Thesis (M.A.)--Boston University / The standardized uptake value (SUV) is increasingly being used for diagnosis, staging, and monitoring disease in clinical oncology. Comparing tumor SUV to background SUV is an attractive way to minimize variability and ensure the quality of scans across different institutions. The liver has been identified as a potential source for background normalization, however no studies have compared the liver to other background sites for a variety of cancers. The purpose of this study was to evaluate the use of liver uptake for the standardization of FDG PET/CT imaging. Scans from 145 patients were prospectively reviewed under the supervision of a radiologist with board certification in nuclear medicine (R.M.S. , 3 years of experience). Liver SUV values were correlated to mediastinum SUV values in lung and breast cancer patients, and internal jugular vein (IJV) SUV values in head and neck cancer patients. The independent t-test was used to determine if there was a statistically significant affect of the amount of incubation time or use of intravenous contrast on the SUV. For the lung and breast cancer patients, a strong correlation was observed between the mediastinum SUVmean and liver SUVmean (r = 0.89), whereas for the head and neck cancer patients, a weaker correlation was observed between the IJV SUVmean and the liver SUVmean (r = 0.69). Neither the amount of incubation time nor the use of IV contrast demonstrated a significant affect on the SUV. We conclude that liver SUVmean may be used to standardize FOG PET/CT studies in cancers of the lung, breast and head and neck. However, additional studies in other cancers as well as the affects of age, gender, benign disease and use of chemotherapy are still desired before widespread adoption of this standard.

Poly(ADP-ribose)polymerase-1 and -2 (PARP1/2) are nuclear proteins involved in DNA repair. Tumors with defects in homologous recombination, including BRCA1- and BRCA2-deficient cancers, have been shown to be sensitive to PARP inhibition. The Weissleder group has synthesized fluorescent and radioactive derivatives of the PARP1/2 inhibitor AZD2281. We hypothesized that fluorescent and radioactive AZD2281-based imaging agents would quantify PARP1/2 expression in vitro and in vivo. To test this hypothesis, a panel of pancreatic ductal adenocarcinoma and ovarian carcinoma cell lines were characterized by immunocytochemistry for PARP1/2 expression. AZD2281-derived fluorescence signal correlated with anti-PARP antibody fluorescence signal strength in vitro. Four cell lines representing a range of PARP1/2 expression levels were then xenografted into Nu/Nu mice. Mice bearing four tumor types each were imaged with AZD2281-derived imaging agents, sacrificed, and their tumors excised for stand-alone imaging and Western blot. AZD2281-derived signal correlated with tumor PARP1/2 expression determined by Western blot, indicating that PARP1/2 expression level is a determinant of fluorescent signal strength and SUVs of AZD2281-derived agents in vivo. These data indicate that AZD2281-derived agents are useful tools for quantifying intracellular PARP1/2 both in vitro and in vivo, which could one day enable prospective identification of tumors likely to respond to PARP inhibitors.

Introduction. Fused Positron Emission Tomography and Computed Tomography (PET/CT) is an emerging investigative tool in cardiovascular disease that provides an imaging-based quantification of pathophysiological processes of interest. The purpose of this thesis was to study the application of PET to identify fundamental pathophysiological processes driving 3 forms of cardiovascular disease: aortic stenosis, myocardial infarction, and atherosclerosis. Methods. Aortic Stenosis. Patients with a spectrum of calcific aortic valve disease (n=121) who underwent PET-CT imaging for the identification of valvular calcification (18Ffluoride) and inflammation (18F-fluorodeoxyglucose, 18F-FDG) underwent serial imaging and clinical follow-up over 2 years. Baseline imaging findings were compared with echocardiographic and CT markers of disease progression and clinical outcome. Myocardial Infarction. Patients underwent PET-CT imaging with 18F-fluciclatide (a novel αvβ3-selective radiotracer highlighting active angiogenesis, inflammation and fibrosis) after ST-segment elevation MI (n=21), alongside stable patients with chronic total occlusion (CTO) of a major coronary vessel (n=7), and healthy volunteers (n=9). Myocardial radiotracer uptake was compared with clinical and cardiac magnetic resonance imaging (CMR) markers of infarction and remodeling. Atherosclerosis. Patients with a spectrum of atherosclerotic disease categorized as stable or unstable (recent MI) underwent PET/CT imaging with 18F-fluciclatide (n=46). Thoracic aortic 18F-fluciclatide uptake was compared with aortic atherosclerotic burden quantified by CT plaque thickness, plaque volume and calcium scoring. Histological validation. Tissue from the aortic valve, myocardium and carotid arteries of study subjects was acquired and examined ex vivo using histology and autoradiography. Results. Aortic Stenosis. Baseline valvular 18F-fluoride uptake correlated strongly with the rate of progression in AVC (r=0.80, p < 0.001) and with haemodynamic progression (mean aortic valve gradient r=0.32, p=0.001). It emerged as independently associated with clinical outcome after age and sex-adjustment (HR 1.55 [1.33-1.81], p < 0.001). 18F-FDG demonstrated moderate correlations with disease progression as assessed by CT (r=0.43, p=0.001) and echocardiography (18F-FDG r=0.30, p=0.001), and was associated with clinical outcomes independent of age and sex (HR 1.35 [1.16-1.58], p < 0.001). Valvular 18F-fluoride uptake correlated with immunohistochemical markers of calcification activity. There was no correlation between 18F-FDG uptake and inflammation. Myocardial Infarction. 18F-Fluciclatide binding was demonstrated in ex vivo peri-infarct myocardium and uptake was increased in vivo at sites of acute infarction compared to remote myocardium (tissue-to-background ratio (TBRmean) 1.34±0.22 vs 0.85±0.17 respectively, p < 0.001) and myocardium of healthy volunteers (TBRmean 1.34±0.22 vs 0.70±0.03; p < 0.001). There was no 18F-fluciclatide uptake at sites of established prior infarction in patients with CTO, with myocardial activity similar to healthy volunteers (TBRmean 0.71±0.06 vs. 0.70±0.03,p=0.83). 18F-Fluciclatide uptake occurred at sites of regional wall hypokinesia (wall motion index ≥1 vs 0; TBRmean 0.93±0.31 vs 0.80±0.26 respectively, p < 0.001), was increased in segments displaying functional recovery (TBRmean 0.95±0.33 vs 0.81±0.27, p=0.002) and associated with increase in probability of regional recovery. Atherosclerosis. 18F-Fluciclatide vascular binding ex vivo co-localised with regions of increased αvβ3 integrin expression, and markers of inflammation and angiogenesis. 18F-Fluciclatide uptake in vivo correlated with measures of aortic atherosclerotic burden: plaque thickness (r=0.57, p=0.001), total plaque volume (r=0.56, p=0.001) and the CT aortic calcium score (r=0.37, p=0.01). Patients with recent MI had greater aortic 18F-fluciclatide uptake than those with stable disease (TBRmax 1.33 vs 1.21, p=0.01). Conclusions. In a range of cardiovascular diseases, PET-CT can provide insights into key pathophysiological processes, guide patient risk stratification and prognosis, and identify important biomarkers of disease activity that can be used for the development of future therapeutic interventions.

Chronic obstructive pulmonary disease (COPD) is a debilitating lung disease almost exclusively related to tobacco smoke. COPD symptoms are typical of numerous other ailments making it difficult to diagnose and track. Technological advancements in CT imaging have allowed clinicians and researchers to expand simple structural information to functional information. These advancements have helped to increase the use of CT imaging in the study of smoking related lung disease. In this thesis, we investigate observations from a previous study which suggested pulmonary artery constriction in inflamed lung regions promotes emphysema progression in smokers susceptible to emphysema. We use CT data from a 1 year longitudinal study to evaluate the pulmonary artery dimensions in rapid and non-progressing emphysema subjects. We show that the enlargement of arteries predicts emphysema progression and can be used to identify subjects showing signs of rapid emphysema progression. We attempt to further our ability to use dual energy computed tomography (DECT) for longitudinal and multi-center studies by developing a DECT perfusion blood volume (PBV) imaging protocol with low radiation dose and diluted contrast. We demonstrate that we can reduce radiation dose by up to 34% with the advanced technology of Siemens SOMATOM Force scanner. Finally, we use DECT PBV imaging to compare perfusion heterogeneity in a multi-center study with both GE and Siemens scanners. We show that perfusion heterogeneity is increased in lung regions showing signs of emphysema, but scanner model/manufacturer appears to be the most important factor as data from the GE scanner had greater noise and thus increased perfusion heterogeneity.

This thesis presents an experimental investigation of two-phase flow properties of porous rock samples having different scales ranging from micro-CT imaging to conventional core plug scales. Advances in micro-CT imaging of porous materials provide the opportunity to extract representative networks from the images. This improves the predictive capability of porescale network models to predict multiphase flow properties. However, all these predictions need to be validated with laboratory data. Micro-CT imaging is currently limited to small sample sizes, having bulk volumes of the order of 0.1 cm??. Conventional core plugs, however, have sizes several orders of magnitude larger than that (bulk volumes of 10 cm?? or larger). The aim of this thesis is to investigate the scale effect on laboratory data and to provide reliable experimental data which can be used to test the predictive value of microCT based network models. Berea and Bentheim sandstones and Mount Gambier carbonate were used in the experiments. The core samples were thoroughly cleaned in order to obtain strongly, uniform water-wet conditions. Simple well-characterized fluid systems were chosen in the experiments: Air-brine fluid-system for drainage capillary pressure, resistivity index and spontaneous imbibition experiments while oil-brine fluid-system for wettability and relative permeability measurements. Drainage capillary pressure, resistivity index, relative permeability and spontaneous imbibition measurements were made on the cores having bulk volumes ranging from 0.1 to 12 cm??. Previous studies have shown that experiments at this scale are still lacking. The wettability was tried to keep strongly water-wet for all experiments. The experimental results show that the measurements of drainage capillary pressure, and resistivity index and spontaneous imbibition on small core samples, having similar scales as micro-CT imaging can be made accurately in the laboratory. The measurement of relative permeability remains challenging. This thesis concludes that commonly used homogeneous rock types (Berea and Bentheim sandstones and Mt. Gambier carbonate) can be considered to be sufficiently homogeneous from the pore to core scale based on the two-phase flow properties examined in this study. Hence, laboratory data taken from these rocks using conventional core plugs can be used to calibrate micro-CT based network models for multiphase flow properties.

<p>Quality assurance (QA) is a critical component of radiation oncology medical physics for both effective treatment and patient safety, particularly as innovations in technology allow movement toward advanced treatment techniques that require increasingly higher accuracy in delivery. Comprehensive 3D dosimetry with PRESAGE® 3D dosimeters read out via optical CT has the potential to detect errors that would be missed by current systems of measurement, and thereby improve the rigor of current QA techniques through providing high-resolution, full 3D verification for a wide range of clinical applications. The broad objective of this dissertation research is to advance and strengthen the standards of QA for radiation therapy, both by driving the development and optimization of PRESAGE® 3D dosimeters for specific clinical and research applications and by applying the technique of high resolution 3D dosimetry toward addressing clinical needs in the current practice of radiation therapy. The specific applications that this dissertation focuses on address several topical concerns: (1) increasing the quality, consistency, and rigor of radiation therapy delivery through comprehensive 3D verification in remote credentialing evaluations, (2) investigating a reusable 3D dosimeter that could potentially facilitate wider implementation of 3D dosimetry through improving cost-effectiveness, and (3) validating deformable image registration (DIR) algorithms prior to clinical implementation in dose deformation and accumulation calculations.</p><p>3D Remote Dosimetry: The feasibility of remote high-resolution 3D dosimetry with the PRESAGE®/Optical-CT system was investigated using two nominally identical optical-CT scanners for 3D dosimetry were constructed and placed at the base (Duke University) and remote (IROC Houston) institutions. Two formulations of PRESAGE® (SS1, SS2) were investigated with four unirradiated PRESAGE® dosimeters imaged at the base institution, then shipped to the remote institution for planning and irradiation. After each dosimeter was irradiated with the same treatment plan and subsequently read out by optical CT at the remote institution, the dosimeters were shipped back to the base institution for remote dosimetry readout 3 days post-irradiation. Measured on-site and remote relative 3D dose distributions were registered to the Pinnacle dose calculation, which served as the reference distribution for 3D gamma calculations with passing criteria of 5%/2mm, 3%/3mm, and 3%/2mm with a 10% dose threshold. Gamma passing rates, dose profiles, and dose maps were used to assess and compare the performance of both PRESAGE® formulations for remote dosimetry. Both PRESAGE® formulations under study maintained high linearity of dose response (R2>0.996) over 14 days with response slope consistency within 4.9% (SS1) and 6.6% (SS2). Better agreements between the Pinnacle plan and dosimeter readout were observed in PRESAGE® formulation SS2, which had higher passing rates and consistency between immediate and remote results at all metrics. This formulation also demonstrated a relative dose distribution that remained stable over time. These results provide a foundation for future investigations using remote dosimetry to study the accuracy of advanced radiation treatments.</p><p>A Reusable 3D Dosimeter: New Presage-RU formulations made using a lower durometer polyurethane matrix (Shore hardness 30-50A) exhibit a response that optically clears following irradiation and opens up the potential for reirradiation and dosimeter reusability. This would have the practical benefit of improving cost-effectiveness and thereby facilitating the wider implementation of comprehensive, high resolution 3D dosimetry. Three formulations (RU-3050-1.7, RU-3050-1.5, and RU-50-1.5) were assessed with multiple irradiations of both small volume samples and larger volume dosimeters, then characterized and evaluated for dose response sensitivity, optical clearing, dose-rate independence, dosimetric accuracy, and the effects of reirradiation on dose measurement. The primary shortcoming of these dosimeters was the discovery of age-dependent gradients in dose response sensitivity, which varied dose response by as much as 30% and prevented accurate measurement. This is unprecedented in the standard formulations and presumably caused by diffusion of a desensitizing agent into the lower durometer polyurethane. The effect of prior irradiation on the dosimeters would also be a concern as it was seen that the relative amount of dose delivered to any given region of the dosimeter will affect subsequent sensitivity in that area, which would in effect create spatially-dependent variable dose sensitivities throughout the dosimeter based on the distributions of prior irradiations. While a successful reusable dosimeter may not have been realized from this work, these studies nonetheless contributed useful information that will affect future development, including in the area of deformable dosimetry, and provide a framework for future reusable dosimeter testing.</p><p>Validating Deformable Image Registration Algorithms: Deformable image registration (DIR) algorithms are used for multi-fraction dose accumulation and treatment response assessment for adaptive radiation therapy, but the accuracy of these methods must be investigated prior to clinical implementation. 12 novel deformable PRESAGE® 3D dosimeter formulations were introduced and characterized for potential use in validating DIR algorithms by providing accurate, ground-truth deformed dose measurement for comparison to DIR-predicted deformed dose distributions. Two commercial clinical DIR software algorithms were evaluated for dose deformation accuracy by comparison against a measured deformed dosimeter dose distribution. This measured distribution was obtained by irradiating a dosimeter under lateral compression, then releasing it from compression so that it could return to its original geometry. The dose distribution within the dosimeter deformed along with the dosimeter volume as it regained to its original shape, thus providing a measurable ground truth deformed dose distribution. Results showed that intensity-based DIR algorithms produce high levels of error and physically unrealistic deformations when deforming a homogeneous structure; this is expected as lack of internal structure is challenging for intensity-based DIR algorithms to deform accurately as they rely on matching fairly closely spaced heterogeneous intensity features. A biomechanical, intensity-independent DIR algorithm demonstrated substantially closer agreement to the measured deformed dose distribution with 3D gamma passing rates (3%/3mm) in the range of 90-91%. These results underscore the necessity and importance of validating DIR algorithms for specific clinical scenarios prior to clinical implementation.</p> / Dissertation

Understanding soil structure, in particular the void spaces through which water, gases and solutes flow and in which organisms exist, is vital to a sustainable future on earth. The investigation of the structural behaviour of soil under different influences is fundamental to understanding and protecting the soil. This study has investigated the impact of bacteria on the biophysics of water retention and flow, aiming to elucidate the effect of three key components produced by the model organism, Pseudomonas fluorescens SBW25. Cellulose is an extracellular polysaccharide involved in the formation of the matrix of the bacterial biofilm, lipopolysaccharide is a cell membrane component required for bacterial attachment, and viscosin is a biosurfactant released from the bacteria. Four isogenic strains mutated so as to heighten or suppress production of one of these key components were used in addition to the wild-type strain. Labfield sandy loam soil was sieved and packed into replicate experimental cores which were incubated with different bacterial treatments. Following sterilisation, the gravimetric water content (u g g-1) of the soil was determined at equilibrated matric potentials from -1 cm to -100 cm during two wet-dry cycles. Sorptivity (S, mm s-1/2) of the soil, indicative of water repellency, was determined using a mini-infiltrometer setup and has been reported as the rate of infiltration of water into the soil. Bacteria have been shown to increase water repellency of soil, decrease the total water content at saturation and increase the water retaining ability of the soil as it drains (p < 0.05). Three-dimensional analysis of core scale structure was carried out using micro X-ray computed tomography (µXCT) and of aggregate scale structure using synchrotron-µXCT. Volumetric analyses of the 3D structures has shown decreased pore connectivity and destabilisation of aggregates in soil systems treated with bacteria deficient in the production of a key extracellular component, cellulose, LPS or viscosin (p < 0.05). Analyses of cracking patterns in two types of sandy loam soil, Labfield and Bullionfield has highlighted the importance of taking into account the soil type and its composition when studying soils, as even within soil classification groups different behaviours are observed. This study has provided clear evidence of the ability of bacteria and their extracellular components to impact upon (i) the hydrodynamics of water retention and flow in soil and (ii) the structural organisation, aggregation and stabilisation of soil.

No description available.

The objective of this work is to develop an on-line planning and delivery technique for palliative radiotherapy of spinal metastases using a linear accelerator capable of cone-beam CT (CBCT) imaging. This technique integrates all preparation and delivery steps into a single session equivalent to an initial treatment session. The key technical challenges pertaining to the development and implementation of this novel treatment technique are related to CBCT image performance, efficient system integration, development of on-line planning tools and design of novel quality assurance (QA) phantoms and processes. Hardware and software image corrections were first implemented to make CBCT images suitable for target definition and planning. These corrections reduced CBCT non-uniformity and improved CBCT-number accuracy. The on-line treatment technique workflow and the integration of all the subsystems involved in the process were assessed on a customized spine phantom constructed for the study. The challenges related to the routine QA of the highly integrated on-line treatment technique were addressed with the construction and validation of an integral test phantom. This phantom, which contains point detectors (diodes) allows for real-time QA of the entire image guidance, planning and treatment process in terms of dose delivery accuracy. The integral test phantom was also effective for the QA of high-dose, high-precision spinal radiosurgery. Simulation of the on-line treatment technique on patient data showed that the planning step was the one of the most time consuming tasks due predominantly to manual target definition. A semi-automatic method for detection and identification of vertebrae on CBCT images was developed and validated to streamline vertebra segmentation and improve the on-line treatment efficiency. With a single patient setup at the treatment unit, patient motion during the on-line process represents the main source of geometric uncertainty for dose delivery. Spine intra-fraction motion was assessed on CBCT for a group of 49 patients treated with a palliative intent. The use of surface marker tracking as a surrogate for spine motion was also evaluated. Finally, the complete on-line planning and delivery technique was implemented in a research ethics board (REB) approved clinical study at the Princess Margaret Hospital and 7 patients have been successfully treated at the time of this report with this novel treatment approach.

Experiments involving the dissociation of artificial methane-hydrate-bearing sediments were performed using X-ray computed tomography (X-CT, 40 s scanning speed at 2 min intervals) to directly observe dissociation behavior in the sediments and the gas and water flows generated by dissociation. Dissociation by depressurization was performed using a backpressure regulator, and showed that the temperature reduction induced by depressurization depends on the phase equilibrium state of methane hydrate, and that preferential dissociation occurs along the periphery of the core. This behavior is caused by heat flux from the outside of the core, and this controls the dissociation rate. A heat exchanger was installed at one end of the core to simulate thermal stimulation, and propagation of a clear and unidirectional dissociation front was observed. Depending on the heating temperature, the dissociation rate was less than that observed for depressurization. Hot water was also injected at a constant rate from the bottom of the core, and CT images showed the movement of distinct accumulations of dissociated gas being pushed by the hot water. The gas production rate increased immediately after the gas accumulation reached the opposite end of the core where the gas and water flow out.