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Recently, progress in technology for accelerator-based neutron sources has increased attention regarding boron neutron capture therapy (BNCT). BNCT is a type of radiotherapy that combines neutrons and boron drugs and is expected to be used in the treatment of refractory and recurrent cancers. Owing to the need for high-intensity neutrons in treatment, compact accelerator-based neutron sources applicable to BNCT are being developed worldwide. These current projects utilize cyclotrons, linear accelerators, and electrostatic accelerators as accelerators for BNCT devices. Beryllium and lithium are the main target materials for neutron generation. The accelerators for BNCT device are required to accelerate charged particles with an average current ranging from a few milliamperes to a few tens of milliamperes in order to generate neutrons of sufficient intensity for the treatment. Moreover, the target systems require technologies and mechanisms that can withstand the large heat load produced by high-power beam irradiation and prevent blistering. This review outlines and explains the accelerator neutron sources for BNCT and the requirements for the components of each device, such as the accelerator, target material, and beam shaping assembly. In addition, various development projects for accelerator-based BNCT devices worldwide are introduced.

The A Body Shape Index (ABSI) was recently introduced to quantify abdominal adiposity relative to the body mass index (BMI) and height. This cross-sectional study was performed to explore whether the ABSI is linked to chronic kidney disease (CKD) in older adults and compare the predictive capacity of the ABSI versus BMI for CKD. In total, 7053 people aged ≥ 60 years were divided into normal, mild, and moderate-to-severe CKD groups based on their estimated glomerular filtration rate (eGFR). The correlation of the ABSI with the eGFR and the differences and trends in the ABSI and BMI among the groups were analyzed, and the cutoff points for moderate-to-severe CKD were calculated. The association between the ABSI and CKD was stronger than that between the BMI and CKD. The ABSI had a better capacity to discriminate the CKD stage than did the BMI. The capacity of the ABSI to predict moderate-to-severe CKD was higher than that of the BMI and was more substantial in women than men. The ABSI cutoff points for CKD were ≥0.0822 and 0.0795 in men and women, respectively. In conclusion, the ABSI serves as a better index than the BMI for screening and detecting high-risk individuals with CKD.

The microdosimetric kinetic model (MKM) is widely used for estimating relative biological effectiveness (RBE)-weighted doses for various radiotherapies because it can determine the surviving fraction of irradiated cells based on only the lineal energy distribution, and it is independent of the radiation type and ion species. However, the applicability of the method to proton therapy has not yet been investigated thoroughly. In this study, we validated the RBE-weighted dose calculated by the MKM in tandem with the Monte Carlo code PHITS for proton therapy by considering the complete simulation geometry of the clinical proton beam line. The physical dose, lineal energy distribution, and RBE-weighted dose for a 155 MeV mono-energetic and spread-out Bragg peak (SOBP) beam of 60 mm width were evaluated. In estimating the physical dose, the calculated depth dose distribution by irradiating the mono-energetic beam using PHITS was consistent with the data measured by a diode detector. A maximum difference of 3.1% in the depth distribution was observed for the SOBP beam. In the RBE-weighted dose validation, the calculated lineal energy distributions generally agreed well with the published measurement data. The calculated and measured RBE-weighted doses were in excellent agreement, except at the Bragg peak region of the mono-energetic beam, where the calculation overestimated the measured data by ~15%. This research has provided a computational microdosimetric approach based on a combination of PHITS and MKM for typical clinical proton beams. The developed RBE-estimator function has potential application in the treatment planning system for various radiotherapies.

This study pursued two goals: Firstly, to search for anatomical structures strongly correlating with dose deterioration, and secondly to investigate the effectiveness of image registration focusing on critical anatomy by comparing it with a conventional method. The aim was to achieve robust image registration to correct for anatomical changes during treatment. Twenty patients with head and neck cancer were enrolled, and 68 simulation computed tomography (CT) and rescan CT image sets were retrospectively analyzed. Forty volumetric-modulated arc therapy and intensity-modulated proton therapy plans were generated and recalculated according to the rescan CT to evaluate the dose effects of anatomical changes. Correlation coefficients were calculated for the relationships between the six-axis motion of the anatomy and the dose indices for the clinical target volume (CTV) and organs at risk. In the image registration, we compared a conventional method and target-based registration that limited the registration range to the CTV and vertebrae. The CTV coverage and spinal cord dose were correlated with the position error associated with the pitch and vertical position of the vertebrae, and the parotid gland and oral cavity dose were strongly correlated with the position error associated with the roll of the clivus and mandible. The target registration improved CTV coverage and suppressed the increase in dose to organs at risk compared with conventional methods. Monitoring vertebral alignment, the assessment and correction of positioning errors associated with the clivus and mandible position errors are important to ensure the quality of daily treatment. Target-based registration may allow for more robust image registration.

We assessed the effect of beam size on plan robustness for intensity-modulated proton therapy (IMPT) of head and neck cancer (HNC) and compared the plan quality including robustness with that of intensity-modulated radiation therapy (IMRT). IMPT plans were generated for six HNC patients using six beam sizes (air-sigma 3–17 mm at isocenter for a 70–230 MeV) and two optimization methods for planning target volume-based non-robust optimization (NRO) and clinical target volume (CTV)-based robust optimization (RO). Worst-case dosimetric parameters and plan robustness for CTV and organs-at-risk (OARs) were assessed under different scenarios, assuming a ± 1–5 mm setup error and a ± 3% range error. Statistical comparisons of NRO-IMPT, RO-IMPT and IMRT plans were performed. In regard to CTV-D99%, RO-IMPT with smaller beam size was more robust than RO-IMPT with larger beam sizes, whereas NRO-IMPT showed the opposite (P < 0.05). There was no significant difference in the robustness of the CTV-D99% and CTV-D95% between RO-IMPT and IMRT. The worst-case CTV coverage of IMRT (±5 mm/3%) for all patients was 96.0% ± 1.4% (D99%) and 97.9% ± 0.3% (D95%). For four out of six patients, the worst-case CTV-D95% for RO-IMPT (±1–5 mm/3%) were higher than those for IMRT. Compared with IMRT, RO-IMPT with smaller beam sizes achieved lower worst-case doses to OARs. In HNC treatment, utilizing smaller beam sizes in RO-IMPT improves plan robustness compared to larger beam sizes, achieving comparable target robustness and lower worst-case OARs doses compared to IMRT.

The dose to the left anterior descending coronary artery (LAD) is associated with mortality in patients with esophageal cancer (EC) who underwent radiotherapy. The aim of this study was to compare the dose distributions to the LAD region achieved through volumetric-modulated arc therapy (VMAT) planning using a dynamic swing arc in OXRAY (DSA-VMAT) and conventional coplanar (Conv-VMAT) planning. Ten patients with EC who had undergone radiotherapy (60 Gy in 30 fractions) at our Institution were selected for inclusion in the study. Two virtual plans (DSA-VMAT and Conv-VMAT) were created to compare the dose distributions of the LAD region, heart, lungs, and planning target volume (PTV). All plans were analyzed using paired -tests. The mean values±standard deviation for 15 Gy to the LAD region (V15) were 10.48±13.04% for DSA-VMAT and 30.28±23.56% for Conv-VMAT. Compared with Conv-VMAT, DSA-VMAT significantly improved V15 of the LAD region ( =0.01). In addition, DSA-VMAT significantly reduced the mean heart dose (8.64±5.37 11.23±7.37 Gy), heart V40 (17.55±4.76% 20.44±6.06%), lung V20 (14.87±5.93% 17.81±7.70%), and lung V5 (57.27±8.24% 61.15±9.97%) compared to Conv-VMAT (all ≤0.01). In contrast, there were no significant differences between the two groups in PTV dose coverage [D95 ( =0.61), D50 ( =0.62)], or conformity index ( =0.91). Compared with Conv-VMAT, DSA-VMAT improved the dose distribution of the LAD region without impairing the PTV dose coverage. Thus, DSA-VMAT may reduce radiation-induced heart disease in patients with EC without loss of efficacy.

Background Maintaining a good level of physical fitness from engaging in regular exercise is important for the treatment and prevention of metabolic syndrome (MetS). However, which components constitutive of physical fitness confer the greatest influence remains controversial. This retrospective cross-sectional study aimed to investigate the association between MetS and physical fitness components including cardiorespiratory fitness, muscle strength, flexibility, and agility and to identify which physical fitness components have the largest influence on MetS. Methods A total of 168 Japanese adult males aged 25–64 years were allocated into non-MetS, pre-MetS, and MetS groups according to the criteria recommended by the Japanese Society of Internal Medicine. Anthropometric measurement of body composition by whole-body dual-energy X-ray absorptiometry and measures related to MetS, including waist circumference, triglyceride level, high-density lipoprotein cholesterol level, blood pressure, glucose level, and physical fitness components, were assessed. For evaluation of cardiorespiratory fitness, muscle strength, flexibility, agility, and balance, maximal oxygen consumption (VO 2peak ) and oxygen uptake at anaerobic threshold (VO 2AnT ), handgrip strength and vertical jumping, trunk extension and flexion, stepping side to side, and single-leg balance task with the eyes closed were assessed, respectively. Results A progressive tendency of increasing body weight, body mass index, whole-body lean and fat mass, percentage of whole-body fat mass, trunk lean and fat mass, percentage of trunk fat mass, arm fat mass, waist circumference, triglyceride level, systolic and diastolic blood pressure, and blood glucose level from the non-MetS group to the MetS group was significant ( P < 0.05). Conversely, the cardiorespiratory endurance parameters VO 2peak and VO 2AnT and the high-density lipoprotein cholesterol level showed a progressively decreasing tendency across the groups ( P < 0.01). In addition, a VO 2peak below 29.84 ml·kg·min −1 ( P = 0.028) and VO2 AnT below 15.89 ml·kg·min −1 ( P = 0.011) were significant risk components for pre-MetS and MetS. However, there was no significant tendency with respect to muscle strength, agility, and flexibility. Conclusion Cardiorespiratory fitness is strongly linked to metabolic syndrome among physical fitness components

PurposeThe accuracy of the CyberKnife Synchrony Respiratory Tracking System is dependent on the breathing pattern of a patient. Therefore, the tracking error in each patient must be determined. Support vector regression (SVR) can be used to easily identify the tracking error in each patient. This study aimed to develop a system with SVR that can predict tracking error according to a patient’s respiratory waveform.MethodsDatasets of the respiratory waveforms of 93 patients were obtained. The feature variables were variation in respiration amplitude, tumor velocity, and phase shift between tumor and the chest wall, and the target variable was tracking error. A learning model was evaluated with tenfold cross-validation. We documented the difference between the predicted and actual tracking errors and assessed the correlation coefficient and coefficient of determination.ResultsThe average difference and maximum difference between the actual and predicted tracking errors were 0.57 ± 0.63 mm and 2.1 mm, respectively. The correlation coefficient and coefficient of determination were 0.86 and 0.74, respectively.ConclusionWe developed a system for obtaining tracking error by using SVR. The accuracy of such a system is clinically useful. Moreover, the system can easily evaluate tracking error.

Passive scattering proton beam therapy (PSPT) is performed by taking actual measurements of all pre-designated fields in a treatment plan followed by appropriate adjustments to the prescribed dose. For this reason, it is necessary to ensure precision management of the measurements (patient-specific calibration) in the administration of a planned dose. Therefore, this study investigated the impact on dose distribution in treatment planning when the patient calibration point differs from the normalized point in a treatment plan. A total of 16 cases were selected, where the patient calibration point and normalized point did not match, and the normalized point used in the treatment plan was changed to the patient calibration point using a treatment planning system (VQA ver. 2.01, HITACHI). At this point, the displacement of the relative dose at the isocenter was estimated as an error owing to the difference compared to the patient calibration point. Overall, the error was within the range of ±1.5%, with the exception of orbit cases. Calibrated points also tended to be lower than the normalized points in the treatment plan. In terms of treatment sites, a greater deviation was observed for head cases. Cases with a large deviation in sites other than the head were attributed to poor flatness within the radiation field owing to a narrower opening of the patient collimator. Dose measurement errors in PSPT due to differing calibration points were generally within ±1.5%, with higher deviations observed in head treatments because of complex structures and narrow collimator openings. A γ analysis for significant deviations showed a 98.7% passing rate, suggesting limited overall impact. It is important to select stable calibration points in dosimetry to ensure high precision in dose administration, particularly in complex treatment areas.

Background Volumetric modulated arc therapy (VMAT) for locally advanced rectal cancer (LARC) has emerged as a promising technique, but the planning process can be time-consuming and dependent on planner expertise. We aimed to develop a fully automated VMAT planning program for LARC and evaluate its feasibility and efficiency. Methods A total of 26 LARC patients who received VMAT treatment and the computed tomography (CT) scans were included in this study. Clinical target volumes and organs at risk were contoured by radiation oncologists. The automatic planning program, developed within the Raystation treatment planning system, used scripting capabilities and a Python environment to automate the entire planning process. The automated VMAT plan (auto-VMAT) was created by our automated planning program with the 26 CT scans used in the manual VMAT plan (manual-VMAT) and their regions of interests. Dosimetric parameters and time efficiency were compared between the auto-VMAT and the manual-VMAT created by experienced planners. All results were analyzed using the Wilcoxon signed-rank sum test. Results The auto-VMAT achieved comparable coverage of the target volume while demonstrating improved dose conformity and uniformity compared with the manual-VMAT. V30 and V40 in the small bowel were significantly lower in the auto-VMAT compared with those in the manual-VMAT (p < 0.001 and < 0.001, respectively); the mean dose of the bladder was also significantly reduced in the auto-VMAT (p < 0.001). Furthermore, auto-VMAT plans were consistently generated with less variability in quality. In terms of efficiency, the auto-VMAT markedly reduced the time required for planning and expedited plan approval, with 93% of cases approved within one day. Conclusion We developed a fully automatic feasible VMAT plan creation program for LARC. The auto-VMAT maintained target coverage while providing organs at risk dose reduction. The developed program dramatically reduced the time to approval.