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There has not been an assessment of the Holman Research Pathway (HRP) in radiation oncology (RO) in nearly 10 years. In this study, we sought to review the demographic characteristics, research productivity during and after residency, job placements, and National Institutes of Health (NIH) grant funding of RO residents who completed the HRP in the modern era.
To provide a comprehensive analysis of radiation oncology (RO) fellowship growth from 2010 to 2020.
Most new nasopharyngeal cancer cases occur in low-income and middle-income countries, and these patients experience poorer overall survival than that of new nasopharyngeal cancer cases in high-income countries. The goal of this research project is to determine whether the introduction of a radiation therapy quality assurance program can ultimately improve outcomes for nasopharyngeal cancer patients in lower-income and middle-income countries. This study reports the results of the first phase of the International Atomic Energy Agency Coordinated Research Project (325-E3-TM-47712).
Climate change mitigation scenarios are being utilized by an ever-wider user base, including companies and financial institutions. Increased collaboration between scenario producers and these new communities will be mutually beneficial, educating companies and investors on climate risks while helping to ground climate science in practical real-world needs.
The rapid growth of rooftop solar photovoltaic systems can pose a number of financial challenges for electric utility shareholders and their customers. One potential pathway to resolving these perceived challenges involves allowing utilities to own and operate rooftop solar systems. However, the financial benefits and costs of this business model are not well understood. Here we model the financial performance of a large-scale utility-owned residential rooftop solar programme. Furthermore, over a 20 yr period, the programme increases shareholder earnings by 2–5% relative to a no-solar scenario, compared to a 2% earnings loss when an equivalent amount of rooftop solar is instead owned by non-utility parties. Such a programme could therefore be attractive from the perspective of utility investors. The impacts on utility customers, however, are more mixed, with average bills of non-solar customers increasing by 1–3% compared to the no-solar scenario, similar to the 2% increase under traditional, non-utility-ownership structures.
This chapter focuses on considerations made when modeling cost of energy to be used in any of the abovementioned applications. The level of fidelity required to model each of the four, primary cost of energy elements depends on the characteristics of the wind power plant under consideration. Some 'top-down' models utilize empirical data to reflect currently installed wind power plants, while physics -based, or 'bottom up,' models may be implemented to estimate aspects of future wind-power-plant technology. Regardless of the ultimate application of cost of energy modeling, it is important to carefully assess the wind-power-plant characteristics to determine the type of model and the level of fidelity required to represent each of the four cost of energy elements.
This paper investigates the adoption and use of electronic invoices (e-invoices) in Greek organizations. The study attempts to evaluate current practices applied in implementing e-invoicing. A field research has been conducted, which is based on a structured questionnaire. The target sample consisted of 42 Greek enterprises. The main issues of the investigation include the existing invoice processing practices, the barriers that prevent the extended adoption and use of e-invoicing, the observed benefits from e-invoicing implementation, and the strategic drivers for transition to e-invoicing. Currently, the use of e-invoicing in Greece is low. However, the research results testify that the adoption of e-invoicing in Greece is promising. Even though, a number of enterprises state that benefits of e-invoicing are not clear yet, the majority of enterprises agree that there are crucial financial priorities that e-invoicing is expected to support.
This paper attempts to investigate the drivers and barriers that large-scale Greek manufacturing industries experience in adopting electronic invoices (e-invoices), based on three case studies with organizations having international presence in many countries. The study focuses on the drivers that may affect the increase of the adoption and use of e-invoicing, including the customers demand for e-invoices, and sufficient know-how and adoption of e-invoicing in organizations. In addition, the study reveals important barriers that prevent the expansion of e-invoicing, such as suppliers’ reluctance to implement e-invoicing, and IT infrastructures incompatibilities. Other issues examined by this study include the observed benefits from e-invoicing implementation, and the financial priorities of the organizations assumed to be supported by e-invoicing.
Purpose: Synchronized moving grid (SMOG) is a promising technique to reduce scatter and ghost artifacts in cone beam computed tomography (CBCT). However, the grid blocks part of image information in each projection, and multiple projections at the same gantry angle have to been taken to obtain full information. Because of the continuity of a patient's anatomy in the projection, the blocked information may be estimated by interpolation. This study aims to evaluate an inpainting-based interpolation approach to recover the missing information for CBCT reconstruction. Method: We used a simple region-based inpainting approach to interpolate the missing information. For a pixel to be interpolated, we divided the nearby regions having image information into 6 sub-regions: up-left, up-middle, up-right, down-left, down-middle, and down-right, each with 9 pixels. The average pixel value of each sub-region was calculated. These average values, along with the pixel location, were used to determine the interpolated pixel value. We compared our approach with the Criminisi Exemplar (CE) and total variation (TV) based inpainting techniques. Projection images of Catphan and a head phantom were used for the comparison. The SMOG was simulated by erasing the information (filling with “0”) of the areas in each projection corresponding to the grid. Results: For the Catphan, the processing time was 178, 45 and 0.98 minutes for CE, TV and our approach, respectively. The signal to noise ratio (SNR) was 19.4, 18.5 and 26.4 db, correspondingly. For the head phantom, the processing time was 222, 45 and 0.93 minutes for CE, TV and our approach, respectively. The SNR was 24.6, 20.2 and 26.2db correspondingly. Conclusion: We have developed a simple inpainting based interpolation approach, which can recover some of the image information for the SMOG-based CBCT imaging. This study is supported by NIH/NCI grant 1R01CA166948-01.
Purpose: To determine the relative task-specific performance of two x-ray imaging detectors including the effect of other components of the imaging chain. Methods: The relative object detectability (ROD) was defined as the ratio of the integral of the detective-quantum efficiency (DQE) of a detector weighted by the square of the Fourier Transform (or frequency spectrum) of the object to the same integral for a second detector. The generalized ROD (G-ROD) is calculated by replacing DQE by the generalized DQE (GDQE) which includes geometric unsharpness and scatter to evaluate the total imaging chain. The G-ROD was calculated for the micro-angiographic fluoroscope (MAF) relative to a flat-panel detector (FPD) for low (1.05) and high (1.2) magnifications with two focal-spot sizes, small (0.3 mm) and medium (0.5 mm), and for the same value of scatter fraction. Solid spheres from 50 to 600 microns were simulated as the objects for this evaluation. The G-ROD results were compared with those of the ROD which considers the detectors alone. Results: For 50-micron spheres, the ROD is 7.93 and, for the small [medium] focus, the G-ROD is 6.74 [5.22] at low magnification and 3.03 [1.66] at high magnification, indicating superior performance of the MAF particularly at low magnification. Both ROD and G-ROD decrease monotonically with size and remain around one above 400-microns. The G-ROD decreases more dramatically with low compared to high magnification for both focal spots. Conclusion: In all cases, the MAF performs better than the FPD and the decreasing trend of the G-ROD indicates that the performance of both detectors becomes similar as the object size increases and becomes nearly equal above 400-micron diameter sphere size. Finally, increased magnification and focal-spot size decrease the G-ROD, indicting that they degrade the performance of the MAF more than that of the FPD for a small-object viewing task. Supported by NIH Grant: 2R01EB002873 and an equipment grant from Toshiba Medical Systems Corporation.
Purpose: Although generalized linear system analytic metrics such as GMTF and GDQE can evaluate performance of the whole imaging system including detector, scatter and focal-spot, a simplified task-specific measured metric may help to better compare detector systems. Methods: Low quantum-noise images of a neuro-vascular stent with a modified ANSI head phantom were obtained from the average of many exposures taken with the high-resolution Micro-Angiographic Fluoroscope (MAF) and with a Flat Panel Detector (FPD). The square of the Fourier Transform of each averaged image, equivalent to the measured product of the system GMTF and the object function in spatial-frequency space, was then divided by the normalized noise power spectra (NNPS) for each respective system to obtain a task-specific generalized signal-to-noise ratio. A generalized measured relative object detectability (GM-ROD) was obtained by taking the ratio of the integral of the resulting expressions for each detector system to give an overall metric that enables a realistic systems comparison for the given detection task. Results: The GM-ROD provides comparison of relative performance of detector systems from actual measurements of the object function as imaged by those detector systems. This metric includes noise correlations and spatial frequencies relevant to the specific object. Additionally, the integration bounds for the GM-ROD can be selected to emphasis the higher frequency band of each detector if high-resolution image details are to be evaluated. Examples of this new metric are discussed with a comparison of the MAF to the FPD for neuro-vascular interventional imaging. Conclusion: The GM-ROD is a new direct-measured task-specific metric that can provide clinically relevant comparison of the relative performance of imaging systems. Supported by NIH Grant: 2R01EB002873 and an equipment grant from Toshiba Medical Systems Corporation.
Purpose: Despite the importance of accurately estimating the respiration regularity of a patient in motion compensation treatment, an effective and simply applicable method has rarely been reported. The authors propose a simple respiration regularity index based on parameters derived from a correspondingly simplified respiration model. Methods: In order to simplify a patient's breathing pattern while preserving the data's intrinsic properties, we defined a respiration model as a power of cosine form with a baseline drift. According to this respiration formula, breathing-pattern fluctuation could be explained using four factors: sample standard deviation of respiration period, sample standard deviation of amplitude and the results of simple regression of the baseline drift (slope and standard deviation of residuals of a respiration signal. Overall irregularity (δ) was defined as a Euclidean norm of newly derived variable using principal component analysis (PCA) for the four fluctuation parameters. Finally, the proposed respiration regularity index was defined as ρ=ln(1+(1/ δ))/2, a higher ρ indicating a more regular breathing pattern. Subsequently, we applied it to simulated and clinical respiration signals from real-time position management (RPM; Varian Medical Systems, Palo Alto, CA) and investigated respiration regularity. Moreover, correlations between the regularity of the first session and the remaining fractions were investigated using Pearson's correlation coefficient. Results: The respiration regularity was determined based on ρ; patients with ρ<0.3 showed worse regularity than the others, whereas ρ>0.7 was suitable for respiratory-gated radiation therapy (RGRT). Fluctuations in breathing cycle and amplitude were especially determinative of ρ. If the respiration regularity of a patient's first session was known, it could be estimated through subsequent sessions. Conclusions: Respiration regularity could be objectively determined using a respiration regularity index, ρ. Such single-index testing of respiration regularity can facilitate determination of RGRT availability in clinical settings, especially for free-breathing cases. This work was supported by a Korea Science and Engineering Foundation (KOSEF) grant funded by the Korean Ministry of Science, ICT and Future Planning (No. 2013043498)
Purpose: Evaluate commonly used segmentation algorithms on a commercially available real-time MR image guided radiotherapy (MR-IGRT) system (ViewRay), compare the strengths and weaknesses of each method, with the purpose of improving motion tracking for more accurate radiotherapy. Methods: MR motion images of bladder, kidney, duodenum, and liver tumor were acquired for three patients using a commercial on-board MR imaging system and an imaging protocol used during MR-IGRT. A series of 40 frames were selected for each case to cover at least 3 respiratory cycles. Thresholding, Canny edge detection, fuzzy k-means (FKM), k-harmonic means (KHM), and reaction-diffusion level set evolution (RD-LSE), along with the ViewRay treatment planning and delivery system (TPDS) were included in the comparisons. To evaluate the segmentation results, an expert manual contouring of the organs or tumor from a physician was used as a ground-truth. Metrics value of sensitivity, specificity, Jaccard similarity, and Dice coefficient were computed for comparison. Results: In the segmentation of single image frame, all methods successfully segmented the bladder and kidney, but only FKM, KHM and TPDS were able to segment the liver tumor and the duodenum. For segmenting motion image series, the TPDS method had the highest sensitivity, Jarccard, and Dice coefficients in segmenting bladder and kidney, while FKM and KHM had a slightly higher specificity. A similar pattern was observed when segmenting the liver tumor and the duodenum. The Canny method is not suitable for consistently segmenting motion frames in an automated process, while thresholding and RD-LSE cannot consistently segment a liver tumor and the duodenum. Conclusion: The study compared six different segmentation methods and showed the effectiveness of the ViewRay TPDS algorithm in segmenting motion images during MR-IGRT. Future studies include a selection of conformal segmentation methods based on image/organ-specific information, different filtering methods and their influences on the segmentation results. Parag Parikh receives research grant from ViewRay. Sasa Mutic has consulting and research agreements with ViewRay. Yanle Hu receives travel reimbursement from ViewRay. Iwan Kawrakow and James Dempsey are ViewRay employees.
Purpose: To evaluate the image quality and imaging dose of the Varian TrueBeam OBIv.1.5 CBCT system in a clinical adaptive radiation therapy environment, simulated by changing phantom thickness. Methods: Various OBI CBCT protocols(Head, Pelvis, Thorax, Spotlight) were used to acquire images of Catphan504 phantom(nominal phantom thickness and 10 cm additional phantom thickness). The images were analyzed for low contrast detectability(CNR), uniformity(UI), and HU sensitivity. These results were compared to the same image sets for planning CT(pCT)(GE LightSpeed 16- slice). Imaging dose measurements were performed with Gafchromic XRQA2 film for various OBI protocols (Pelvis, Thorax, Spotlight) in a pelvic-sized phantom(nominal thickness and 4cm additional thickness). Dose measurements were acquired in the interior and at the surface of the phantom. Results: The nominal CNR[additional thickness CNR] for OBI was—Pelvis:1.45[0.81],Thorax:0.86[0.48], Spotlight:0.67[0.39],Head:0.28 [0.10]. The nominal CNR[additional thickness CNR] for pCT was— Pelvis:0.87[0.41],Head:0.60[0.22]. The nominal UI[additional thickness UI] for OBI was—Pelvis:11.5[24.1],Thorax:17.0[20.6], Spotlight:23.2[23.2], Head:15.6[59.9]. The nominal UI[additional thickness UI] for pCT was— Pelvis:9.2[8.6],Head:2.1[2.9]. The HU difference(averaged over all material inserts) between nominal and additional thickness scans for OBI: 8.26HU(Pelvis), 33.39HU(Thorax), 178.98HU(Head), 108.20HU (Spotlight); for pCT: 16.00HU(Pelvis), 19.85HU(Head). Uncertainties in electron density were calculated based on HU values with varying phantom thickness. Average electron-density deviations (ρ(water)=1)for GE-Pelvis, GE-Head, OBI-Pelvis, OBI-Thorax, OBI-Spotlight, and OBI-Head were: 0.0182, 0.0180, 0.0058, 0.0478, 0.2750, and 0.3115, respectively.The average phantom interior dose was(OBI-nominal):2.35cGy(Pelvis), 0.60cGy(Thorax), 1.87cGy(Spotlight); OBI-increased thickness: 1.77cGy(Pelvis), 0.43cGy(Thorax), 1.53cGy (Spotlight). Average surface dose(OBI-nominal): 2.29cGy(Pelvis), 0.56cGy(Thorax), 1.79cGy (Spotlight); OBI-increased thickness: 1.94cGy(Pelvis), 0.48cGy(Thorax), 1.47cGy (Spotlight). Conclusion: The OBI-Pelvis protocol offered comparable CNR and HU constancy to pCT for each geometry; other protocols, particularly Spotlight and Head, exhibited lower HU constancy and CNR. The uniformity of pCT was superior to OBI for all protocols. CNR and UI were degraded for both systems/scan types with increased thickness. The OBI interior dose decreased by approximately 30% with additional thickness. This work was funded, in part, under a grant with the Pennsylvania Department of Health. The Department of Health specifically declaims responsibility for any analyses, interpretations, or conclusions.
Purpose: To investigate a Hybrid VMAT/IMRT technique which combines volumetric modulated arc therapy (VMAT) and intensity modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC). Methods: 2 full arcs VMAT, 9-field IMRT and Hybrid VMAT/IMRT plans were created for 10 patients with NPC. The Hybrid VMAT/IMRT technique consisted of 1 full VMAT arc and 7 IMRT fields. The dose distribution of planning target volume (PTV) and organs at risk (OARs) for Hybrid VMAT/IMRT was compared with IMRT and VMAT. The monitor units (MUs) were also evaluated. Results: The Hybrid VMAT/IMRT technique significantly improved target dose homogeneity compared with IMRT and VMAT for PTV70 and PTV54. For PTV70 and PTV60, the Hybrid VMAT/IMRT technique significantly improved target dose conformity compared with IMRT (0.62 vs 0.47; p<0.05 and 0.64 vs 0.58; p<0.05, respectively) and VMAT (0.62 vs 0.43; p<0.05 and 0.64 vs 0.6; p<0.05, respectively). The near maximum dose (D2%) of temporomandibular joint (TMJ), temporal lobe and mandible for Hybrid plans were 5.5%, 7.9% and 5.2% lower than IMRT plans (p<0.05). The mean dose of TMJ, temporal lobe, mandible and unspecified tissue for Hybrid plans were 12.8%, 11.4%, 4.2% and 4.1% lower than IMRT plans (p<0.05). The mean dose of right parotid, mandible and unspecified tissue for Hybrid plans were 3.3%, 2.4% and 3.1% lower than VMAT plans (p<0.05). The mean MUs needed for IMRT, VMAT and Hybrid plans were 2256, 507 and 1394, respectively. Conclusion: Hybrid VMAT/IMRT technique significantly improved the target dose homogeneity and conformity compared with IMRT and VMAT and reduced the dose of OARs and unspecified tissue compared with IMRT with fewer MUs. Compared with VMAT, Hybrid VMAT/IMRT technique can better protect parotid gland, mandible and unspecified tissue. Ruijie Yang was funded by the grant project: National Natural Science Foundation of China (No. 81071237). Other authors have no competing interest for this work.
Purpose: To assess dose calculated by the 3DVH software (Sun Nuclear Systems, Melbourne, FL) against TLD measurements and treatment planning system calculations in anthropomorphic phantoms. Methods: The IROC Houston (RPC) head and neck (HN) and lung phantoms were scanned and plans were generated using Eclipse (Varian Medical Systems, Milpitas, CA) following IROC Houston procedures. For the H and N phantom, 6 MV VMAT and 9-field dynamic MLC (DMLC) plans were created. For the lung phantom 6 MV VMAT and 15 MV 9-field dynamic MLC (DMLC) plans were created. The plans were delivered to the phantoms and to an ArcCHECK (Sun Nuclear Systems, Melbourne, FL). The head and neck phantom contained 8 TLDs located at PTV1 (4), PTV2 (2), and OAR Cord (2). The lung phantom contained 4 TLDs, 2 in the PTV, 1 in the cord, and 1 in the heart. Daily outputs were recorded before each measurement for correction. 3DVH dose reconstruction software was used to project the calculated dose to patient anatomy. Results: For the HN phantom, the maximum difference between 3DVH and TLDs was -3.4% and between 3DVH and Eclipse was 1.2%. For the lung plan the maximum difference between 3DVH and TLDs was 4.3%, except for the spinal cord for which 3DVH overestimated the TLD dose by 12%. The maximum difference between 3DVH and Eclipse was 0.3%. 3DVH agreed well with Eclipse because the dose reconstruction algorithm uses the diode measurements to perturb the dose calculated by the treatment planning system; therefore, if there is a problem in the modeling or heterogeneity correction, it will be carried through to 3DVH. Conclusion: 3DVH agreed well with Eclipse and TLD measurements. Comparison of 3DVH with film measurements is ongoing. Work supported by PHS grant CA10953 and CA81647 (NCI, DHHS)
Purpose: To investigate the feasibility, efficiency, and delivery accuracy of volumetric modulated arc therapy with constant dose rate (VMAT-CDR) for whole-pelvic radiotherapy (WPRT) of endometrial cancer. Methods: The nine-Field intensity-modulated radiotherapy (IMRT), VMAT with variable dose-rate (VMAT-VDR), and VMAT-CDR plans were created for 9 patients with endometrial cancer undergoing WPRT. The dose distribution of planning target volume (PTV), organs at risk (OARs), and normal tissue (NT) were compared. The monitor units (MUs) and treatment delivery time were also evaluated. For each VMAT-CDR plan, a dry Run was performed to assess the dosimetric accuracy with MatriXX from IBA. Results: Compared with IMRT, the VMAT-CDR plans delivered a slightly greater V20 of the bowel, bladder, pelvis bone, and NT, but significantly decreased the dose to the high-dose region of the rectum and pelvis bone. The MUs Decreased from 1105 with IMRT to 628 with VMAT-CDR. The delivery time also decreased from 9.5 to 3.2 minutes. The average gamma pass rate was 95.6% at the 3%/3 mm criteria with MatriXX pretreatment verification for 9 patients. Conclusion: VMAT-CDR can achieve comparable plan quality with significant shorter delivery time and smaller number of MUs compared with IMRT for patients with endometrial cancer undergoing WPRT. It can be accurately delivered and be an alternative to IMRT on the linear accelerator without VDR capability. This work is supported by the grant project, National Natural; Science Foundation of China (No. 81071237)