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.

No description available.

Traumatic spinal cord injury (SCI) is a devastating condition for which there is no effective clinical treatment. Neuroprotective molecules that minimize tissue loss have shown promising results; however systemic delivery may limit in vivo benefits due to short systemic half-life and minimal passage across the blood-spinal cord barrier. To overcome these limitations, an injectable intrathecal delivery vehicle comprised of hyaluronan and methylcellulose (HAMC) was developed, and previously demonstrated to be safe and biocompatible intrathecally. Here, HAMC was determined to persist in the intrathecal space for between 4-7 d in vivo, indicating it as an optimal delivery system for neuroprotective agents to reduce tissue degeneration after SCI. HAMC was then investigated as an in vivo delivery system for two neuroprotective proteins: erythropoietin (EPO) and fibroblast growth factor 2 (FGF2). Both proteins demonstrated a diffusive release profile in vitro and maintained significant bioactivity during release. When EPO was delivered intrathecally with HAMC to the injured spinal cord, reduced cavitation in the tissue and significantly improved neuron counts were observed relative to the conventional delivery strategies of intraperitoneal and intrathecal bolus. When FGF2 was delivered intrathecally from HAMC, therapeutic concentrations penetrated into the injured spinal cord tissue for up to 6 h. Poly(ethylene glycol) modification of FGF2 significantly increased the amount of protein that diffused into the tissue when delivered similarly. Because FGF2 is a known angiogenic agent, dynamic computed tomography was developed for small animal serial assessment of spinal cord hemodynamics. Following SCI and treatment with FGF2 from HAMC, moderate improvement of spinal cord blood flow and a reduction in permeability were observed up to 7 d post-injury, suggesting that early delivery of neuroprotective agents can have lasting effects on tissue recovery. Importantly, the entirety of this work demonstrates that HAMC is an effective short-term delivery system for neuroprotective agents by improving tissue outcomes following traumatic SCI.

Traumatic spinal cord injury (SCI) is a devastating condition for which there is no effective clinical treatment. Neuroprotective molecules that minimize tissue loss have shown promising results; however systemic delivery may limit in vivo benefits due to short systemic half-life and minimal passage across the blood-spinal cord barrier. To overcome these limitations, an injectable intrathecal delivery vehicle comprised of hyaluronan and methylcellulose (HAMC) was developed, and previously demonstrated to be safe and biocompatible intrathecally. Here, HAMC was determined to persist in the intrathecal space for between 4-7 d in vivo, indicating it as an optimal delivery system for neuroprotective agents to reduce tissue degeneration after SCI. HAMC was then investigated as an in vivo delivery system for two neuroprotective proteins: erythropoietin (EPO) and fibroblast growth factor 2 (FGF2). Both proteins demonstrated a diffusive release profile in vitro and maintained significant bioactivity during release. When EPO was delivered intrathecally with HAMC to the injured spinal cord, reduced cavitation in the tissue and significantly improved neuron counts were observed relative to the conventional delivery strategies of intraperitoneal and intrathecal bolus. When FGF2 was delivered intrathecally from HAMC, therapeutic concentrations penetrated into the injured spinal cord tissue for up to 6 h. Poly(ethylene glycol) modification of FGF2 significantly increased the amount of protein that diffused into the tissue when delivered similarly. Because FGF2 is a known angiogenic agent, dynamic computed tomography was developed for small animal serial assessment of spinal cord hemodynamics. Following SCI and treatment with FGF2 from HAMC, moderate improvement of spinal cord blood flow and a reduction in permeability were observed up to 7 d post-injury, suggesting that early delivery of neuroprotective agents can have lasting effects on tissue recovery. Importantly, the entirety of this work demonstrates that HAMC is an effective short-term delivery system for neuroprotective agents by improving tissue outcomes following traumatic SCI.

Se zvyšující se dostupností medicínského CT vyšetření a s rostoucím počtem patologických stavů, pro které je indikováno, se redukce pacientské dávky ionizujícího záření stává stále aktuálnějším tématem. Výrazný pokrok v tomto odvětví představují nové metody rekonstrukce obrazů z projekcí, tzv. moderní iterativní rekonstrukční metody. Zároveň se zavedením těchto metod vzrostla potřeba pro měření obrazové kvality. Kvalita iterativně rekonstruovaných dat byla doposud kvantitativně hodnocena pouze na fantomových datech nebo na malých oblastech zájmu v reálných pacientských datech. Charakter iterativně rekonstruovaných dat však naznačuje, že tyto přístupy nadále nejsou dostatečné a je nutné je nahradit přístupy novými. Hlavním cílem této dizertační práce je navrhnout nové přístupy k měření kvality CT obrazových dat, které budou respektovat specifika iterativně rekonstruovaných obrazů a budou počítána plně automaticky přímo z reálných pacientských dat.

The traditional Computed Tomography (CT) is based on the Radon Transform and its inversion. The Radon transform uses parallel beam geometry and its inversion is based on the Fourier slice theorem. In practice, it is very efficient to employ a back-projection algorithm in connection with the Fast Fourier Transform, and which can be interpreted as a 1-D filtering across the radial dimension of the 2-D Fourier plane of the transformed image. This approach can easily be adapted to windowing techniques in the frequency domain, giving the capability to reduce image noise. In this work we are investigating the capabilities of the so called Kaiser window (giving an optimal trade-off between the main lobe energy and the sidelobe suppression) to achieve a near optimal trade-off between the noise reduction and the image sharpness in the context of Radon inversion. Finally, we simulate our image reconstruction using MATLAB software and compare and estimate our results based on the normalized Least Square Error (LSE). We conclude that the Kaiser window can be used to achieve an optimal trade-off between noise reduction and sharpness in the image, and hence outperforms all the other classical window function in this regard.

<p>Allergic asthma is a disease involving airway inflammation, commonly linked to allergen exposure. Computed tomography (CT) is used to quantitatively assess changes in density, hence inflammation, in the lung. CT imaging provides the ability to non-invasively and longitudinally study disease progression and evaluate treatment efficacy. The objective of this study was to determine the sensitivity of CT to detect the anti-inflammatory effects of budesonide (BUD) by measuring airway tissue density in a rat model of allergic airway disease.</p> <p>Female<strong> </strong>Brown Norway rats were exposed intratracheally to house dust mite (HDM) extract (250 µg in 100µL saline) or saline control every other day for a total of five administrations (inflammatory phase). ABUD dose and temporal response study was performed usingBUD 0, 10, 100, and 300 µg/kg administered concurrently with HDM for three and six treatments (treatment phase). CT scanning was performed at baseline, post inflammatory phase, and after three and six BUD treatments. From the CT, density was measured in a defined volume of interest surrounding the major airways. Bronchoalveolar lavage (BAL) and histological samples were collected at the same time points.</p> <p>After the inflammatory phase, a significant increase in peribronchial density was found in the HDM group compared to controls. This corresponded to a significant increase in inflammation by histology andBALtotal cell count (TCC), specifically eosinophils. Within the treatment phase after three treatments,BUD100 and 300 µg/kg led to a significant shift in lung density compared to HDM exposure alone, to a state similar to baseline. All BUD treated groups expressed a significant reduction in peribronchial density after six treatments. However, histology andBALTCC only showed a significant decrease in inflammation after six treatments for all three BUD doses.</p> <p>CT densitometry is a sensitive, non-invasive method of evaluating the anti-inflammatory effects of budesonide and can be used for future screening of therapies in allergic lung models. Airway segmentation of CT permits the localized assessment of peribronchial inflammation, while other outcome measurements, such as BAL cytology, provide whole lung assessment which may not accurately reflect important regional changes.</p> / Master of Science (MSc)

No description available.

La radiothérapie est une des méthodes principales utilisée dans le traitement thérapeutique des tumeurs malignes. Pour améliorer son efficacité, deux problèmes essentiels doivent être soigneusement traités : la prédication fiable des résultats thérapeutiques et la segmentation précise des volumes tumoraux. La tomographie d’émission de positrons au traceur Fluoro- 18-déoxy-glucose (FDG-TEP) peut fournir de manière non invasive des informations significatives sur les activités fonctionnelles des cellules tumorales. Les objectifs de cette thèse sont de proposer: 1) des systèmes fiables pour prédire les résultats du traitement contre le cancer en utilisant principalement des caractéristiques extraites des images FDG-TEP; 2) des algorithmes automatiques pour la segmentation de tumeurs de manière précise en TEP et TEP-TDM. La théorie des fonctions de croyance est choisie dans notre étude pour modéliser et raisonner des connaissances incertaines et imprécises pour des images TEP qui sont bruitées et floues. Dans le cadre des fonctions de croyance, nous proposons une méthode de sélection de caractéristiques de manière parcimonieuse et une méthode d’apprentissage de métriques permettant de rendre les classes bien séparées dans l’espace caractéristique afin d’améliorer la précision de classification du classificateur EK-NN. Basées sur ces deux études théoriques, un système robuste de prédiction est proposé, dans lequel le problème d’apprentissage pour des données de petite taille et déséquilibrées est traité de manière efficace. Pour segmenter automatiquement les tumeurs en TEP, une méthode 3-D non supervisée basée sur le regroupement évidentiel (evidential clustering) et l’information spatiale est proposée. Cette méthode de segmentation mono-modalité est ensuite étendue à la co-segmentation dans des images TEP-TDM, en considérant que ces deux modalités distinctes contiennent des informations complémentaires pour améliorer la précision. Toutes les méthodes proposées ont été testées sur des données cliniques, montrant leurs meilleures performances par rapport aux méthodes de l’état de l’art. / Radiation therapy is one of the most principal options used in the treatment of malignant tumors. To enhance its effectiveness, two critical issues should be carefully dealt with, i.e., reliably predicting therapy outcomes to adapt undergoing treatment planning for individual patients, and accurately segmenting tumor volumes to maximize radiation delivery in tumor tissues while minimize side effects in adjacent organs at risk. Positron emission tomography with radioactive tracer fluorine-18 fluorodeoxyglucose (FDG-PET) can noninvasively provide significant information of the functional activities of tumor cells. In this thesis, the goal of our study consists of two parts: 1) to propose reliable therapy outcome prediction system using primarily features extracted from FDG-PET images; 2) to propose automatic and accurate algorithms for tumor segmentation in PET and PET-CT images. The theory of belief functions is adopted in our study to model and reason with uncertain and imprecise knowledge quantified from noisy and blurring PET images. In the framework of belief functions, a sparse feature selection method and a low-rank metric learning method are proposed to improve the classification accuracy of the evidential K-nearest neighbor classifier learnt by high-dimensional data that contain unreliable features. Based on the above two theoretical studies, a robust prediction system is then proposed, in which the small-sized and imbalanced nature of clinical data is effectively tackled. To automatically delineate tumors in PET images, an unsupervised 3-D segmentation based on evidential clustering using the theory of belief functions and spatial information is proposed. This mono-modality segmentation method is then extended to co-segment tumor in PET-CT images, considering that these two distinct modalities contain complementary information to further improve the accuracy. All proposed methods have been performed on clinical data, giving better results comparing to the state of the art ones.

Les agents d’imagerie aux rayons X sont essentiels en combinaison avec la tomodensitométrie pour améliorer le contraste de manière à permettre la visualisation complète des vaisseaux sanguins et de fournir l'information structurelle et fonctionnelle de lésions permettant la détection d'une tumeur. Ces outils fondamentaux permettent également de faire la distinction entre les cellules et les agents pathogènes sains. Les agents de contraste aux rayons X commercialisés sont limités dans leur succès dans le cas du Fenestra® VC par le temps court de circulation dans le sang et celui qui est lié à l'élimination rénale rapide du corps comme dans le cas du Xenetix® (Iobitriol). Nous avons développé des agents de contraste à base d’α-tocophérol (vitamine E), de Cholécalciférol (vitamine D3), d'huile de ricin, de Capmul® MCMC8 et d’acide oléique qui sont tous dénués de toxicité, qui contiennent de l’iode sous forme de nano-émulsion et qui sont destinés à l’imagerie préclinique en μ-CT. Ces nano-émulsions formulées ont été préparées par la technique d’émulsification spontanée de basse énergie avec une légère modification pour chaque composé iodé. Ces formulations ont montré de nouvelles caractéristiques spécifiques les rendant prometteuses dans des expérimentations in vivo avec une augmentation du rapport de la toxicité et de celui des interventions thérapeutiques visées. Nous avons étudié l'effet de la taille et de la composition chimique des systèmes nanoparticulaires sur leur biodistribution, leur pharmacocinétique et leur toxicité. Ces études ont permis de mettre en évidence l’importance de la constitution chimique des agents iodés utilisés avec par exemple la vectorisation du foie dans le cas de la vitamine E et une accumulation passive dans la rate pour les formulations à base d'huile de ricin, faisant la preuve-de-concept de l'effet EPR. D'autre part, des formulations identiques ayant deux tailles de gouttelettes différentes et contenant du cholécalciférol indiquent qu’il n’y a pas de réels impacts sur la pharmacocinétique et la biodistribution mais présentaient une augmentation importante de la toxicité. Une autre étude a consisté a étudié l’effet des charges de surface des systèmes nanoparticulaires sur leur biodistribution, c’est pourquoi la nano-émulsion a été sélectionnée pour réaliser cette étude en présence d’un polymère amphiphile tel que le poly (anhydride-alt-1-octadecene maléique) (PMAO). Les résultats in vitro et les évaluations in vivo étaient tout à fait cohérents sachant que les systèmes nanoparticulaires neutres présentent moins de toxicité comparée à celles qui sont chargés négativement qui ont été capturés de manière plus importante dans les cellules causant un stress cellulaire et delà affectent la toxicité. Selon les résultats, elles présentent des biodistributions et des pharmacocinétiques différentes. Dans ce contexte, pour la première fois, nous avons pu fonctionnaliser les nanogouttes des nanoémulsions en fixant des ligands par des liaisons covalentes. Nous avons conçu des nanogouttes enrobées avec un enrobage de silice terminé par des groupements aminés et ainsi réalisé la formation de liaisons amides avec le greffage d’un colorant modèle (colorant bleu coumarine). La quantification des groupements aminés a été réalisée à l'aide de techniques spectroscopiques et microscopiques ainsi que la détermination de l'efficacité du greffage déterminé à 41%. [...] Un de nos objectifs réalisés était de concevoir des systèmes nanoparticulaires polymères multifonctionnels qui peuvent encapsuler des principes actifs hydrophobes modèles et des agents de contraste pour l’imagerie à rayons X, de sorte à construire des dispositifs théranostiques. Pour conclure, de nouveaux agents de contraste et des systèmes de délivrance ont été synthétisés ayant des caractéristiques physico-chimiques exceptionnelles et acceptables pour être utilisées in vivo avec une grande efficacité et une faible toxicité. / X-ray imaging agents are essential in combination with X-ray computed tomography to improve contrast enhancement aiming at providing complete visualization of blood vessels and giving structural and functional information on lesions allowing the detection of a tumor. As well as it is fundamental tool to discriminate between healthy cells and pathogens. We successfully limit the problems presented in commercial Xray contrast agents like poor contrasting in Fenestra® VC associated with short blood circulation time and to avoid rapid renal elimination from the body as found in Xenetix (Iobitriol). We developed nontoxic and blood pool iodine-containing nano-emulsion contrast agents serving in preclinical X-ray μ-CT imaging such as, α- Tocopherol (vitamin E), Cholecalciferol (vitamin D3), Castor oil, Capmul MCMC8 oil and oleic acid. Those formulated nanoemulsions were prepared by low energy spontaneous emulsification technic with slight modification for each platform. They showed new specific features rendering them promising agents in in vivo experiments as improving the balance between the efficacy and the toxicity of targeted therapeutic interventions. We investigate the effect of size and the chemical composition of the nanoparticles on their biodistribution, pharmacokinetics and toxicity. They demonstrated that the chemical structures of the droplet’s cores have significant role in targeting for example vitamin E was mainly accumulated in liver and castor oil formulation was passively accumulated in spleen explaining the proof-of-concept of EPR effect. On the other hand, two different platform sizes of Cholecalciferol molecule revealing that no real impact on the pharmacokinetics and biodistribution but presented remarkable effect on the toxicity. Of particular interest is studying the effect of the surface charge of nanoparticles on their biodistribution, this is why oleic acid nano-emulsion was selected to proceed this study by presence of amphiphilepolymer poly(maleic anhydride-alt-1-octadecene) (PMAO). The in vitro results and in vivo evaluations were completely coherent approving that the neutral charged NPs are less toxic compared to the negatively charged ones that were highly uptaked in the cells causing stress to the cells and thereby affecting the toxicity. As a result they are different in biodistribution and pharmacokinetics. In this context, for the first time, we were able to functionalize the nano-emulsion droplets with ligand molecules by covalent bonds. Likewise we designed nano-droplets and coated by silica shell ended by amino groups and then followed by formation of amide bonds with grafting to dye ligand model (coumarin blue dye). The quantification of amino groups was performed by using spectroscopic and microscopic techniques, with a grafting efficiency as high as 41%. This process improves the targeting properties of such chemotherapeutic agents to the location of interest following active targeting mechanism (ligand receptorstrategy). One of our achieved objectives was to engineer multifunctional polymer-based NPs encapsulating hydrophobic drug model as DDs and iron oxide NPs as a theranostic model. To conclude, novel contrast agents and delivering systems were synthesized with outstanding physicochemical characteristics and suitable for in vivo medium with high efficacy and low toxicity.