Objective: This study was conducted to assess the serum 25-hydroxy (OH) vitamin D levels in patients with breast cancer compared to healthy controls and to identify its association with aggressive breast cancer phenotypes. Materials and methods: Serum 25-OH vitamin D levels of 78 breast cancer patients and 78 matched healthy controls were estimated using ELISA. The cases and controls were matched with respect to age, menopausal status, parity, weight, height and co-morbidities. Prognostic factors like grade of tumour, hormone receptor status, HER2 neu status and lymphovascular invasion were compared with 25-OH vitamin D levels. Results: The mean serum 25-OH vitamin D levels of cases were significantly lower compared to the controls (22.33 ± 8.19 vs. 37.41 ± 12.9 ng/mL; p = 0.0001). Patients with higher grades of tumour, non-luminal types of breast cancer and breast cancers with estrogen receptor negativity had significantly lower serum 25-OH vitamin D levels than their opposing groups. Patients with excellent and good Nottingham's prognostic Index (NPI) had significantly higher serum 25-OH vitamin D levels than the moderate and poor NPI groups. Conclusion: Newly diagnosed breast cancer patients have significantly lower serum 25-OH vitamin D levels than healthy controls. Lower level of serum 25-OH vitamin D correlates with aggressive breast cancer phenotypes. Arch
time, adaptive, image guided treatment. A thorough understanding of normal anatomy as seen on the MRL is required for radiotherapy to the heart, such as in treating arrhythmias, thoracic tumors, and breast tumors. To assist radiation oncologists and physicists in further developing and perfecting MRL based radiotherapy techniques, a cardiac MRL based atlas designed for radiation oncologists is necessary. This atlas could also be used for image registration to enhance future adaptive radiotherapy techniques and as a basis for developing novel protocols for treating these diseases. We sought to comprehensively characterize cardiac structures on 1.5 T MR cardiac images. Materials/Methods: 5 subjects were enrolled in a prospective protocol (NCT03500081) and were imaged on the 1.5 T MRL. Images acquired included breath held Half Fourier-Acquired Single-Shot Turbo Spin-Echo (HASTE) in axial, sagittal, coronal, short axis, and vertical long axis and free-breathing 3D radial stack of stars balanced steady-state free precession (3D bSSFP). These images were then uploaded in commercially available software where cardiac anatomy was contoured, labeled, and confirmed by a licensed cardiologist (JR). Contours of basic cardiac anatomy, the electrical conduction system, cardiac imaging principles, and explanations of the cardiac planes were also created to better prepare clinicians for treating arrhythmias with radiation. Results: A total of 5 subjects had images acquired with the HASTE sequence, and 1 patient with 4D vane in the cardiac planes. A total of 20 contours were created on each image set for each patient. Contours generated (with respective median volume in cubic centimeters in parentheses) included Left ventricle (LV wall + LV interior) (271.95), Left atrium (84.52), Right ventricle (117.06), Right atrium (80.38), Interventricular septum (39.09), Atrial septum (5.77), Atrioventricular septum (11.13), Tricuspid valve (0.16), Inferior vena cava (13.72), Superior vena cava (14.76), Aorta (126.93), Pulmonary trunk (36.4), Left pulmonary artery (15.76), Right pulmonary artery (24.13), Trachea (4.11), Esophagus (25.78), Right main bronchus (2.38), Left main bronchus (2.22), Tricuspid valve (0.16), and Mitral valve (0.21). Conclusion:We present a comprehensive cardiac atlas using novel images acquired prospectively on a 1.5 T MRL. This cardiac atlas will provide an excellent resource for radiation oncologists in delineating cardiac structures for radiotherapy planning and delivery, with a special focus on providing background information and relevant anatomy essential for treating nearby tumors and refractory arrhythmias using 1.5 T MR guidance.
an ion-acoustic signal strong enough to reach the body surface overcoming all the interferences and attenuation. To translate proton FLASH-RT to the clinic, precise dosimetry and dose administration are critically important. One wants to verify that the high dose of radiation is delivered to the right location. Ion-acoustic imaging is an attractive modality for Bragg peak range verification for proton FLASH-RT. However, standard ultrasound transducers, which typically operate in the 3.5-7.5 MHz range, are not tuned to capture the ion-acoustic signal from proton FLASH-RT, which could range from 10-100 kHz. Novel ultrasound transducers with lower resonance frequencies are needed to make ion-acoustic imaging for proton FLASH-RT a reality. In this study, we hypothesize that simulating ionacoustic signals imaging with parameters derived from an actual proton FLASH-RT experiment can determine the target frequency response of a potential ion-acoustic transducer. Materials/Methods: We simulated the propagation of an ion-acoustic mechanical wave through an anatomical phantom using the k-wave toolbox. The proton FLASH synchrocyclotron, whose parameters we were simulating, can deliver a dose of 22,000 cGy in 750 pulses of »10 us in duration. Therefore, we simulated one pulse using a gaussian whose FWHM was 10 us and whose integral summed to 29.333 cGy. The size of the beamlet was about 1cm in diameter. The dose was converted to pressure using the following equation: dp = GrD, where D is the dose delivered, G is the dimensionless Gr€ uneisen parameter, and r is target density. For the simulation, D = 29.333 cGy, G = 0.1, and r = 1000. The anatomical phantom was a slice of an abdominal CT scan whose Hounsfield units were converted to density and speed of sound using a hounsfield2density function. The dose was delivered to the center of the phantom. Ultrasonic sensors were placed along the surface of the phantom. Results: The average frequency response of all the sensors was obtained for the simulation. The resonance frequency of the average frequency response was 38.8 kHz. Conclusion:In this study, we demonstrate that the k-wave toolbox can be used to simulate the propagation of the ion-acoustic mechanical wave generated from proton FLASH-RT. This simulation can be used to guide the development of novel ultrasonic transducers. The results of this simulation indicate that ultrasonic transducers with lower resonance frequencies are needed.
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