The MR-Sim setup and automatic sCT generation methods using standard MR sequences generates realistic contours and electron densities for prostate cancer radiation therapy dose planning and digitally reconstructed radiograph generation.

The aggregate potential for urban mitigation of global climate change is insufficiently understood. Our analysis, using a dataset of 274 cities representing all city sizes and regions worldwide, demonstrates that economic activity, transport costs, geographic factors, and urban form explain 37% of urban direct energy use and 88% of urban transport energy use. If current trends in urban expansion continue, urban energy use will increase more than threefold, from 240 EJ in 2005 to 730 EJ in 2050. Our model shows that urban planning and transport policies can limit the future increase in urban energy use to 540 EJ in 2050 and contribute to mitigating climate change. However, effective policies for reducing urban greenhouse gas emissions differ with city type. The results show that, for affluent and mature cities, higher gasoline prices combined with compact urban form can result in savings in both residential and transport energy use. In contrast, for developing-country cities with emerging or nascent infrastructures, compact urban form, and transport planning can encourage higher population densities and subsequently avoid lock-in of high carbon emission patterns for travel. The results underscore a significant potential urbanization wedge for reducing energy use in rapidly urbanizing Asia, Africa, and the Middle East.urbanization | manufactured capital | energy use | urban climate change mitigation C ities constitute the primary agglomerations of manufactured capital. Their infrastructures modulate energy flows in economic activities, buildings, and transport. Urban built environments, including transport infrastructure, shape energy consumption patterns for decades. Urban energy use significantly contributes to climate change. The most recent Intergovernmental Panel on Climate Change (IPCC) report shows that urban areas consume between 67% and 76% of global energy and generate about three quarters of global carbon emissions (1). This share of global greenhouse gas (GHG) emissions is likely to increase as global urban populations increase by two to three billion this century (2). Additionally, to accommodate growing urbanizing populations and economies, urban areas and their built environments are projected to more than triple between 2000 and 2030 (3). This ongoing urban transformation worldwide raises three key questions about future urbanization and climate change. How can cities contribute to climate change mitigation? What urban strategies are effective for different types of cities? What is the magnitude of the total mitigation potential of future urbanization?Previous studies have identified significant factors that shape per capita urban GHG emission for individual cities (4), small sets of cities (5, 6), and for cities globally in a qualitative way (7). In these studies, factors that have been identified as correlating with urban GHG emissions include heating degree days, economic activity, population density, power generation, and technology (8). Other studies show that population density scales negativ...

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Climate change confronts the health care sector with a dual challenge. Accumulating climate impacts are putting an increased burden on the service provision of already stressed health care systems in many regions of the world. At the same time, the Paris agreement requires rapid emission reductions in all sectors of the global economy to stay well below the 2°C target. This study shows that in OECD countries, China, and India, health care on average accounts for 5% of the national CO 2 footprint making the sector comparable in importance to the food sector. Some countries have seen reduced CO 2 emissions related to health care despite growing expenditures since 2000, mirroring their economy wide emission trends. The average per capita health carbon footprint across the country sample in 2014 was 0.6 tCO 2 , varying between 1.51 tCO 2 /cap in the US and 0.06 tCO 2 /cap in India. A statistical analysis shows that the carbon intensity of the domestic energy system, the energy intensity of the domestic economy, and health care expenditure together explain half of the variance in per capita health carbon footprints. Our results indicate that important leverage points exist inside and outside the health sector. We discuss our findings in the context of the existing literature on the potentials and challenges of reducing GHG emissions in the health and energy sector.

Background Health-care services are necessary for sustaining and improving human wellbeing, yet they have an environmental footprint that contributes to environment-related threats to human health. Previous studies have quantified the carbon emissions resulting from health care at a global level. We aimed to provide a global assessment of the wide-ranging environmental impacts of this sector.Methods In this multiregional input-output analysis, we evaluated the contribution of health-care sectors in driving environmental damage that in turn puts human health at risk. Using a global supply-chain database containing detailed information on health-care sectors, we quantified the direct and indirect supply-chain environmental damage driven by the demand for health care. We focused on seven environmental stressors with known adverse feedback cycles: greenhouse gas emissions, particulate matter, air pollutants (nitrogen oxides and sulphur dioxide), malaria risk, reactive nitrogen in water, and scarce water use.Findings Health care causes global environmental impacts that, depending on which indicator is considered, range between 1% and 5% of total global impacts, and are more than 5% for some national impacts.Interpretation Enhancing health-care expenditure to mitigate negative health effects of environmental damage is often promoted by health-care practitioners. However, global supply chains that feed into the enhanced activity of health-care sectors in turn initiate adverse feedback cycles by increasing the environmental impact of health care, thus counteracting the mission of health care.

In this pilot study, the new method of implantation of an esophageal stent was found to be a safe and effective treatment for massive bleeding from esophageal varices in patients with liver cirrhosis. These initial clinical results will of course have to be confirmed in comparative studies including a large number of patients.

An novel automatic framework for gold fiducial marker detection in MRI is proposed and evaluated with detection accuracies comparable to manual detection. When radiation therapists are unable to determine the seed location in MRI, they refer back to the planning CT (only available in the existing clinical framework); similarly, an automatic quality control is built into the automatic software to ensure that all gold seeds are either correctly detected or a warning is raised for further manual intervention.

To clinically implement MRI simulation or MRI-alone treatment planning requires comprehensive end-to-end testing to ensure an accurate process. The purpose of this study was to design and build a geometric phantom simulating a human male pelvis that is suitable for both CT and MRI scanning and use it to test geometric and dosimetric aspects of MRI simulation including treatment planning and digitally reconstructed radiograph (DRR) generation.A liquid filled pelvic shaped phantom with simulated pelvic organs was scanned in a 3T MRI simulator with dedicated radiotherapy couch-top, laser bridge and pelvic coil mounts. A second phantom with the same external shape but with an internal distortion grid was used to quantify the distortion of the MR image. Both phantoms were also CT scanned as the gold-standard for both geometry and dosimetry. Deformable image registration was used to quantify the MR distortion. Dose comparison was made using a seven-field IMRT plan developed on the CT scan with the fluences copied to the MR image and recalculated using bulk electron densities. Without correction the maximum distortion of the MR compared with the CT scan was 7.5 mm across the pelvis, while this was reduced to 2.6 and 1.7 mm by the vendor's 2D and 3D correction algorithms, respectively. Within the locations of the internal organs of interest, the distortion was <1.5 and <1 mm with 2D and 3D correction algorithms, respectively. The dose at the prostate isocentre calculated on CT and MRI images differed by 0.01% (1.1 cGy). Positioning shifts were within 1 mm when setup was performed using MRI generated DRRs compared to setup using CT DRRs.The MRI pelvic phantom allows end-to-end testing of the MRI simulation workflow with comparison to the gold-standard CT based process. MRI simulation was found to be geometrically accurate with organ dimensions, dose distributions and DRR based setup within acceptable limits compared to CT.