Monte Carlo (MC) and Pencil Beam (PB) calculations are compared to their measured planar dose distributions using a 2-D diode array for lung Stereotactic Body Radiation Therapy (SBRT). The planar dose distributions were studied for two different phantom types: an in-house heterogeneous phantom and a homogeneous phantom. The motivation is to mimic the human anatomy during a lung SBRT treatment and incorporate heterogeneities into the pre-treatment Quality Assurance process, where measured and calculated planar dose distributions are compared before the radiation treatment. Individual and combined field dosimetry has been performed for both fixed gantry angle (anterior to posterior) and planned gantry angle delivery. A gamma analysis has been performed for all beam arrangements. The measurements were obtained using the 2-D diode array MapCHECK 2™. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2015. / FAU Electronic Theses and Dissertations Collection

Material und Methode: In einer retrospektiven Analyse wurden die Daten von 53 konsekutiven Patienten, 31 Männer und 22 Frauen, mit klinisch oder röntgenologisch präsenten metastatischen epiduralen Spinalkanalkompression ausgewertet. Das mediane Alter war 60 Jahre. Als Primärtumor waren Bronchialkarzinome (13 Patienten), Mammakarzinome (10) und Prostatakarzinome (10) am häufigsten zu finden. Ergebnisse: Die Therapieergebnisse hinsichtlich der Schmerzlinderung waren mit der Literatur vergleichbar (Ansprechrate= 66%). Als wichtigster prognostischer Faktor hinsichtlich der Gehfähigkeit hat sich der prätherapeutische Status erwiesen. Patienten, die Anfang der Therapie gehfähig waren, blieben in 94% der Fälle auch gehfähig, während nur ein Patient seine Gehfähigkeit bis Ende der Therapie wiedergewann (p< 0,001). Im Chi-Quadrat Test war auch der diagnosestellende Arzt prognostisch relevant: Patienten, deren Diagnose durch einen onkologisch tätigen Arzt gestellt wurde, hatten eine höhere Chance gehfähig zu bleiben (p=0,04). Das Gesamtüberleben (8 Monate median, Range 1-27 Monate ) entsprach den Literaturangaben. Nicht ambulante Patienten und Patienten mit Bronchialkarzinom hatten eine signifikant schlechtere Prognose (p / Materials and Methods: therapy charts of 53 consecutive patients, 31 male and 22 female, with metastatic epidural spinal cord compression treated with radiation therapy only have been analyzed. Median age was 60 ys. The most frequent primary tumours were bronchogenic carcinoma (13 patients), breast cancer (10 patients) and prostate cancer (10 patients),respectively.Results: MRI was the most sensitive diagnostic tool in detecting spinal cord compression. Plain X-ray films were not useful.Pain symptoms improved in 66% of the patients. The most important prognostic factor was the pretreatment mobility status. 94% of the ambulatory patients kept their walking ability but only one plegic patient could walk again after radiation therapy. (p=0.001) Patients whose back pain was presented to an oncologist were more likely to keep walking ability by the end of the therapy. (p=0.04) Patients with bronchogenic cancer and plegic patients had a significant worse survival. Conclusion: Patients with a known malignant tumor and progressive or axial back pain should undergo MRI scan to rule out spinal cord compression. For patients without severe neuorologic deficit and MRI proven epidural compression radiation therapy is able to preserve walking ability and reduce pain. General practitioners and patients should be informed about the symptoms and the therapeutic and diagnostic possibilities of spinal cord dompression.

Base teórica: O câncer de pulmão é uma doença com alta incidência e mortalidade, cujo prognóstico permanece discreto apesar do melhor entendimento da doença nas últimas décadas. A radioterapia tem papel terapêutico em todos os estágios da doença. A expressão da cofilina-1, uma proteína relacionada à mobilidade celular, determinou maior radiossensibilidade a células de adenocarcinoma brônquico em estudos in vitro, porém pior sobrevida em estádios iniciais Objetivo: Avaliar se a expressão da cofilina-1 interfere na sobrevida e no controle local em pacientes com câncer de pulmão submetidos a tratamento com radioterapia definitiva Métodos: Foram avaliados pacientes com câncer de pulmão não pequenas células, com estádios I–IV, que receberam radioterapia exclusiva ou combinada com quimioterapia, dirigida à neoplasia brônquica, na unidade de radioterapia do HCPA, nos anos de 2009 a 2015. Todos os pacientes tiveram a expressão de cofilina-1 aferida e foram distribuídos conforme os níveis de expressão de cofilina-1 utilizando-se de protocolo específico. Os prontuários foram avaliados retrospectivamente para calcular a sobrevida mediana. A progressão foi verificada através de avaliação de tomografias de tórax de controle. Resultados: Foram avaliados 45 pacientes neste estudo. A sobrevida mediana de todos os pacientes foi de 11,3 meses e a sobrevida global em 5 anos de 17,3%. Pacientes com expressão média ou alta de cofilina-1 tiveram maior mortalidade quando comparados com pacientes com baixa expressão (respectivamente, HR 1,628, IC95 1,137-8,287 e HR 1,59 IC95 1,105-7,342). Não houve diferença significantemente estatística entre controle local e expressão de cofilina-1. Conclusão: A expressão de cofilina-1 está associada à sobrevida em pacientes com carcinoma brônquico tratados com radioterapia e existe uma tendência a melhor controle local com baixa expressão. Nossos resultados sugerem um novo campo a ser explorado no manejo do carcinoma de pulmão localmente avançado, utilizando-se dos níveis de cofilina-1. / Background: Lung cancer is a disease with high incidence and mortality, whose prognosis remains poor despite a better understanding of the disease in the last decades. Radiotherapy plays a therapeutic role in all stages of disease. The expression of cofilin-1, a protein related to cellular mobility, determined greater radiosensitivity to lung adenocarcinoma cells in in vitro studies, but worse survival at initial stages. Objective: To evaluate if the expression of cofilin-1 modified survival and local control in lung cancer patients submitted to definitive treatment with radiotherapy. Methods: Patients with non-small cell lung cancer with stage IIV who received radiotherapy alone or combined with chemotherapy for lung cancer at the HCPA radiotherapy unit from 2009 to 2015 were evaluated. All patients had the expression of measured cofilin-1 evaluated and were distributed by cofilin-1 expression according to specific protocol. The medical records were retrospectively evaluated to estimate median survival. The progression was verified through evaluation of control chest tomography. Results: 45 patients were assessed in this study. The median survival of all patients was 11.3 months and the 5-year overall survival was 17.3%. Patients with medium or high expression of cofilin-1 had higher mortality rates when compared to patients with low expression (HR, 1,628, CI95, 1,137-8,287 and HR, 1.59, CI95, 1,105-7,342). There was no statistically significant difference between local control and cofilin-1 expression. Conclusion: cofilin-1 expression is associated with survival in patients with lung cancer treated with radiotherapy and there is a tendency for better local control with low CFL1 expression. Our results suggest a new field to be explored in the management of locally advanced lung carcinoma, using cofilin-1 expression levels.

At present, the combination of high drug development costs and external pressure to lower consumer prices is forcing the pharmaceutical industry to innovate in ways unlike ever before. One of the main drivers of increased productivity in research and development recently has been the application of computational methods to the drug discovery process. While this investment has generated promising insights in many cases, there is still much progress to be made.<div><br></div><div>There currently exists a dichotomy in the types of algorithms employed which are roughly defined by the extent to which they compromise predictive accuracy for computational efficiency, and vice versa. Many computational drug discovery algorithms exist which yield commendable predictive power but are typically associated with overwhelming resource costs. High-throughput methods are also available, but often suffer from disappointing and inconsistent performance. <br></div><div><br></div><div>In the world of kinase inhibitor design, which often takes advantage of such computational tools, small molecules tend to have myriad side effects. These are usually caused by off-target binding, especially with other kinases (given the large size of the enzyme family and overall structural conservation), and so inhibitors with tunable selectivity are generally desirable. This issue is compounded when considering therapeutically relevant targets like Abelson Protein Tyrosine Kinase (Abl) and Lymphocyte Specific Protein Tyrosine Kinase (Lck) which have opposing effects in many cancers. <br></div><div><br></div><div>This work attempts to solve both of these problems by creating a methodology which incorporates high-throughput computational drug discovery methods, modern machine learning techniques, and novel protein-ligand binding descriptors based on backbone hydrogen bond (dehydron) wrapping, chosen because of their potential in differentiating between kinases. Using this approach, a procedure was developed to quickly screen focused chemical libraries (in order to narrow the domain of applicability and keep medicinal chemistry at the forefront of development) for detection of selective kinase inhibitors. In particular, five pharmacologically relevant kinases were investigated to provide a proof of concept, including those listed above.</div><div><br></div><div>Ultimately, this work shows that dehydron wrapping indeed has predictive value, though it's likely hindered by common and current issues derived from noisy training data, imperfect feature selection algorithms, and simplifying assumptions made by high-throughput algorithms used for structural determination. It also shows that the procedure's predictive value varies depending on the target, leading to the conclusion that the utility of dehydron wrapping for drug design is not necessarily universal, as originally thought. However, for those targets which are amenable to the concept, there are two major benefits: relatively few features are required to produce modest results; and those structural features chosen are easily interpretable and can thereby improve the overall design process by pointing out regions to optimize within any given lead. Of the five kinases explored, Src and Lck are shown in this work to fit particularly well with the general hypothesis; given their importance in treating cancer and evading off-target related side effects, the developed methodology now has the potential to play a major role in the development of drug candidates which specifically inhibit and avoid these kinases.<br></div>

Este estudo avaliou, in vitro, a influência da radioterapia na resistência de união (RU) e na interface adesiva entre diferentes cimentos resinosos e dentina radicular. Sessenta caninos superiores foram distribuídos em 2 grupos (n=30) de acordo com a irradiação: não irradiados e irradiados. Os dentes do grupo irradiado foram submetidos à radioterapia com raios-X de 6 MV em frações de 2 Gy, com 30 ciclos, perfazendo 60 Gy. Os dentes foram seccionados para obtenção de raízes com 16 mm de comprimento, sendo realizado em seguida o preparo biomecânico com instrumento Reciproc R50 e obturação pela técnica de condensação lateral com cimento a base resina epóxica. Cada grupo foi subdividido de acordo com o cimento resinoso utilizado para a cimentação dos pinos de fibra de vidro (n=10): RelyX U200; Panavia F 2.0; RelyX ARC. Os pinos foram submetidos a tratamento de superfície com ácido fluorídrico 10% e cimentados de acordo com as recomendações de cada fabricante. Após a cimentação dos pinos, os dentes foram seccionados transversalmente em slices de 1 mm de espessura, obtendo-se 3 slices de cada terço da raiz. Os slices mais cervicais de cada terço foram utilizados para avaliar a RU, por meio do teste de push-out com velocidade de 0,5 mm/min, e posterior análise do padrão de falha em estereomicroscópio. Os slices mais apicais de cada terço foram selecionados para análise da interface cimento/dentina em MEV com aumentos de 100, 1000, 2000 e 4000X. Os dados de RU e adaptação da interface cimento/dentina foram submetidos à análise estatística pelos testes de ANOVA e Tukey, e Kruskal-Wallis e Duns, respectivamente. Os espécimes irradiados apresentaram menores valores de RU (8,23&plusmn;4,26) comparados aos dentes não irradiados (11,88&plusmn;6,42) (p<0,00001). Quanto aos cimentos resinosos, o RelyX U200 apresentou maiores valores na RU (15,17&plusmn;5,89) comparado aos cimentos RelyX ARC (7,68&plusmn;4,22) (p<0,0001) e Panavia F 2.0 (7,32&plusmn;2,71) (p<0,0001). O terço cervical apresentou maiores valores de RU (13,08&plusmn;6,10) comparado aos terços médio (9,72&plusmn;5,03) e apical (7,38&plusmn;4,53) (p<0,0001). O padrão de falhas mostrou ocorrência de falhas coesivas na dentina para os espécimes irradiados. Na análise da interface cimendo/dentina por MEV, observou-se maior desadaptação nos dentes submetidos à radioterapia. Em relação aos cimentos resinosos, foi observada maior adaptação com RelyX U200 e RelyX ARC comparados à Panavia F 2.0. Na análise qualitativa em MEV observou-se presença de fraturas e microfraturas na dentina radicular e menor presença de fibras colágenas em dentes irradiados. Para o cimento resinoso RelyX U200 e Panavia F 2.0 observou-se interface justaposta do cimento com a dentina radicular em dentes irradiados e não irradiados, sendo que para o cimento resinoso RelyX ARC foi observada formação de camada híbrida e tags de maneira similar para dentes irradiados e não irradiados. Concluiu-se que a radioterapia resultou na redução da resistência de união e na maior desadaptação da interface cimento resinoso/dentina radicular e que o cimento resinoso autoadesivo se apresentou como melhor alternativa para cimentação de pinos de fibra de vidro em dentes irradiados. / This in vitro study, evaluated the influency of radiotherapy on bond strength (BS) and adhesive interface between different resin cements and root dentin. Sixty maxillary canines were selected and distributed into two groups (n = 30) according to the irradiation protocol: non-irradiated and irradiated. The irradiated group were submitted to X-ray radiotherapy of 6 MV in fractions of 2 Gy, with 30 cycles, until complete 60 Gy. The teeth were sectioned to obtain 16 mm of root length, followed by biomechanical preparation with R50 reciproc instrument and obturation using the lateral condensation technique with epoxy resin-based sealer. Then, each group was subdivided according to the resin cement used for the glass fiber post cementation (n = 10): RelyX U200, Panavia F 2.0 and RelyX ARC. The posts were submitted to surface treatment with 10% hydrofluoric acid, and then cemented according to the manufacturer instructions. After the posts cementation, the teeth were sectioned transversely into 1 mm thick slices, and 3 slices were obtained from each root third. The most cervical slice of each third was used to evaluate the BS by the push-out test at 0.5 mm/min of velocity and the failure pattern was analyzed using stereomicroscopy. The most apical slice of each third was selected for SEM analysis, which were prepared and metalized. The dentin/cement interface analysis was performed at the following magnification: 100, 1000, 2000 and 4000X. The BS data and dentin/cement interface adaptation were submitted to statistical analysis by ANOVA, Tukey and Kruskal-Wallis, and Duns tests respectively. The irradiated specimens had lower BS values (8.23 &plusmn; 4.26) compared to non-irradiated group (11.88 &plusmn; 6.42) (p <0.00001). Regarding the resin cements, the RelyX U200 showed the higher values in BS (15.17 &plusmn; 5.89) compared to RelyX ARC (7.68 &plusmn; 4.22) and Panavia F 2.0 (7 , 32 &plusmn; 2.71) (p <0.0001). In addition, the cervical third presented higher BS values (13.08 &plusmn; 6.10) when compared to the middle (9.72 &plusmn; 5.03) and apical (7.38 &plusmn; 4.53) thirds (p <0.0001). The failure pattern showed cohesive failures in root dentin of the irradiated specimens. In the SEM dentin/cement interface analysis, a greater misadaptation was observed for the teeth submitted to radiotherapy. Regarding the resin cements, a better adaptation was observed for the RelyX U200 and RelyX ARC compared to the Panavia F 2.0. In the SEM qualitative analysis of the irradiated teeth, was possible to observe the presence of fractures and microfractures in the root dentin and a small number of collagen fibers. The resin cements RelyX U200 and Panavia F 2.0 showed a juxtaposed interface of the cement with the root dentin in irradiated and non-irradiated teeth, being that for the RelyX ARC cement the presence of hybrid layer and tags was similar for irradiated and non-irradiated groups. It was concluded that the radiotherapy promoted reduction of the bond strength and increase the gaps in the dentin/resin cement interface and the self-adhesive resin cement is the best alternative for glass fiber posts cementation in irradiated teeth.

La radiothérapie externe représente une part importante du traitement conservateur du sein. Le calendrier classique consiste à délivrer une dose totale de 50 Gy en 25 fractions sur 5 semaines. Pour certaines catégories de femmes, une radiothérapie de 5 à 6 semaines, avec des transports longs et fréquents est parfois difficile à réaliser. La radiothérapie peropératoire (RIOP) permet de prévenir le risque de récidive locale dans le lit tumoral, et ne nécessite que quelques jours d’hospitalisation. Cette étude se concentre sur l’utilisation d'une source de rayons X miniaturisée de faible énergie (50kV). Après résection chirurgicale de la tumeur, un applicateur est inséré dans le lit tumoral et le système délivre une dose unique de 20 Gy à sa surface. Cependant, il n'y a pas de prescription personnalisée ni d'information sur la dose délivrée et ce point est contestable, car un texte officiel recommande une optimisation de la dose individuelle. Dans ce contexte, un calcul Monte Carlo permet d'évaluer avec précision la dose délivrée à la patiente en simulant le transport des particules. Cette thèse propose d'évaluer ce critère de dose absorbée le plus justement possible à partir d'une modélisation réaliste de la source de rayons X et de calculs de dose individuels à l'aide de simulations de Monte Carlo en prenant en compte les hétérogénéités tissulaires du sein. Des mesures dosimétriques in vivo viennent également confirmer les résultats de simulations. / External radiation therapy is an important part of breast conservative treatment. The conventional calendar is to deliver a total dose of 50 Gy in 25 fractions over 5 weeks. For certain categories of women, 5 to 6 weeks of radiotherapy, with long and frequent transport is sometimes difficult to achieve. Intra-operative radiotherapy (IORT) helps to prevent the risk of local recurrence in the tumor bed, and only requires a few days of hospitalization. This study focuses on the use of a miniaturized low energy X-ray source (50kV). After surgical resection of the tumor, an applicator is inserted into the tumor bed and the system delivers a single dose of 20 Gy on its surface. However, there is no custom prescription and this is questionable since an official text recommends optimizing the individual dose. In this context, a Monte Carlo calculation makes it possible to accurately assess the dose delivered to the patient by simulating the transport of particles. This thesis proposes to assess the absorbed dose criterion as accurately as possible from a realistic model of the X-ray source and individual dose calculations using Monte Carlo simulations taking into account the tissue heterogeneities of the breast. In vivo dosimetric measurements also confirm the results of simulations.

Nearly 80% of children treated for cancer are expected to survive, but not without cost. Survivors face unprecedented challenges associated with long-term consequences of treatment, also called late effects. Approximately half of children treated for cancer are at risk for experiencing cognitive late effects, which typically emerge several years post diagnosis. The nature and extent of cognitive late effects appear to be developmental and related to patient, disease, and treatment variables. However, the relationships between these variables is not well understood because there have been few prospective and longitudinal studies that report on the contributions of these variables over time. This dissertation examined the effects of patient, disease, and treatment variables, as well as their interactions over time on neurocognitive functioning in childhood cancer survivors. It comprises part of a large prospective, randomized clinical trial designed to examine changes in cognitive function over three years as a function of different levels of monitoring of school-based intervention based on individual educational plans (IEPs). This dissertation uniquely contributed a new measure (the Treatment Intensity Rating Scale) that was used to systematically classify treatment severity across different types of cancer and cancer treatments. Participants included 61 children ages 7 to 12 years at enrollment who were two to five years from completion of treatment for a brain tumor, leukemia, or lymphoma. Participants received yearly neuropsychological evaluations for a follow-up period of 3 years. Results of these evaluations were used to develop IEPs. Participants were randomized to have their IEPs monitored on a quarterly or annual basis for the duration of the study. Contrary to the progressive decline in neurocognitive functioning that is typically anticipated in pediatric cancer survivors, analyses revealed relative stability of performance on neurocognitive measures over time. Higher neurocognitive performance was noted in children whose IEPs were monitored more frequently versus less frequently. Results also supported gender-specific risk for late effects, with lower performance on select neurocognitive measures in females compared to males. Results of this study provide encouraging evidence of the positive effects of school-based interventions and their close monitoring. This has important implications for quality of life as these children survive well beyond childhood into adulthood.

In recent years intensity modulated radiation therapy with photons (xIMRT) has gained attention due to its ability to reduce the dose in the tissues close to the tumour volume. However, this technique also results in a large low dose volume. Electron IMRT (eIMRT) has the potential to reduce the integral dose to the patient due to the dose fall off in the electron depth dose curves. This dose fall off makes it possible to modulate the dose distribution in the direction of the beam by selecting appropriate electron energies. The use of a computer based energy selection method was examined in combination with the IMRT technique to optimise the electron dose distribution. It is clearly illustrated that the energy optimisation procedure reduces the dose to lung and heart in a breast cancer treatment. To shape the multiple electron subfields (beamlets) that are used in eIMRT, an electron multi leaf collimator (eMLC) is needed. However, photons produced in a conventional electron treatment head could penetrate such an added eMLC, thus producing an undesirable dose contribution. The leakage levels normally achieved are acceptable for standard single electron field treatments but could become unacceptably high in eIMRT treatments where a lot of small subfields are combined. To limit this photon contribution, the photon MLC (xMLC) was used to shield off large parts of the photon leakage. The effect of this xMLC shielding on the reduction of photon leakage, the electron beam penumbras, and electron output (dose level), was studied using Monte Carlo methods for different electron treatment head designs. The use of helium as a mean to reduce the electron scatter in the treatment head, and thus the perturbating effect of the xMLC on electron beam penumbra and output, was also investigated. This thesis shows that the effect of the xMLC shielding on the electron beam penumbra and output can be made negligible while still obtaining a significantly reduced x-ray leakage dose contribution. The result is a large gain in radiation protection of the patient and a better dynamic range for the eIMRT dose optimisation. For this optimisation a computer based electron energy selection method was developed and tested on two clinical cases.

In this thesis, optimization approaches for intensity-modulated radiation therapy are developed and evaluated with focus on numerical efficiency and treatment delivery aspects. The first two papers deal with strategies for solving fluence map optimization problems efficiently while avoiding solutions with jagged fluence profiles. The last two papers concern optimization of step-and-shoot parameters with emphasis on generating treatment plans that can be delivered efficiently and accurately. In the first paper, the problem dimension of a fluence map optimization problem is reduced through a spectral decomposition of the Hessian of the objective function. The weights of the eigenvectors corresponding to the p largest eigenvalues are introduced as optimization variables, and the impact on the solution of varying p is studied. Including only a few eigenvector weights results in faster initial decrease of the objective value, but with an inferior solution, compared to optimization of the bixel weights. An approach combining eigenvector weights and bixel weights produces improved solutions, but at the expense of the pre-computational time for the spectral decomposition. So-called iterative regularization is performed on fluence map optimization problems in the second paper. The idea is to find regular solutions by utilizing an optimization method that is able to find near-optimal solutions with non-jagged fluence profiles in few iterations. The suitability of a quasi-Newton sequential quadratic programming method is demonstrated by comparing the treatment quality of deliverable step-and-shoot plans, generated through leaf sequencing with a fixed number of segments, for different number of bixel-weight iterations. A conclusion is that over-optimization of the fluence map optimization problem prior to leaf sequencing should be avoided. An approach for dynamically generating multileaf collimator segments using a column generation approach combined with optimization of segment shapes and weights is presented in the third paper. Numerical results demonstrate that the adjustment of leaf positions improves the plan quality and that satisfactory treatment plans are found with few segments. The method provides a tool for exploring the trade-off between plan quality and treatment complexity by generating a sequence of deliverable plans of increasing quality. The final paper is devoted to understanding the ability of the column generation approach in the third paper to find near-optimal solutions with very few columns compared to the problem dimension. The impact of different restrictions on the generated columns is studied, both in terms of numerical behaviour and convergence properties. A bound on the two-norm of the columns results in the conjugate-gradient method. Numerical results indicate that the appealing properties of the conjugate-gradient method on ill-conditioned problems are inherited in the column generation approach of the third paper. / QC 20100709

Ο μυελός των οστών επηρεάζεται από λεμφοϋπερπλαστικές διαταραχές, μεταστατική νόσο, αλλά και από διάφορες θεραπευτικές προσεγγίσεις. Η μαγνητική τομογραφία είναι η πιο κατάλληλη μέθοδος για την ανίχνευση των μεταστάσεων και την παρακολούθηση μετά τη θεραπεία. Τεχνικές ανάλυσης εικόνας χρησιμοποιούνται επιπλέον προκειμένου να αντλήσουμε πρόσθετες διαγνωστικές πληροφορίες. Η παρούσα μελέτη επικεντρώνεται στις πρώιμες αλλαγές που προκαλούνται στον οστικό μυελό μετά από ακτινοβόληση και συγκρίνει καθιερωμένες μεθόδους για την ταυτοποίηση και τον χαρακτηρισμό αυτών των βλαβών με τη χρήση ενός αυτοματοποιημένου συστήματος ταξινόμησης. ΜΕΘΟΔΟΙ: 36 ασθενείς με ιστολογικά επιβεβαιωμένη πρωτοπαθή κακοήθεια και οστικές μεταστάσεις συμπεριλήφθηκαν στη μελέτη. Όλοι οι ασθενείς υποβλήθηκαν σε ακττινοθεραπεία για την αντιμετώπιση οστικών μεταστάσεων στη σπονδυλική στήλη ή τη λεκάνη. Η μαγνητική τομογραφία πραγματοποιήθηκε ακριβώς πριν, 12 έως 18 ημέρες και 3 μήνες μετά την έναρξη της ακτινοθεραπείας. Ελήφθησαν εικόνες εντός, πλησίον και εκτός του πεδίου ακτινοβόλησης. Η ποιοτική αξιολόγηση πραγματοποιήθηκε ανεξάρτητα από δύο έμπειρους ακτινολόγους. Για την ποσοτική αξιολόγηση, συγκεκριμένες μετρήσεις επιλέχθηκαν και αξιολογήθηκαν με τη μέθοδο της περιοχής ενδιαφέροντος. Επιπλέον, χαρακτηριστικά υφής 1ης και 2ης τάξης εξήχθησαν και τοποθετήθηκαν σε ένα πιθανοτικό νευρωνικό δίκτυο, προκειμένου να δημιουργηθεί ένα σύστημα αυτόματης ταξινόμησης των βλαβών. ΑΠΟΤΕΛΕΣΜΑΤΑ: Σύμφωνα με την ποιοτική και ποσοτική αξιολόγηση, εντός του πεδίου ακτινοβολίας 22.22% και 33.33% των ασθενών αντίστοιχα παρουσίασε λιπώδη μεταστροφή του μυελού, 19.44% και 16.67% των ασθενών παρουσίασε αιμορραγία, ενώ 11.11% και 16.67% των ασθενών εμφάνισε οίδημα του οστικού μυελού. Παρακείμενα του πεδίου ακτινοβόλησης 11.11% και 19.44% των ασθενών παρουσίασε λιπώδη μεταστροφή, 8.33% παρουσίασε αιμορραγία, ενώ 2.78% και 8.33% έδειξε οίδημα του μυελού των οστών. Εκτός του πεδίου ακτινοβολίας 5.56% των ασθενών παρουσίασαν αλλαγές συμβατές με λιπώδη μεταστροφή, ενώ το υπόλοιπο 94.44% δεν έδειξε σημαντικές μεταβολές. Δεν υπήρξε στατιστικά σημαντική μεταβολή του δείκτη σκιαγραφικής ενίσχυσης μετά τη χορήγηση γαδολινίου. Με βάση την πολυπαραγοντική ανάλυση, καμία από τις παραμέτρους που μελετήθηκαν δεν φάνηκε να επηρεάζει στατιστικά σημαντικά την εμφάνιση οποιασδήποτε από τις μετακτινικές αλλοιώσεις. Η μέγιστη συνολική ακρίβεια ταξινόμησης του συστήματός μας, ως προς τη διάκριση μεταξύ προ και μετακτινικών εικόνων ήταν 93.02%, με χρήση του συστήματος ταξινόμησης LSFT - PNN και της μεθόδου ECV. Η ακρίβεια του συστήματος στη διάκριση μεταξύ των τριών κυρίων τύπων των μετακτινικών βλαβών ήταν 86.67% . ΣΥΜΠΕΡΑΣΜΑΤΑ: Η παρούσα μελέτη δείχνει ότι σημαντικό ποσοστό των ασθενών που υποβάλλονται σε ακτινοθεραπεία θα εμφανίσει τουλάχιστον μία από τις κοινές μετακτινικές μεταβολές του οστικού μυελού. Η λιπώδης μεταστροφή του μυελού είναι η πιο συχνά εμφανιζόμενη πρώιμη μεταβολή. Η ποιοτική ανάλυση των εικόνων μαγνητικής τομογραφίας υστερεί σε ευαισθησία σε σύγκριση με τις ποσοτικές μετρήσεις. Το βασζόμενο σε νευρικό δίκτυο προτεινόμενο σύστημα ταξινόμησης μπορεί να αποδειχθεί χρήσιμο εργαλείο για το χαρακτηρισμό αυτών των βλαβών. / Bone marrow can be affected by lymphoproliferative disorders and metastatic disease but also by several therapeutic approaches. MRI is the most suitable method for the detection of metastases and post-treatment follow-up. Image analysis techniques are now used to extract additional diagnostic information. This study focuses on the early radiation-induced changes that can be detected by MRI and compares the established methods for the identification and characterization of these lesions with an automated classification system. METHODS: 36 patients with histologically confirmed primary malignancy and associated bone metastases were included in the study. All patients underwent radiation therapy (RT) to treat bone metastases to the spinal column or the pelvis. Magnetic resonance imaging (MRI) was performed just before the start of RT, 12 to 18 days and up to 3 months after the start of RT. Images were obtained within, adjacent and outside the radiation field. Qualitative assessment was performed independently by two experienced radiologists. For quantitative assessment, specific measurements were selected and evaluated by the method of the region of interest (ROI). In addition, textural features of 1st and 2nd class were exported and inserted into a probabilistic neural network classifier, in order to create an automatic classification system for these lesions. RESULTS: Following qualitative and quantitative assessment, within the radiation field, 22.22% and 33.33% of patients respectively showed fatty conversion of the bone marrow, 19.44% and 16.67% of patients showed haemorrhage, while 11.11% and 16.67% of the patients demonstrated bone marrow oedema. Adjacent to the radiation field, 11.11% and 19.44% of patients showed fatty conversion, 8.33% showed haemorrhage, while 2.78% and 8.33% demonstrated bone marrow oedema. Outside of the radiation field, 5.56% of patients showed changes compatible with fatty conversion, while the remaining 94.44% showed no significant change. There was no statistically significant change of the enhancement index after gadolinium administration. In multivariate analysis, none of the studied parameters did not appear to affect significantly the appearance of any of the radiation-induced lesions. The largest overall classification accuracy of the system designed to distinguish between the pre- radiation and radiation-induced images was 93.02% using the LSFT-PNN classification system of multiple sequences and the ECV method. Discrimination accuracy of the classification system designed to distinguish between the three main types of post-radiation lesions was 86.67%. CONCLUSIONS: This study shows that a significant proportion of patients undergoing RT will experience at least one of the common radiation-induced bone marrow changes. Fatty marrow conversion is the most often featured change in the examined period. Qualitative analysis of the MRI images lacks sensitivity comparing to quantitative measurements. The proposed classification system, based on the neural network, can be used as a very helpful tool for the characterization of these lesions.