Journal of Biomedical Physics & Engineering
Volume:11 Issue: 2, Mar-Apr 2021

The use of imaging is indispensable in modern radiation therapy, both for simulation and treatment delivery. For safe and sure utilization, dose delivery from imaging must be evaluated.

This study aims to investigate the dose to organ at risk (OAR) delivered by imaging during lung stereotactic body radiation therapy (SBRT) and to evaluate its contribution to the treatment total dose.

In this retrospectively study, imaging total dose to organs at risk (OARs) (spinal cord, esophagus, lungs, and heart) and effective dose were retrospectively evaluated from 100 consecutive patients of a single institution who had lung SBRT. For each patient, dose was estimated using Monte-Carlo convolution for helical computed tomography (helical CT), Four-Dimensional CT (4D-CT), and kilovoltage Cone-Beam CT (kV-CBCT). Helical CT and kV-CBCT dose were evaluated for the entire thorax acquisition, while 4D-CT dose was analyzed on upper lobe (UL) or lower lobe (LL) acquisition. Treatment dose was extracted from treatment planning system and compared to imaging total dose.

Imaging total dose maximum values were 117 mGy to the spinal cord, 127 mGy to the esophagus, 176 mGy to the lungs and 193 mGy to the heart. The maximum effective dose was 19.65 mSv for helical CT, 10.62 mSv for kV-CBCT, 25.95 mSv and 38.45 mSv for 4D-CT in UL and LL regions, respectively. Depending on OAR, treatment total dose was higher from 1.7 to 8.2 times than imaging total dose. Imaging total dose contributed only to 0.3% of treatment total dose.

Imaging dose delivered with 4D-CT to the OARs is higher than those of others modalities. The heart received the highest imaging dose for both UL and LL. Total imaging dose is negligible since it contributed only to 0.3% of treatment total dose.

Dose distribution can be obtained from total energy released per unit mass (TERMA) and inhomogeneous energy deposition kernel (EDK) convolution. Since inhomogeneous EDK data is location-dependent, it is calculated by employing the density scaling method rather than Monte Carlo based user code EDKnrc.

The present study aimed at investigating EDK scaling formula accuracy in the presence of lung and bone inhomogeneities.

In this theoretical-practical study, six EDKs datasets with lung and bone inhomogeneity in different radii were generated using EDKnrc user code and density scaling formula. Then the scaling method data and corresponding EDKnrc-generated ones were compared to enhance the calculations, and some correction factors for error reduction were also derived to create more consistency between these data.

The study has shown that the errors in the theoretical method for calculating inhomogeneous EDKs were significantly reduced based on the attenuation coefficient and ραrel parameter, with α equal to 1.2 and 0.8 for bone and lung voxels, respectively.

Although the density scaling method has acceptable accuracy, the error values are significant at the location of lung or bone voxels. By using the mentioned correction factors, the calculation inaccuracy of heterogeneous EDKs can be reduced down to 5%. However, the lung heterogeneity results corrected by the method are not as good as the bone cases.

The use of small fields has increased by the emergence of advanced radiotherapy. Dose calculations of these fields are complex and challenging for many reasons such as lack of electrical equilibrium even in homogeneous environments, and this complexity will increase in presence of heterogeneity. According to the importance of delivery the accurate prescription dose to the target volume in the patient’s body, the dose calculation accuracy of used commercial algorithms in clinical treatment planning systems (TPS) should be evaluated.

The present study aims to evaluate the accuracy of Collapsed-Cone dose measurement algorithm in Isogray treatment planning system.

In this analytical study, the measurements were made in tissue equivalent solid water phantom with lung and bone heterogeneities by Pinpoint dosimeter (0.015 cm3 sensitive volume) in several radiation fields (1×1 to 5×5 cm2). The phantoms were irradiated with 6, 10 and 18 MV photon beams and finally, the results of experimental calculations were compared with treatment planning outputs.

In all setups, the maximum deviation occurred in the field of 1×1 cm2. Then, the maximum deviation was observed for 2×2 cm2 field size; however, it was up to 5% for homogeneous water phantom and lung heterogeneity. In 3×3 cm2 and larger fields, there was a good agreement between the results of the TPS and experimental dosimetry. The maximum deviation was observed in water-bone heterogeneity.

This algorithm was able to pass the standard audit criteria, but it is better to be used more cautiously in bone heterogeneity, especially in low energies.

Periodic quality control (QC) procedures are important in order to guarantee the image quality of radiological equipment and are also conducted using phantoms simulating human body. To perform (QC) measurements in intraoral imaging devices, a new and simple phantom was manufactured. Besides, to simplify QC procedures, computerized LabView-based software has been devised, enabling determination of image quantitative parameters in real time or during post processing. In this experimental study, the novel developed phantom consists of a Polymethyl methacrylate (PMMA) circular insert. It is able to perform a complete QC image program of X-ray intraoral equipment and also causes the evaluation of image uniformity, high and low contrast spatial resolution, image linearity and artefacts, with only two exposures. Three raters analyzed the images using the LabView dedicated software and determined the quantitative and qualitative parameters in an innovative and accurate way. Statistical analysis evaluated the reliability of this study. Good accuracy of the quantitative and qualitative measurements for the different intraoral systems was obtained and no statistical differences were found using the inter-rater analysis. The achieved results and the related statistical analysis showed the validity of this methodology, which could be proposed as an alternative to the commonly adopted procedures, and suggested that the novel phantom, coupled with the LabView based software, could be considered as an effective tool to carry out a QC image program in a reproducible manner.

It is necessary to have an automated noise measurement system working accurately to optimize dose in computerized tomography (CT) examinations. This study aims to develop an algorithm to automate noise measurement that can be implemented in CT images of all body regions. In this retrospective study, our automated noise measurement method consists of three steps as follows: the first is segmenting the image of the patient. The second is developing a standard deviation (SD) map by calculating the SD value for each pixel with a sliding window operation. The third step is estimating the noise as the smallest SD from the SD map. The proposed method was applied to the images of a homogenous phantom and a full body adult anthropomorphic phantom, and retrospectively applied to 27 abdominal images of patients. For a homogeneous phantom, the noises calculated using our proposed and previous algorithms have a linear correlation with R2 = 0.997. It is found that the noise magnitude closely follows the magnitude of the water equivalent diameter (Dw) in all body regions. The proposed algorithm is able to distinguish the noise magnitude due to variations in tube currents and different noise suppression techniques such as strong, standard, mild, and weak ones in a reconstructed image using the AIDR 3D algorithm. An automated noise calculation has been proposed and successfully implemented in all body regions. It is not only accurate and easy to implement but also not influenced by the subjectivity of user.

Repetitive transcranial magnetic stimulation (rTMS) is a novel technique that may improve recovery in patients with stoke, but the role of rTMS as an applied and practical treatment modality for stroke rehabilitation has not been established yet. This study was conducted to determine the effects of a rehabilitation program (RP) in conjunction with rTMS on functional indices of the paretic upper limb in the subacute phase of stroke. In this experimental study, twenty patients in the subacute phase of stroke were randomly assigned into two groups: The high frequency rTMS (HF-rTMS) in conjunction with RP (experimental group), and the RP group (control group). The experimental group received 10 sessions of 20 Hz rTMS on the affected primary motor cortex and the other group received 10 sessions of RP. In experimental group, RP for the paretic hand was conducted following rTMS session. Box and block test (BBT), Fugl-Meyer Motor Assessment for upper limb (FMA-UL), grip strength and pinch strength were used to assess motor function before the first session and after the last session of treatment. Significant improvement in BBT, FMA-UL, grip strength and pinch strength was observed in both groups. Improvement of BBT and grip strength was significantly greater in the experimental group rather than the control group (p <0.05). FMA-UL score and the pinch strength were greater in the experimental group, although the differences were not statistically significant. HF-rTMS in conjunction with RP is effective to improve the function of upper limb. It seems HF-rTMS is a novel feasible and safe technique for hemiparesis patients in the subacute phase of stroke.

Status epilepticus is one of the most common emergency neurological conditions with high morbidity and mortality. The study aims is to propose an intelligent approach to determine prognosis and the most common causes and outcomes based on clinical symptoms. A perceptron artificial neural network was used to predict the outcome of patients with status epilepticus on discharge. But this method, which is understandable, is known as black boxes. Therefore, some rules were extracted from it in this study. The case study of this paper is data of Nemazee hospital’s patients. The proposed model was prognosticated with 70% accuracy, while Bayesian network and Random Forest approaches have 51% and 46% accuracy. According to the results, recovery and mortality groups had often used phenytoin and anesthetic drugs as seizure controlling drug, respectively. Moreover, drug withdrawal and cerebral infarction were known as the most common etiology for recovery and mortality groups, respectively and there was a relationship between age and outcome, like as previous studies. To identify some factors affecting the outcome such as withdrawal, their effects either can be avoided or can use sensitive treatment for patients with poor prognosis.

Fetal heart rate (FHR) extracted from abdominal electrocardiogram (ECG) is a powerful non-invasive method in appropriately assessing the fetus well-being during pregnancy. Despite significant advances in the field of electrocardiography, the analysis of fetal ECG (FECG) signal is considered a challenging issue which is mainly due to low signal to noise ratio (SNR) of FECG.

In this study, we present an approach for accurately locating the fetal QRS complexes in non-invasive FECG.

In this experimental study, the proposed method included 4 steps. In step 1, comb notching filter was employed to pre-process the abdominal ECG (AECG). Furthermore, low frequency noises were omitted using wavelet decomposition. In next step, principal component analysis (PCA) and signal quality assessment (SQA) were used to obtain an optimal AECG reference channel for maternal R-peaks detection. In step 3, maternal ECG (MECG) was removed from mixture signal and FECG was extracted. In final step, the extracted FECG was first decomposed by discrete wavelet transforms at level 10. Then, by employing details of levels 2, 3, 4, the new FECG signal was reconstructed in which various noises and artifacts were removed and FECG components whose frequency were close to the fetal QRS complexes remained which increased the performance of the method.

For evaluation, 15 recordings of PhysioNet Noninvasive FECG database were used and the average F1 measure of 98.77% was obtained.

The results indicate that use of both an efficient analysis of major component of AECG along with a signal quality assessment technique has a promising performance in FECG analysis.

Brain source imaging based on electroencephalogram (EEG) data aims to recover the neuron populations’ activity producing the scalp potentials. This procedure is known as the EEG inverse problem. Recently, beamformers have gained a lot of consideration in the EEG inverse problem.

Beamformers lack acceptable performance in the case of correlated brain sources. These sources happen when some regions of the brain have simultaneous or correlated activities such as auditory stimulation or moving left and right extremities of the body at the same time. In this paper, we have developed a multichannel beamformer robust to correlated sources.

In this simulation study, we have looked at the problem of brain source imaging and beamforming from a blind source separation point of view. We focused on the spatially constraint independent component analysis (scICA) algorithm, which generally benefits from the pre-known partial information of mixing matrix, and modified the steps of the algorithm in a way that makes it more robust to correlated sources. We called the modified scICA algorithm Multichannel ICA based EEG Beamformer (MIEB).

We evaluated the proposed algorithm on simulated EEG data and compared its performance quantitatively with three algorithms: scICA, linearly-constrained minimum-variance (LCMV) and Dual-Core beamformers; it is considered that the latter is specially designed to reconstruct correlated sources.

The MIEB algorithm has much better performance in terms of normalized mean squared error in recovering the correlated/uncorrelated sources both in noise free and noisy synthetic EEG signals. Therefore, it could be used as a robust beamformer in recovering correlated brain sources.

Alzheimer’s disease (AD) is a common form of dementia, characterized by production and deposition of β-amyloid peptide in the brain. Thus, β-amyloid peptide is a potentially promising biomarker used to diagnose and monitor the progression of AD. The study aims to develop a biosensor based on a molecularly imprinted poly-pyrrole for detection of β-amyloid. In this experimental study, an imprinted poly-pyrrole was employed as an artificial receptor synthesized by electro-polymerization of pyrrole on screen-printed carbon electrodes in the presence of β-amyloid. β-amyloid acts as a molecular template within the polymer. The biosensor was evaluated by cyclic voltammetry using ferro/ferricyanide marker. The parameters influencing the biosensor performance, including electro-polymerization cycle umbers and β-amyloid binding time were optimized to achieve the best biosensor sensitivity. The β-amyloid binding affinity with the biosensor surface was evaluated by the Freundlich isotherm, and Freundlich constant and exponent were obtained as 0.22 ng mL-1 and 10.60, respectively. The biosensor demonstrated a detection limit of 1.2 pg mL-1. The biosensor was applied for β-amyloid determination in artificial cerebrospinal fluid. The biosensor is applicable for early Alzheimer’s disease detection.

Ionizing radiation plays a significant role in cancer treatment. Despite recent advances in radiotherapy approaches, the existence of irradiation-resistant cancer cells is still a noteworthy challenge. Therefore, developing novel therapeutic approaches are still warranted in order to increase the sensitivity of tumor cells to radiation. Many types of research rely on the role of mitochondria in radiation protection.

Here, we aimed to target the mitochondria of monocyticleukemia (THP-1) radio-resistant cell line cells by a mitochondrial disrupting peptide, D (KLAKLAK)2, and investigate the synergistic effect of Gamma-irradiation and KLA for tumor cells inhibition in vitro.

In this experimental study, KLA was delivered into THP-1 cells using a Cell-Penetrating Peptide (CPP).The cells were then exposed to gamma-ray radiation both in the presence and absence of KLA conjugated with CPP. The impacts of KLA, ionizing radiation or combination of both were then evaluated on the cell proliferation and apoptosis of THP-1 cells using MTT assay and flow cytometry, respectively.

The MTT assay indicated the anti-proliferative effects of combined D (KLAKLAK)2 peptide with ionizing radiation on THP-1cells. Moreover, synergetic effects of KLA and ionizing radiation reduced cell viability and consequently enhanced cell apoptosis.

Using KLA peptide in combination with ionizing irradiation increases the anticancer effects of radio-resistant THP-1 cells. Therefore, the combinational therapy of (KLAKLAK)2 and radiation is a promising strategy for cancer treatment the in future.

One of the most important challenges in treatment of patients with cancerous tumors of chest and abdominal areas is organ movement. The delivery of treatment radiation doses to tumor tissue is a challenging matter while protecting healthy and radio sensitive tissues. Since the movement of organs due to respiration causes a discrepancy in the middle of planned and delivered dose distributions. The moderation in the fatalistic effect of intra-fractional target travel on the radiation therapy correctness is necessary for cutting-edge methods of motion remote monitoring and cancerous growth irradiancy. Tracking respiratory milling and implementation of breath-hold techniques by respiratory gating systems have been used for compensation of respiratory motion negative effects. Therefore, these systems help us to deliver precise treatments and also protect healthy and critical organs. It seems aspiration should be kept under observation all over treatment period employing tracking seed markers (e.g. fiducials), skin surface scanners (e.g. camera and laser monitoring systems) and aspiration detectors (e.g. spirometers). However, these systems are not readily available for most radiotherapy centers around the word. It is believed that providing and expanding the required equipment, gated radiotherapy will be a routine technique for treatment of chest and abdominal tumors in all clinical radiotherapy centers in the world by considering benefits of respiratory gating techniques in increasing efficiency of patient treatment in the near future.This review explains the different technologies and systems as well as some strategies available for motion management in radiotherapy centers.

An acceptable reliability is needed for each scale and a valid decision-making process. Ultrasonography is a simple, cost-effective, and accessible tool compared to magnetic resonance imaging (MRI) to assess echo intensity (EI) as a biomarker of muscle function in neck musculoskeletal problems. However, no evidence is available regarding the reliability of neck muscle echogenicity according to rehabilitative ultrasonography in clinical studies on forward head posture (FHP). We determined the reliability of neck muscles EI in individuals with and without FHP. Transverse images of deep neck flexors (Longus Coli) and suboccipital (Rectus capitis posterior minor) muscles were acquired from 20 individuals with FHP and 20 controls in one session. The intraclass correlation coefficient (ICC), minimum detectable change (MDC), and standard error of measurement (SEM) for EI were measured in this study. The ICC, SEM, and MDC ranges were 0.50 - 0.51, 2.73 - 3.41, and 7.56 - 9.46 for the Longus colli muscle and 0.48 - 0.49, 3.29 - 4.98, and 9.13 - 13.81 for the rectus capitis posterior minor (RCPm) muscle, respectively. Based on the present findings, EI showed acceptable reliability; therefore, it can be used for assessment of neck muscle morphology.