MV-CBCT scenario. This scenario also shows increased NTCP for the rectum. Conclusion Daily kV-CBCT has negligible influence on plan quality and is commendable for the clinical routine. If no kV-modality is available, a daily IGRT scenario with one CBCT per week and planar axial images on the other days should be preferred over daily MV-CBCT.

A probabilistic eruption forecast is provided for seven historically active volcanoes along the Central American Volcanic Arc (CAVA), as a pivotal empirical contribution to multi-disciplinary volcanic hazards assessment. The eruption probabilities are determined with a Kaplan–Meier estimator of survival functions, and parametric time series models are applied to describe the historical eruption records. Aside from the volcanoes that are currently in a state of eruptive activity (Santa Maria, Fuego, and Arenal), the highest probabilities for eruptions of VEI ≥ 2 occur at Concepcion and Cerro Negro in Nicaragua, which are likely to erupt to 70–85 % within the next 10 years. Poas and Irazu in Costa Rica show a medium to high eruption probability, followed by San Miguel (El Salvador), Rincon de la Vieja (Costa Rica), and Izalco (El Salvador; 24 % within the next 10 years).

Purpose: Several works have recently focused on flattening-filter-free (FFF) beams of linear accelerators of various companies (in particular, Varian and Elekta), but no overview as yet exists for the flattening-filter free 7XU beam (Siemens Artiste). Methods: Dosimetric properties of the 7XU beam were measured in May and September 2011. We present depth dose curves and beam profiles, output factors, and MLC transmission and assess the stability of the measurements. The 7XU beam was commissioned in the Pinnacle³ treatment planning system (TPS), and modeling results including the spectrum are presented. Results: The percent depth dose curve of the 7XU beam is similar to the flat 6X beam line, with a slightly smaller surfacedose. The beam profiles show the characteristic shape of flattening-filter free beams, with deviations between measurements of generally less than 1%. The output factors of the 7XU beam decrease more slowly than for the 6X beam. The MLC transmission is comparable but slightly less for the 7XU beam. The 7XU beam can be adequately modeled by the Pinnacle³ TPS, with successful dosimetric verification. The spectrum of the 7XU beam has lower photon fluence up to approximately 2.5 MeV and higher fluence beyond, with a slightly higher mean energy. Conclusions: The 7XU beam has been commissioned for clinical use after successful modeling, stability checks, and dosimetric verification.

The maximum slip area of the 1960 Mw 9.5 Valdivia (Chile) earthquake has been investigated down to 100 km depth by a receiver function survey along two trench-perpendicular profiles at 39.3° and 39.5°S. The data are compared with seismicity and local earthquake tomography. We find a slab of ca. 35° dip at depths similar to what is observed to the north and south of the study area. The slab and the overlying mantle wedge show a local decrease in seismic velocities possibly caused by hydration or underplating of sediments. The presence of hydrated or sedimentary rocks would reduce plate coupling in this region in agreement with recent GPS measurements. The Moho is found at depths of 30 to 40 km deepening from the coast to the Andes. The Moho topography is close to isostatic equilibrium. Under the volcanic centre of Villarrica, Quetrupillan and Lanin the Moho conversion occurs about 10 km shallower than expected for a standard isostatic model. This can be explained by a density reduction in the lower crust due to magmatic processes or by non-compensated stress.

The 27 February, 2010 Maule earthquake (Mw=8.8) ruptured ~400 km of the Nazca-South America plate boundary and caused hundreds of fatalities and billions of dollars in material losses. Here we present constraints on the fore-arc structure and subduction zone of the rupture area derived from seismic refraction and wide-angle data. The results show a wedge shaped body ~40 km wide with typical sedimentary velocities interpreted as a frontal accretionary prism (FAP). Landward of the imaged FAP, the velocity model shows an abrupt velocity-contrast, suggesting a lithological change which is interpreted as the contact between the FAP and the paleo accretionary prism (backstop). The backstop location is coincident with the seaward limit of the aftershocks, defining the updip limit of the co-seismic rupture and seismogenic zone. Furthermore, the seaward limit of the aftershocks coincides with the location of the shelf break in the entire earthquake rupture area (33°S–38.5°S), which is interpreted as the location of the backstop along the margin. Published seismic profiles at the northern and southern limit of the rupture area also show the presence of a strong horizontal velocity gradient seismic backstop at a distance of ~30 km from the deformation front. The seismic wide-angle reflections from the top of the subducting oceanic crust constrain the location of the plate boundary offshore, dipping at ~10°. The projection of the epicenter of the Maule earthquake onto our derived interplate boundary yielded a hypocenter around 20 km depth, this implies that this earthquake nucleated somewhere in the middle of the seismogenic zone, neither at its updip nor at its downdip limit.

Standard stochastic failure-analysis techniques are applied to the geological eruption records of Villarrica and Lanin volcanoes in the Chilean Southern Volcanic Zone. These statistical methods are used to estimate the probabilities of eruptions large enough to leave a trace in the geological record. For Villarrica, the standard lifetime distributions predict a near 100% probability that such an eruption should have occurred between 489 AD and today. If the VEI=3 eruptions observed in the historical record are large enough to be preserved in the geological record, the probability of such a future eruption of Villarrica is about 20% in the next 100 years. In the case of Lanin, the applicability of the exponential, Weibull and log-logistic distributions to the geological record is doubtful, since the volcano appears to have experienced alternating high- and lowactivity regimes. Only the mixture-of-exponentials distribution can take into account the possible dormancy descending to final extinction, resulting in a probability of about 16% that Lanin will ever erupt again in the future. The contrasting behaviour of the eruption records of these two neighbouring volcanoes in terms of the number of eruptions and the length of the repose-time intervals serves to examine to what extent the method can be applied to geological eruption records. This study contributes to directing statistical eruption analysis towards time scales long enough to investigate large-magnitude eruptions, and it includes the possibility of dormancy/extinction.

A probabilistic eruption forecast is provided for ten volcanoes of the Chilean Southern Volcanic Zone (SVZ). Since 70% of the Chilean population lives in this area, the estimation of future eruption likelihood is an important part of hazard assessment. After investigating the completeness and stationarity of the historical eruption time series, the exponential, Weibull, and log-logistic distribution functions are fit to the repose time distributions for the individual volcanoes and the models are evaluated. This procedure has been implemented in two different ways to methodologically compare details in the fitting process. With regard to the probability of at least one VEI ≥ 2 eruption in the next decade, Llaima, Villarrica and Nevados de Chillán are most likely to erupt, while Osorno shows the lowest eruption probability among the volcanoes analysed. In addition to giving a compilation of the statistical eruption forecasts along the historically most active volcanoes of the SVZ, this paper aims to give "typical" eruption probabilities, which may in the future permit to distinguish possibly enhanced activity in the aftermath of the large 2010 Concepción earthquake.

Probabilistic forecasting of volcanic eruptions is a central issue of applied volcanology with regard to mitigating consequences of volcanic hazards. Recent years have seen great advances in the techniques of statistical analysis of volcanic eruption time series, which constitutes an essential component of a multi-discipline volcanic hazard assessment. Here, two of the currently most active volcanoes of South America, Villarrica and Llaima, are subjected to an established statistical procedure, with the aim to provide predictions for the likelihood of future eruptions within a given time interval. In the eruptive history of both Villarrica and Llaima Volcanoes, time independence of eruptions provides consistency with Poissonian behaviour. A moving-average test, helping to assess whether the distribution of repose times between eruptions changes in response to the time interval considered, validates stationarity for at least the younger eruption record. For the earlier time period, stationarity is not entirely confirmed, which may artificially result from incompleteness of the eruption record, but can also reveal fluctuations in the eruptive regime. To take both possibilities into account, several different distribution functions are fit to the eruption time series, and the fits are evaluated for their quality and compared. The exponential, Weibull and log–logistic distributions are shown to fit the repose times sufficiently well. The probability of future eruptions within defined time periods is therefore estimated from all three distribution functions, as well as from a mixture of exponential distribution (MOED) for the different eruption regimes and from a Bayesian approach. Both the MOED and Bayesian estimates intrinsically predict lower eruption probabilities than the exponential distribution function, while the Weibull distributions have increasing hazard rates, hence giving the highest eruption probability forecasts. This study provides one of the first approaches to subject historical time series of small eruptions (including those of Volcanic Explosivity Index = 2) of very active volcanoes to this type of statistical analysis. Since both Villarrica and Llaima are situated in a region of high population density, the eruption probabilities determined in this study present a valuable contribution to regional hazard assessment.

The aim of this study was to make dynamic rotation treatment with mARC available for the non-dedicated Philips Pinnacle treatment planning system by converting SmartArc plans, offering insight into the relationship between SmartArc, mARC, and stationary field irradiation. A scripting solution is presented that can be run in the Pinnacle system. This allows for the conversion of SmartArc plans into mARC format. The dose distribution of the converted mARC plan can be evaluated both in the form of a “real” mARC plan with arclets and—as is generally done in treatment planning systems certified for mARC planning—by approximating the arclets as stationary fields. We present the proof of principle and dosimetric comparisons. The converted plans were irradiated without problems. For the measured 3D dose distributions, on average over 90 % points agreed with the calculated dose distributions (mARC and stationary field plans) within the gamma criteria of 3 % deviation in the local dose, 3-mm distance to agreement, for all dose values above 10 % of the maximum. The agreement between the three calculated dose distributions (SmartArc with both converted plans) was above 87 % (above 92 % when comparing mARC with stationary fields). Our solution offers the possibility of mARC planning in Pinnacle. The dose comparisons furthermore prove that the dosimetric differences between SmartArc and mARC, when appropriately translated, are minor.