Diese Arbeit wurde vom NIH NINDS gewähren R01 NS074388 581 (CL Limoli), California Institute for Regenerative Medicine (CIRM) Grant RS1-00413 (CLL) und ein CIRM Zuschuss zur Unterstützung der Video-Dokumentation JOVE. Wir möchten auch Rudy Limburg und Edward Lau von der University of California, Irvine Biological Sciences Machine Shop für ihre Beratung, Unterstützung und hervorragende technische Fähigkeiten danken in Vorbereitung aller maßgeschneiderte Materialien für Verhaltens-Tests verwendet.

<ol>
	<li>Abayomi, O. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pathogenesis+of+irradiation-induced+cognitive+dysfunction.">Pathogenesis of irradiation-induced cognitive dysfunction.</a> Acta. Oncol. 35, 659-663 (1996).</li><li>Anderson, V. A., Godber, T., Smibert, E., Weiskop, S., Ekert, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cognitive+and+academic+outcome+following+cranial+irradiation+and+chemotherapy+in+children:+a+longitudinal+study.">Cognitive and academic outcome following cranial irradiation and chemotherapy in children: a longitudinal study.</a> Br. J. Cancer. 82, 255-262 (2000).</li><li>Acharya, M. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Rescue+of+radiation-induced+cognitive+impairment+through+cranial+transplantation+of+human+embryonic+stem+cells.">Rescue of radiation-induced cognitive impairment through cranial transplantation of human embryonic stem cells.</a> Proc. Natl. Acad. Sci. U. S. A. 106, 19150-19155 (2009).</li><li>Mumby, D. G., Gaskin, S., Glenn, M. J., Schramek, T. E., Lehmann, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hippocampal+damage+and+exploratory+preferences+in+rats:+memory+for+objects,+places,+and+contexts.">Hippocampal damage and exploratory preferences in rats: memory for objects, places, and contexts.</a> Learn. Mem. 9, 49-57 (2002).</li><li>Walf, A. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+use+of+the+elevated+plus+maze+as+an+assay+of+anxiety-related+behavior+in+rodents.">The use of the elevated plus maze as an assay of anxiety-related behavior in rodents.</a> Nat. Protoc. 2, 322-328 (2007).</li><li>Macleod, J. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cancer+chemotherapy+impairs+contextual+but+not+cue-specific+fear+memory.">Cancer chemotherapy impairs contextual but not cue-specific fear memory.</a> Behav Brain Res. 181, 168-172 (2007).</li><li>Schafe, G. E., Nadel, N. V., Sullivan, G. M., Harris, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Memory+consolidation+for+contextual+and+auditory+fear+conditioning+is+dependent+on+protein+synthesis,+PKA,+and+MAP+kinase.">Memory consolidation for contextual and auditory fear conditioning is dependent on protein synthesis, PKA, and MAP kinase.</a> Learn. Mem. 6, 97-110 (1999).</li><li>Winocur, G., Wojtowicz, J. M., Sekeres, M., Snyder, J. S., Wang, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Inhibition+of+neurogenesis+interferes+with+hippocampus-dependent+memory+function.">Inhibition of neurogenesis interferes with hippocampus-dependent memory function.</a> Hippocampus. 16, 296-304 (2006).</li><li>Phillips, R. G., LeDoux, J. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Differential+contribution+of+amygdala+and+hippocampus+to+cued+and+contextual+fear+conditioning.">Differential contribution of amygdala and hippocampus to cued and contextual fear conditioning.</a> Behav. Neurosci. 106, 274-285 (1992).</li><li>D'Hooge, R., De Deyn, P. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Applications+of+the+Morris+water+maze+in+the+study+of+learning+and+memory.">Applications of the Morris water maze in the study of learning and memory.</a> Brain. Res. Brain. Res. Rev. 36, 60-90 (2001).</li><li>Morris, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Developments+of+a+water-maze+procedure+for+studying+spatial+learning+in+the+rat.">Developments of a water-maze procedure for studying spatial learning in the rat.</a> J. Neurosci. Methods. 11, 47-60 (1984).</li><li>Meyers, C. A., Brown, P. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Role+and+relevance+of+neurocognitive+assessment+in+clinical+trials+of+patients+with+CNS+tumors.">Role and relevance of neurocognitive assessment in clinical trials of patients with CNS tumors.</a> J. Clin. Oncol. 24, 1305-1309 (2006).</li><li>de Ruiter, M. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cerebral+hyporesponsiveness+and+cognitive+impairment+10+years+after+chemotherapy+for+breast+cancer.">Cerebral hyporesponsiveness and cognitive impairment 10 years after chemotherapy for breast cancer.</a> Hum. Brain. Mapp. , (2010).</li><li>Hess, D. C., Borlongan, C. V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cell-based+therapy+in+ischemic+stroke.">Cell-based therapy in ischemic stroke.</a> Expert. Rev. Neurother. 8, 1193-1201 (2008).</li></ol>

Keine Interessenskonflikte erklärt.

Es gibt einen dringenden Bedarf an langfristigen Strategien entwickelt, um die Entwicklung der kognitiven Dysfunktion, dass immer häufiger wird in der Krebs-Überlebenden 12,13 zuvorzukommen. Stammzell-Therapien können die Mittel für die Linderung einer Reihe von normalem Gewebe Folgeerscheinungen im ZNS geben, wie sie die Gelegenheit zum Austausch Zellen verloren gehen oder von zytotoxischen Krebsmedikamenten 14 beschädigt sind. Zur Beschleunigung der Umsetzung dieser Bemühungen haben wir eine Reihe von Beweis der wichtigsten Experimente, die die Fähigkeit von kranial eingepflanzt hNSCs funktionell wiederherzustellen Erkenntnis innerhalb des bestrahlten Gewebes Bett des ZNS 3 bestätigt haben zugesagt. Entscheidend für dieses Unterfangen war in der Lage, zuverlässig führen eine Reihe von sorgfältig kontrollierten kognitiven Tests reproduzierbar. Wir haben diese kritischen Verfahren bei den Bemühungen um die translationale Potenzial der Stammzellen-Therapien in der Klinik zu beschleunigen detailliert. Weitere Überlegungen, diewahrscheinlich einen bedeutenden Einfluss auf die Qualität der Daten haben, sind im Folgenden erläutert. Kognitive Tests erfordert viel Liebe zum Detail und die Einhaltung bestimmter Standards können helfen, zu minimieren Artefakte, die die Interpretation der Ergebnisse erschwert. Der Einsatz von dedizierten Verhaltenstests Zimmer getrennt von Tierhaltung Zimmer und Experimentatoren ist vorzuziehen. Es ist auch ratsam, &quot;weißes Rauschen&quot;, dass Außengeräusche Blöcke in der Tierhaltung, die Tiere von der Aufgabe zur Hand kann ablenken zu verwenden. Zur Minimierung der Belastung der Tiere für die kognitive Tests bestimmt, ist es wichtig für sie werden, um mit den Experimentatoren, die Verhaltens-Tests durchführen wird vor Aufgabenverwaltung. Im Allgemeinen, wenn der Test Frauen und Männer, empfiehlt es sich, Weibchen ersten Test, wie sie sein ängstlicher während der Prüfung, ob männliche Geruch Cues in der Erprobung Arenen bleiben neigen. Bei der Verabreichung einer seriellen Batterie von Aufgaben, ist es wichtig, Tiere zu lea aussetzenst stressigen Aufgaben zuerst (wie EPM, NPR) und am stärksten belastenden Aufgaben letzten (wie FC, MWM).

quantifying cognitive decrements caused by cranial radiotherapy

Mit Ausnahme des Überlebens, ist die kognitive Beeinträchtigung, die aus der klinischen Behandlung von Krebs ein wichtiger Faktor diktieren therapeutische Ergebnis. Für viele Patienten mit ZNS-und Nicht-ZNS-Tumoren leiden, bieten Strahlen-und Chemotherapie die besten Optionen für die Seuchenbekämpfung. Diese Behandlungen jedoch seinen Preis, und fast alle Krebs Überlebenden (~ 11 Millionen allein in den USA ab 2006) entstehen ein gewisses Risiko für die Entwicklung kognitiver Dysfunktion, mit den schwersten Fällen bei Patienten unterzogen kranialen Strahlentherapie (~ 200.000 / Jahr gefunden ) für die Steuerung von primären und metastatischen Hirntumoren 1. Besonders problematisch sind pädiatrischen Fällen, deren langfristiges Überleben geplagt mit deutlichen kognitiven dekrementiert führt zu erheblichen sozioökonomischen Belastungen 2. Bis heute gibt es noch keine befriedigenden Lösungen für dieses großes klinisches Problem. Wir haben diese schwere gesundheitliche Bedenken mit transplantierten Stammzellen ce angesprochenlls zu strahleninduzierten kognitiven Fähigkeiten in athymischen Ratten ausgesetzt Bestrahlung des Kopfes 3 zu bekämpfen. Details der stereotaktischen Bestrahlung und der In-vitro-Kultivierung und Verpflanzung von menschlichen neuronalen Stammzellen (hNSCs) finden Sie in unserem Begleiter Papier (Acharya et al. JoVE Referenz) gefunden werden. Nach der Bestrahlung und Transplantation Chirurgie, sind Ratten dann für Veränderungen in Kognition, veredelt das Überleben der Zelle und die Expression von Differenzierungs-spezifischer Marker 1 und 4-Monate nach der Bestrahlung untersucht. Kritisch zu bewerten den Erfolg oder Misserfolg eines möglichen Intervention zur strahleninduzierten kognitiven Folgen, einer Reihe von strengen quantitativen kognitive Aufgaben durchgeführt werden müssen lindern. Um dies zu erreichen, unterziehen wir unsere Tiere auf eine Reihe von kognitiven Tests Paradigmen einschließlich neuartiger Platz Anerkennung, water maze, Elevated Plus Maze und Angstkonditionierung, um Hippocampus und Nicht-Hippocampus-Lernen und Gedächtnis zu quantifizieren. Wir haben den Nutzen nachgewiesendiese Tests für die Quantifizierung von bestimmten Arten von kognitiven dekrementiert in bestrahlten Tiere, und benutzte sie, um zu zeigen, dass Tiere mit hNSCs eingepflanzt signifikante Verbesserungen der kognitiven Funktion 3 aufweisen. Die kognitiven Vorteile aus eingepflanzt menschlichen Stammzellen lassen vermuten, dass ähnliche Strategien können eines Tages dringend benötigte klinische Rückgriff auf Krebs Überlebenden leiden an eingeschränkter Wahrnehmung. Dementsprechend haben wir schriftliche und bildliche Dokumentation der kritischen Schritte in unserem kognitiven Tests Paradigmen verwendet, um die Übersetzung unserer vielversprechenden Ergebnisse in die Klinik zu erleichtern.

Watch this Scientific Journal Video about Quantifying Cognitive Decrements Caused by Cranial Radiotherapy at JoVE.com

Quantifying Cognitive Decrements Caused by Cranial Radiotherapy

Cognitive Impairment, die aus der strahlentherapeutischen Management von Hirntumoren stellt eine klinisch hartnäckigen Bedingung, dass schädliche Auswirkung auf die Lebensqualität. Die Fähigkeit, kritisch zu bewerten potenzieller Interventionen zur Besserung Strahlung induzierten kognitiven verringert, hängt letztlich von der Fähigkeit, rigorose quantitative Einschätzungen der Erkenntnis zu unternehmen.

Quantifizierung Kognitive Dekrementiert von Cranial Strahlentherapie verursachten Schäden

With the exception of survival, cognitive impairment stemming from the clinical management of cancer is a major factor dictating therapeutic outcome. For ...

quantifying-cognitive-decrements-caused-by-cranial-radiotherapy

Research

JoVE Journal

Medicine

12.5K Aufrufe.  University of California Irvine. Cognitive Impairment, die aus der strahlentherapeutischen Management von Hirntumoren stellt eine klinisch hartnäckigen Bedingung, dass schädliche Auswirkung auf die Lebensqualität. Die Fähigkeit, kritisch zu bewerten potenzieller Interventionen zur Besserung Strahlung induzierten kognitiven verringert, hängt letztlich von der Fähigkeit, rigorose quantitative Einschätzungen der Erkenntnis zu unternehmen.

Serie: Quantifying Cognitive Decrements Caused by Cranial Radiotherapy

Stem Cell Transplantation Strategies for the Restoration of Cognitive Dysfunction Caused by Cranial Radiotherapy

Radiotherapy often provides the only clinical recourse for those afflicted with primary or metastatic brain tumors. While beneficial, cranial irradiation can induce a progressive and debilitating decline in cognition that may, in part, be caused by the depletion of neural stem cells. Given the increased survival of patients diagnosed with brain cancer, quality of life in terms of cognitive health has become an increasing concern, especially in the absence of any satisfactory long-term treatments.
To address this serious health concern we have used stem cell replacement as a strategy to combat radiation-induced cognitive decline. Our model utilizes athymic nude rats subjected to cranial irradiation. The ionizing radiation is delivered as either whole brain or as a highly focused beam to the hippocampus via linear accelerator (LINAC) based stereotaxic radiosurgery. Two days following irradiation, human neural stem cells (hNSCs) were stereotaxically transplanted into the hippocampus. Rats were then assessed for changes in cognition, grafted cell survival and for the expression of differentiation-specific markers 1 and 4-months after irradiation. Our cognitive testing paradigms have demonstrated that animals engrafted with hNSCs exhibit significant improvements in cognitive function. Unbiased stereology reveals significant survival (10-40%) of the engrafted cells at 1 and 4-months after transplantation, dependent on the amount and type of cells grafted. Engrafted cells migrate extensively, differentiate along glial and neuronal lineages, and express a range of immature and mature phenotypic markers.
Our data demonstrate direct cognitive benefits derived from engrafted human stem cells, suggesting that this procedure may one day afford a promising strategy for the long-term functional restoration of cognition in individuals subjected to cranial radiotherapy. To promote the dissemination of the critical procedures necessary to replicate and extend our studies, we have provided written and visual documentation of several key steps in our experimental plan, with an emphasis on stereotaxic radiosurgey and transplantation.

Brain tumor patients routinely undergo cranial radiotherapy, and while beneficial, this treatment often results in debilitating cognitive dysfunction. This serious unresolved problem has at present, no clinical recourse, and has driven our efforts to devise stem cell based therapies for the recovery of radiation-induced cognitive decrements.

Stem Cell Transplantation Strategien für die Wiederherstellung der kognitiven Dysfunktion von Cranial Strahlentherapie verursachten Schäden

Radiotherapy often provides the only clinical recourse for those afflicted with primary or metastatic brain tumors. While beneficial, cranial irradiation ...

Forschung

Medizin

Combination Radiotherapy in an Orthotopic Mouse Brain Tumor Model

Glioblastoma multiforme (GBM) are the most common and aggressive adult primary brain tumors1. In recent years there has been substantial progress in the understanding of the mechanics of tumor invasion, and direct intracerebral inoculation of tumor provides the opportunity of observing the invasive process in a physiologically appropriate environment2. As far as human brain tumors are concerned, the orthotopic models currently available are established either by stereotaxic injection of cell suspensions or implantation of a solid piece of tumor through a complicated craniotomy procedure3. In our technique we harvest cells from tissue culture to create a cell suspension used to implant directly into the brain. The duration of the surgery is approximately 30 minutes, and as the mouse needs to be in a constant surgical plane, an injectable anesthetic is used. The mouse is placed in a stereotaxic jig made by Stoetling (figure 1). After the surgical area is cleaned and prepared, an incision is made; and the bregma is located to determine the location of the craniotomy. The location of the craniotomy is 2 mm to the right and 1 mm rostral to the bregma. The depth is 3 mm from the surface of the skull, and cells are injected at a rate of 2 &mu;l every 2 minutes. The skin is sutured with 5-0 PDS, and the mouse is allowed to wake up on a heating pad. From our experience, depending on the cell line, treatment can take place from 7-10 days after surgery. Drug delivery is dependent on the drug composition. For radiation treatment the mice are anesthetized, and put into a custom made jig. Lead covers the mouse's body and exposes only the brain of the mouse. The study of tumorigenesis and the evaluation of new therapies for GBM require accurate and reproducible brain tumor animal models. Thus we use this orthotopic brain model to study the interaction of the microenvironment of the brain and the tumor, to test the effectiveness of different therapeutic agents with and without radiation.

The purpose of this article is to describe the use of an orthotopic glioblastoma model for chemoradiation studies. This article will go though cell processing, implanting, and radiotherapy of the mouse using an intracranial model.

Kombination Strahlentherapie in einem orthotopen Maus Brain Tumor-Modell

Glioblastoma multiforme (GBM) are the most common and aggressive adult primary brain tumors1. In recent years there has been substantial progress in the ...

Voluntary Breath-hold Technique for Reducing Heart Dose in Left Breast Radiotherapy

Breath-holding techniques reduce the amount of radiation received by cardiac structures during tangential-field left breast radiotherapy. With these techniques, patients hold their breath while radiotherapy is delivered, pushing the heart down and away from the radiotherapy field. Despite clear dosimetric benefits, these techniques are not yet in widespread use. One reason for this is that commercially available solutions require specialist equipment, necessitating not only significant capital investment, but often also incurring ongoing costs such as a need for daily disposable mouthpieces. The voluntary breath-hold technique described here does not require any additional specialist equipment. All breath-holding techniques require a surrogate to monitor breath-hold consistency and whether breath-hold is maintained. Voluntary breath-hold uses the distance moved by the anterior and lateral reference marks (tattoos) away from the treatment room lasers in breath-hold to monitor consistency at CT-planning and treatment setup. Light fields are then used to monitor breath-hold consistency prior to and during radiotherapy delivery.

The current priority in breast cancer radiotherapy is to reduce cardiac doses without compromising target tissue coverage. The voluntary breath-hold technique described here is a simple, inexpensive solution to this problem and capable of being instituted widely without the need for specialized equipment.

Freiwillige Atemanhaltetechnik zur Verringerung der Herz-Dose in der linken Brust Strahlentherapie

Breath-holding techniques reduce the amount of radiation received by cardiac structures during tangential-field left breast radiotherapy. With these ...

State of the Art Cranial Ultrasound Imaging in Neonates

Cranial ultrasound (CUS) is a reputable tool for brain imaging in critically ill neonates. It is safe, relatively cheap and easy to use, even when a patient is unstable. In addition it is radiation-free and allows serial imaging. CUS possibilities have steadily expanded. However, in many neonatal intensive care units, these possibilities are not optimally used. We present a comprehensive approach for neonatal CUS, focusing on optimal settings, different probes, multiple acoustic windows and Doppler techniques. This approach is suited for both routine clinical practice and research purposes. In a live demonstration, we show how this technique is performed in the neonatal intensive care unit. Using optimal settings and probes allows for better imaging quality and improves the diagnostic value of CUS in experienced hands. Traditionally, images are obtained through the anterior fontanel. Use of supplemental acoustic windows (lambdoid, mastoid, and lateral fontanels) improves detection of brain injury. Adding Doppler studies allows screening of patency of large intracranial arteries and veins. Flow velocities and indices can be obtained. Doppler CUS offers the possibility of detecting cerebral sinovenous thrombosis at an early stage, creating a window for therapeutic intervention prior to thrombosis-induced tissue damage. Equipment, data storage and safety aspects are also addressed.

Cranial ultrasound (CUS) is a valuable tool for brain imaging in critically ill neonates. This video shows a comprehensive approach for neonatal (Doppler) CUS for both clinical and research purposes, including a bedside demonstration of the technique.

State of the Art Hirn Ultraschall-Bildgebung bei Neugeborenen

Cranial ultrasound (CUS) is a reputable tool for brain imaging in critically ill neonates. It is safe, relatively cheap and easy to use, even when a ...

Treatment of Liver Metastases Using an Internal Target Volume Method for Stereotactic Body Radiotherapy

The prognosis of patients with metastatic cancers has improved in the past decades due to effective chemotherapy and oligometastatic surgery. For inoperable patients, local ablation therapies, such as stereotactic body radiotherapy (SBRT), can provide effective local tumor control with minimal toxicity. Because of its high precision and accuracy, SBRT delivers a higher radiation dose per fraction, is more effective, and targets smaller irradiation volumes than does conventional radiotherapy. In addition, steep dose gradients from target lesions to surrounding normal tissues are achieved using SBRT; thus, SBRT provides more effective tumor control and exhibits fewer side effects than conventional radiotherapy. The use of SBRT is prevalent for treating intracranial lesions (known as stereotactic radiosurgery); however, it is now also used for treating spinal and adrenal metastases. Because of advancements in image-guided assistance and respiratory motion management, several studies have investigated the use of SBRT for treating lung or liver tumors, which move as a patient breathes. The results of these studies have suggested that SBRT favorably controls tumors in the case of moving lesions.
Four-dimensional computed tomography (4D-CT) with an abdominal compressor (AC) is clinically convenient for effective respiratory motion management. Because this method is noninvasive and allows free breathing, its use reduces complications. Furthermore, patients consider this method convenient. Moreover, it is considered more efficient than other methods of respiratory motion management by physicians and therapists. The use of 4D-CT with an AC for treating pulmonary lesions has also been widely investigated, and the technique is gaining acceptance for treating hepatic lesions. However, the protocols for using 4D-CT with an AC for treating hepatic lesions are different from those used for treating pulmonary lesions. In this article, we describe a new protocol for SBRT with 4D-CT and an AC for treating liver metastases.

Stereotactic body radiotherapy (SBRT) requires rigorous accuracy and precision for delivering high radiation doses per fraction to small treatment volumes to improve tumor control and simultaneously reduce toxicity. Herein, we present a noninvasive and clinically convenient respiratory motion management protocol for SBRT for liver metastases.

Behandlung von Lebermetastasen mit ein internes Ziel-Volumen-Methode für Stereotaktische Körper Strahlentherapie

The prognosis of patients with metastatic cancers has improved in the past decades due to effective chemotherapy and oligometastatic surgery. For ...

Radiation Planning Assistant - A Streamlined, Fully Automated Radiotherapy Treatment Planning System

The Radiation Planning Assistant (RPA) is a system developed for the fully automated creation of radiotherapy treatment plans, including volume-modulated arc therapy (VMAT) plans for patients with head/neck cancer and 4-field box plans for patients with cervical cancer. It is a combination of specially developed in-house software that uses an application programming interface to communicate with a commercial radiotherapy treatment planning system. It also interfaces with a commercial secondary dose verification software. The necessary inputs to the system are a Treatment Plan Order, approved by the radiation oncologist, and a simulation computed tomography (CT) image, approved by the radiographer. The RPA then generates a complete radiotherapy treatment plan. For the cervical cancer treatment plans, no additional user intervention is necessary until the plan is complete. For head/neck treatment plans, after the normal tissue and some of the target structures are automatically delineated on the CT image, the radiation oncologist must review the contours, making edits if necessary. They also delineate the gross tumor volume. The RPA then completes the treatment planning process, creating a VMAT plan. Finally, the completed plan must be reviewed by qualified clinical staff.

Radiation therapy is a highly complex cancer treatment that requires multiple specialists to create a treatment plan and provide quality assurance (QA) prior to delivery to a patient. This protocol describes the use of a fully automated system, the Radiation Planning Assistant (RPA), to create high-quality radiation treatment plans.

Voll automatisierter Strahlung Assistant - eine optimierte Planung Strahlentherapie Planungssystem

The Radiation Planning Assistant (RPA) is a system developed for the fully automated creation of radiotherapy treatment plans, including volume-modulated ...

Digital Handwriting Analysis of Characters in Chinese Patients with Mild Cognitive Impairment

An increasing amount of evidence shows that cognitive deficits and movement dysfunctions are not separated. Patients with mild cognitive impairment (MCI) can manifest fine motor disorders of the upper extremities. Handwriting is a complex and unique human activity involving both motor and cognitive coordination. Researchers from western countries have discovered that patients with MCI have abnormal handwriting features. However, no relevant studies have been conducted in the Chinese population. Owing to the cross-culture phenomenon of handwriting, the aim of this study is to find new handwriting tasks to demonstrate the differences in handwriting features between elderly patients with MCI and age-matched healthy individuals.

This study proposed a digital handwriting analysis of characters in individuals with mild cognitive impairment to find more information than is revealed by traditional pencil&#8211;paper handwriting analysis.

Digitale Handschriftanalyse von Charakteren bei chinesischen Patienten mit leichter kognitiver Beeinträchtigung

An increasing amount of evidence shows that cognitive deficits and movement dysfunctions are not separated. Patients with mild cognitive impairment (MCI) ...

Verbesserung der Strahlentherapie mit webbasiertem Strahlenplanungsassistenten

Radiation Planning Assistant - A Web-based Tool to Support High-quality Radiotherapy in Clinics with Limited Resources

Access to radiotherapy worldwide is limited. The Radiation Planning Assistant (RPA) is a fully automated, web-based tool that is being developed to offer fully automated radiotherapy treatment planning tools to clinics with limited resources. The goal is to help clinical teams scale their efforts, thus reaching more patients with cancer. The user connects to the RPA via a webpage, completes a Service Request (prescription and information about the radiotherapy targets), and uploads the patient&#39;s CT image set. The RPA offers two approaches to automated planning. In one-step planning, the system uses the Service Request and CT scan to automatically generate the necessary contours and treatment plan. In two-step planning, the user reviews and edits the automatically generated contours before the RPA continues to generate a volume-modulated arc therapy plan. The final plan is downloaded from the RPA website and imported into the user&#39;s local treatment planning system, where the dose is recalculated for the locally commissioned linac; if necessary, the plan is edited prior to approval for clinical use.

Autor im Rampenlicht: Verbesserung des Zugangs zur Strahlentherapie mit dem Strahlenplanungsassistenten

This protocol describes a series of automated tools designed for high-quality radiotherapy autocontouring and autoplanning that are being packaged into a web-based service to maximize robustness and scalability while minimizing operational costs.

Bestrahlungsplanungsassistent - Ein webbasiertes Tool zur Unterstützung einer qualitativ hochwertigen Strahlentherapie in Kliniken mit begrenzten Ressourcen

Access to radiotherapy worldwide is limited. The Radiation Planning Assistant (RPA) is a fully automated, web-based tool that is being developed to offer ...