| 1. |
- Giesler, Reiner, et al.
(författare)
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Catchment-scale dissolved carbon concentrations and exportestimates across six subarctic streams in northern Sweden
- 2014
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Ingår i: Biogeosciences. - : Copernicus GmbH. - 1726-4170 .- 1726-4189. ; 11:2, s. 525-537
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Tidskriftsartikel (refereegranskat)abstract
- Climatic change is currently enhancing permafrost thawing and the flow of water through the landscape in subarctic and arctic catchments, with major consequences for the carbon export to aquatic ecosystems. We studied stream water carbon export in several tundra-dominated catchments in northern Sweden. There were clear seasonal differences in both dissolved organic carbon (DOC) and dissolved inorganic carbon (DIC) concentrations. The highest DOC concentrations occurred during the spring freshet while the highest DIC concentrations were always observed during winter baseflow conditions for the six catchments considered in this study. Long-term trends for the period 1982 to 2010 for one of the streams showed that DIC concentrations has increased by 9% during the 28 yr of measurement while no clear trend was found for DOC. Similar increasing trends were also found for conductivity, Ca and Mg. When trends were discretized into individual months, we found a significant linear increase in DIC concentrations with time for September, November and December. In these subarctic catchments, the annual mass of C exported as DIC was in the same order of magnitude as DOC; the average proportion of DIC to the total dissolved C exported was 61% for the six streams. Furthermore, there was a direct relationship between total runoff and annual dissolved carbon fluxes for these six catchments. These relationships were more prevalent for annual DIC exports than annual DOC exports in this region. Our results also highlight that both DOC and DIC can be important in high-latitude ecosystems. This is particularly relevant in environments where thawing permafrost and changes to subsurface ice due to global warming can influence stream water fluxes of C. The large proportion of stream water DIC flux also has implications on regional C budgets and needs to be considered in order to understand climate-induced feedback mechanisms across the landscape.
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| 2. |
- Johansson, Karl-Axel, et al.
(författare)
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The quality assurance process for the ARTSCAN head and neck study - a practical interactive approach for QA in 3DCRT and IMRT.
- 2008
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Ingår i: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. - : Elsevier BV. - 0167-8140 .- 1879-0887. ; 87:2, s. 290-9
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Tidskriftsartikel (refereegranskat)abstract
- AIM: This paper describes the quality assurance (QA) work performed in the Swedish multicenter ARTSCAN (Accelerated RadioTherapy of Squamous cell CArcinomas in the head and Neck) trial to guarantee high quality in a multicenter study which involved modern radiotherapy such as 3DCRT or IMRT. MATERIALS AND METHODS: The study was closed in June 2006 with 750 randomised patients. Radiation therapy-related data for every patient were sent by each participating centre to the QA office where all trial data were reviewed, analysed and stored. In case of any deviation from the protocol, an interactive process was started between the QA office and the local responsible clinician and/or physicist to increase the compliance to the protocol for future randomised patients. Meetings and workshops were held on a regular basis for discussions on various trial-related issues and for the QA office to report on updated results. RESULTS AND DISCUSSION: This review covers the 734 patients out of a total of 750 who had entered the study. Deviations early in the study were corrected so that the overall compliance to the protocol was very high. There were only negligible variations in doses and dose distributions to target volumes for each specific site and stage. The quality of the treatments was high. Furthermore, an extensive database of treatment parameters was accumulated for future dose-volume vs. endpoint evaluations. CONCLUSIONS: This comprehensive QA programme increased the probability to draw firm conclusions from our study and may serve as a concept for QA work in future radiotherapy trials where comparatively small effects are searched for in a heterogeneous tumour population.
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| 3. |
- Jonsson, Joakim H, et al.
(författare)
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Treatment planning using MRI data: an analysis of the dose calculation accuracy for different treatment regions
- 2010
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Ingår i: Radiation Oncology. - 1748-717X. ; 5, s. 62-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Because of superior soft tissue contrast, the use of magnetic resonance imaging (MRI) as a complement to computed tomography (CT) in the target definition procedure for radiotherapy is increasing. To keep the workflow simple and cost effective and to reduce patient dose, it is natural to strive for a treatment planning procedure based entirely on MRI. In the present study, we investigate the dose calculation accuracy for different treatment regions when using bulk density assignments on MRI data and compare it to treatment planning that uses CT data.METHODS: MR and CT data were collected retrospectively for 40 patients with prostate, lung, head and neck, or brain cancers. Comparisons were made between calculations on CT data with and without inhomogeneity corrections and on MRI or CT data with bulk density assignments. The bulk densities were assigned using manual segmentation of tissue, bone, lung, and air cavities.RESULTS: The deviations between calculations on CT data with inhomogeneity correction and on bulk density assigned MR data were small. The maximum difference in the number of monitor units required to reach the prescribed dose was 1.6%. This result also includes effects of possible geometrical distortions.CONCLUSIONS: The dose calculation accuracy at the investigated treatment sites is not significantly compromised when using MRI data when adequate bulk density assignments are made. With respect to treatment planning, MRI can replace CT in all steps of the treatment workflow, reducing the radiation exposure to the patient, removing any systematic registration errors that may occur when combining MR and CT, and decreasing time and cost for the extra CT investigation.
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| 4. |
- Jonsson, Joakim, 1984-
(författare)
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Integration of MRI into the radiotherapy workflow
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The modern day radiotherapy treatments are almost exclusively based on computed tomography (CT) images. The CT images are acquired using x-rays, and therefore reflect the radiation interaction properties of the material. This information is used to perform accurate dose calculation by the treatment planning system, and the data is also well suited for creating digitally reconstructed radiographs for comparing patient set up at the treatment machine where x-ray images are routinely acquired for this purpose.The magnetic resonance (MR) scanner has many attractive features for radiotherapy purposes. The soft tissue contrast as compared to CT is far superior, and it is possible to vary the sequences in order to visualize different anatomical and physiological properties of an organ. Both of these properties may contribute to an increase in accuracy of radiotherapy treatment.Using the MR images by themselves for treatment planning is, however, problematic. MR data reflects the magnetic properties of protons, and thus have no connection to the radiointeraction properties of the material. MRI also has inherent difficulty in imaging bone, which will appear in images as areas of no signal similar to air. This makes both dose calculation and patient positioning at the treatment machine troublesome.There are several clinics that use MR images together with CT images to perform treatment planning. The images are registered to a common coordinate system, a process often described as image fusion. In these cases, the MR images are primarily used for target definition and the CT images are used for dose calculations. This method is now not ideal, however, since the image fusion may introduce systematic uncertainties into the treatment due to the fact that the tumor is often able to move relatively freely with respect to the patients’ bony anatomy and outer contour, especially when the image registration algorithms take the entire patient anatomy in the volume of interest into account.The work presented in the thesis “Integration of MRI into the radiotherapy workflow” aim towards investigating the possibilities of workflows based entirely on MRI without using image registration, as well as workflows using image registration methods that are better suited for targets that can move with respect to surrounding bony anatomy, such as the prostate.
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| 5. |
- Karlsson, Mikael, et al.
(författare)
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Dedicated magnetic resonance imaging in the radiotherapy clinic
- 2009
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Ingår i: International journal of radiation oncology, biology, physics. - : Elsevier BV. - 1879-355X .- 0360-3016. ; 74:2, s. 644-651
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To introduce a novel technology arrangement in an integrated environment and outline the logistics model needed to incorporate dedicated magnetic resonance (MR) imaging in the radiotherapy workflow. An initial attempt was made to analyze the value and feasibility of MR-only imaging compared to computed tomography (CT) imaging, testing the assumption that MR is a better choice for target and healthy tissue delineation in radiotherapy. METHODS AND MATERIALS: A 1.5-T MR unit with a 70-cm-bore size was installed close to a linear accelerator, and a special trolley was developed for transporting patients who were fixated in advance between the MR unit and the accelerator. New MR-based workflow procedures were developed and evaluated. RESULTS: MR-only treatment planning has been facilitated, thus avoiding all registration errors between CT and MR scans, but several new aspects of MR imaging must be considered. Electron density information must be obtained by other methods. Generation of digitally reconstructed radiographs (DRR) for x-ray setup verification is not straight forward, and reliable corrections of geometrical distortions must be applied. The feasibility of MR imaging virtual simulation has been demonstrated, but a key challenge to overcome is correct determination of the skeleton, which is often needed for the traditional approach of beam modeling. The trolley solution allows for a highly precise setup for soft tissue tumors without the invasive handling of radiopaque markers. CONCLUSIONS: The new logistics model with an integrated MR unit is efficient and will allow for improved tumor definition and geometrical precision without a significant loss of dosimetric accuracy. The most significant development needed is improved bone imaging.
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| 6. |
- Karlsson, Magnus G, et al.
(författare)
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Semi-conductor detectors in output factor measurements
- 1997
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Ingår i: Radiotherapy and Oncology. - 0167-8140 .- 1879-0887. ; 42:3, s. 293-296
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose: Output factors are generally measured with cylindrical ionization chambers. It was investigated if Si-diodes of p-type instead could be used. The advantage would be the small detector size and the robust construction of the detector. Materials and methods: Two types of diodes were studied, one with a shielding layer of tungsten specially made to reduce the excess response for scattered photons and one standard diode without any extra shielding. The measurements were performed at accelerating potentials between 4 and 50 MV and beam sizes between 4 cm x 4 cm and 40 cm x 40 cm. Results: The results showed that both types of diodes are suitable for measurements of head scatter factors in mini-phantoms. However, the diodes were found inappropriate for measurement of output factors for large fields in extended water phantoms. For small fields (<10 cm x 10 cm) a small detector is advantageous and no errors due to the scatter contribution were seen. Conclusions: An cylindrical ionization chamber is the best choice for output factor measurements in extended water phantoms for large field sizes while diodes are an alternative in small fields. There were negligible differences between the detectors in head scatter measurements in mini phantoms.
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| 7. |
- Karlsson, Mikael, et al.
(författare)
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MR-only procedures for improved overall precision in radiotherapy
- 2009
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Ingår i: International Journal of Radiation Oncology Biology Physics. - : Elsevier BV. - 0360-3016. ; , s. S656-S656
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Konferensbidrag (refereegranskat)abstract
- Purpose/Objective(s) To reduce the overall geometrical uncertainty in radiotherapy by introducing a novel technology arrangement based on a dedicated MR in an integrated workflow. A new logistics model needed to incorporate MR in this way was developed and clinically evaluated. Testing the assumption that MR is a better choice for target and healthy tissue delineation in radiotherapy, the suggested procedure was analyzed with respect to feasibility and precision of MR-only imaging compared to CT. The focus of the present study was on the geometrical uncertainty which is connected to the required margins between PTV and CTV. Materials/Methods A 1.5-T “open bore” MR unit with a 70-cm-bore size, Siemens Espree, was installed in close proximity to a treatment unit. A new MR-based workflow procedure was developed where all target drawing and treatment planning was performed on MR-data only. For non-fixed soft tissue targets, e.g. prostate, a special trolley was developed for transporting patients, who were immobilized, between the MR unit and the accelerator. The geometrical uncertainty using the transport solution was added to the uncertainty originating from the target definition process and compared with the total uncertainty in a more conventional CT based workflow. Results MR-only treatment planning has been facilitated, thus avoiding all registration errors between CT and MR data, but several new aspects of MR imaging must be considered. Reliable corrections of geometrical distortions must be applied and electron density information must be obtained by other methods. The feasibility of MR virtual simulation has previously been demonstrated. However, a key challenge is improve the visualization of skeletal structures, which is often needed for the traditional approach of set-up verification. The trolley solution allows for a highly precise setup of soft tissue targets without the invasive handling of fiducial markers. In the overall analyses of geometrical uncertainties it was shown that the combined uncertainty is reduced with the MR based workflow, mostly because of reduced systematic uncertainties when the CT-image registration is avoided. Conclusions The new logistics model is efficient and will allow for improved tumor definition and geometrical precision without a significant loss of dosimetric accuracy. Treatment planning directly on MR images is a way to reduce the geometrical uncertainty for e.g. prostate treatments. MR aided patient positioning does not require implanted fiducial markers and will be facilitated by rigid MR-MR registration. Less precise soft tissue CT-CT or CT-MR registrations will thus be avoided.
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| 8. |
- Nordström, Anna, et al.
(författare)
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Bone loss and fracture risk after reduced physical activity.
- 2005
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Ingår i: Journal of Bone and Mineral Research. - 0884-0431 .- 1523-4681. ; 20:2, s. 202-207
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Tidskriftsartikel (refereegranskat)abstract
- Former male young athletes partially lost benefits in BMD (g/cm2) with cessation of exercise, but, despite this, had a higher BMD 4 years after cessation of career than a control group. A higher BMD might contribute to the lower incidence of fragility fractures found in former older athletes > or =60 years of age compared with a control group. INTRODUCTION: Physical activity increases peak bone mass and may prevent osteoporosis if a residual high BMD is retained into old age. MATERIALS AND METHODS: BMD was measured by DXA in 97 male young athletes 21.0 +/- 4.5 years of age (SD) and 48 controls 22.4 +/- 6.3 years of age, with measurements repeated 5 years later, when 55 of the athletes had retired from sports. In a second, older cohort, fracture incidence was recorded in 400 former older athletes and 800 controls > or =60 years of age. RESULTS: At baseline, the young athletes had higher BMD than controls in total body (mean difference, 0.08 g/cm2), spine (mean difference, 0.10 g/cm2), femoral neck (mean difference, 0.13 g/cm2), and arms (mean difference, 0.05 g/cm2; all p < 0.001). During the follow-up period, the young athletes who retired lost more BMD than the still active athletes at the femoral neck (mean difference, 0.07 g/cm2; p = 0.001) and gained less BMD at the total body (mean difference, 0.03 g/cm2; p = 0.004). Nevertheless, BMD was still higher in the retired young athletes (mean difference, 0.06-0.08 g/cm2) than in the controls in the total body, femoral neck, and arms (all p < 0.05). In the older cohort, there were fewer former athletes > or =60 of age than controls with fragility fractures (2.0% versus 4.2%; p < 0.05) and distal radius fractures (0.75% versus 2.5%; p < 0.05). CONCLUSIONS: Although exercise-induced BMD benefits are reduced after retirement from sports, former male older athletes have fewer fractures than matched controls.
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| 9. |
- Nyholm, Tufve, et al.
(författare)
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A national approach for automated collection of standardized and population-based radiation therapy data in Sweden
- 2016
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Ingår i: Radiotherapy and Oncology. - : Elsevier BV. - 0167-8140 .- 1879-0887. ; 119:2, s. 344-350
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To develop an infrastructure for structured and automated collection of interoperable radiation therapy (RT) data into a national clinical quality registry. Materials and methods: The present study was initiated in 2012 with the participation of seven of the 15 hospital departments delivering RT in Sweden. A national RT nomenclature and a database for structured unified storage of RT data at each site (Medical Information Quality Archive, MIQA) have been developed. Aggregated data from the MIQA databases are sent to a national RT registry located on the same IT platform (INCA) as the national clinical cancer registries. Results: The suggested naming convention has to date been integrated into the clinical workflow at 12 of 15 sites, and MIQA is installed at six of these. Involvement of the remaining 3/15 RT departments is ongoing, and they are expected to be part of the infrastructure by 2016. RT data collection from ARIA (R), Mosaiq (R), Eclipse (TM), and Oncentra (R) is supported. Manual curation of RT-structure information is needed for approximately 10% of target volumes, but rarely for normal tissue structures, demonstrating a good compliance to the RT nomenclature. Aggregated dose/volume descriptors are calculated based on the information in MIQA and sent to INCA using a dedicated service (MIQA2INCA). Correct linkage of data for each patient to the clinical cancer registries on the INCA platform is assured by the unique Swedish personal identity number. Conclusions: An infrastructure for structured and automated prospective collection of syntactically inter operable RT data into a national clinical quality registry for RT data is under implementation. Future developments include adapting MIQA to other treatment modalities (e.g. proton therapy and brachytherapy) and finding strategies to harmonize structure delineations. How the RT registry should comply with domain-specific ontologies such as the Radiation Oncology Ontology (ROO) is under discussion.
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| 10. |
- Nyholm, Tufve, et al.
(författare)
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MR based treatment workflow for external radiotherapy of prostate cancer
- 2009
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Ingår i: World Congress on Medical Physics and Biomedical Engineering, September 7 - 12, 2009, Munich, Germany. - Berlin : Springer. ; , s. 60-63
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Konferensbidrag (refereegranskat)abstract
- The requirements on spatial accuracy are high in external radiotherapy of prostate cancer. The technical achievements in image guided radiotherapy (IGRT) during the recent years have lead to a significant improvement of teh daily positioning accuracy. Improved accuracy has made it possible to reduce the margin between the clinical target volume and the planning target volume, thus reduce the risk for normal tissue complications.MRI is to prefer to CT for delineation of the prostate target because of superior soft tissue contrast. Recent studies have shown that the dosimetric accuracy of dose calculations on MR material is acceptable. In the present work we analyze the spatial uncertainties that are connected to workflows where the CT has been excluded.We found that accuracy increase with a fully MR based workflow. The main reason is that the MR based workflow does not require any registration between MR and CT to enable target delineation on the MR series. Two different methodologies for patient positioning with MR as baseline were identified: A. Implanted fiducial markers with portal imaging at each treatment session. B. Imaging of the patient in the MR at every treatment session to localize the prostate. We found that the two positioning methods give equivalent spatial accuracy. The estimated required margins for the MR based workflows was around 8 mm, corresponding numbers for a CT based workflow using the same assessment methods was around 10 mm.
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