| 1. |
- Grefve, Josefine, et al.
(författare)
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Histopathology-validated gross tumor volume delineations of intraprostatic lesions using PSMA-positron emission tomography/multiparametric magnetic resonance imaging
- 2024
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Ingår i: Physics and Imaging in Radiation Oncology. - : Elsevier. - 2405-6316. ; 31
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose: Dose escalation in external radiotherapy of prostate cancer shows promising results in terms of biochemical disease-free survival. Boost volume delineation guidelines are sparse which may cause high interobserver variability. The aim of this research was to characterize gross tumor volume (GTV) delineations based on multiparametric magnetic resonance imaging (mpMRI) and prostate specific membrane antigen-positron emission tomography (PSMA-PET) in relation to histopathology-validated Gleason grade 4 and 5 regions.Material and methods: The study participants were examined with [68Ga]PSMA-PET/mpMRI prior to radical prostatectomy. Four radiation oncologists delineated GTVs in 15 study participants, on four different image types; T2-weighted (T2w), diffusion weighted imaging (DWI), dynamic contrast enhanced (DCE) and PSMA-PET scans separately. The simultaneous truth and performance level estimation (STAPLE) algorithm was used to generate combined GTVs. GTVs were subsequently compared to histopathology. We analysed how Dice similarity coefficient (DSC) and lesion coverage are affected by using single versus multiple image types as well as by adding a clinical target volume (CTV) margin.Results: Median DSC (STAPLE) for different GTVs varied between 0.33 and 0.52. GTVPSMA-PET/mpMRI generated the highest median lesion coverage at 0.66. Combining different image types achieved similar lesion coverage as adding a CTV margin to contours from a single image type, while reducing non-malignant tissue inclusion within the target volume.Conclusion: The combined use of mpMRI or PSMA-PET/mpMRI shows promise, achieving higher DSC and lesion coverage while minimizing non-malignant tissue inclusion, in comparison to the use of a single image type with an added CTV margin.
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| 2. |
- Nilsson, Erik, et al.
(författare)
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The grade of individual prostate cancer lesions predicted by magnetic resonance imaging and positron emission tomography
- 2023
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Ingår i: Communications Medicine. - : Springer Nature. - 2730-664X. ; 3:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Multiparametric magnetic resonance imaging (mpMRI) and positron emission tomography (PET) are widely used for the management of prostate cancer (PCa). However, how these modalities complement each other in PCa risk stratification is still largely unknown. We aim to provide insights into the potential of mpMRI and PET for PCa risk stratification.Methods: We analyzed data from 55 consecutive patients with elevated prostate-specific antigen and biopsy-proven PCa enrolled in a prospective study between December 2016 and December 2019. [68Ga]PSMA-11 PET (PSMA-PET), [11C]Acetate PET (Acetate-PET) and mpMRI were co-registered with whole-mount histopathology. Lower- and higher-grade lesions were defined by International Society of Urological Pathology (ISUP) grade groups (IGG). We used PET and mpMRI data to differentiate between grades in two cases: IGG 3 vs. IGG 2 (case 1) and IGG ≥ 3 vs. IGG ≤ 2 (case 2). The performance was evaluated by receiver operating characteristic (ROC) analysis.Results: We find that the maximum standardized uptake value (SUVmax) for PSMA-PET achieves the highest area under the ROC curve (AUC), with AUCs of 0.72 (case 1) and 0.79 (case 2). Combining the volume transfer constant, apparent diffusion coefficient and T2-weighted images (each normalized to non-malignant prostatic tissue) results in AUCs of 0.70 (case 1) and 0.70 (case 2). Adding PSMA-SUVmax increases the AUCs by 0.09 (p < 0.01) and 0.12 (p < 0.01), respectively.Conclusions: By co-registering whole-mount histopathology and in-vivo imaging we show that mpMRI and PET can distinguish between lower- and higher-grade prostate cancer, using partially discriminative cut-off values.
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| 3. |
- Sandgren, Kristina, et al.
(författare)
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Histopathology-validated lesion detection rates of clinically significant prostate cancer with mpMRI, [68Ga]PSMA-11-PET and [11C]Acetate-PET
- 2023
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Ingår i: Nuclear medicine communications. - : Lippincott Williams & Wilkins. - 0143-3636 .- 1473-5628. ; 44:11, s. 997-1004
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Tidskriftsartikel (refereegranskat)abstract
- Objective: PET/CT and multiparametric MRI (mpMRI) are important diagnostic tools in clinically significant prostate cancer (csPC). The aim of this study was to compare csPC detection rates with [68Ga]PSMA-11-PET (PSMA)-PET, [11C] Acetate (ACE)-PET, and mpMRI with histopathology as reference, to identify the most suitable imaging modalities for subsequent hybrid imaging. An additional aim was to compare inter-reader variability to assess reproducibility.Methods: During 2016–2019, all study participants were examined with PSMA-PET/mpMRI and ACE-PET/CT prior to radical prostatectomy. PSMA-PET, ACE-PET and mpMRI were evaluated separately by two observers, and were compared with histopathology-defined csPC. Statistical analyses included two-sided McNemar test and index of specific agreement.Results: Fifty-five study participants were included, with 130 histopathological intraprostatic lesions >0.05 cc. Of these, 32% (42/130) were classified as csPC with ISUP grade ≥2 and volume >0.5 cc. PSMA-PET and mpMRI showed no difference in performance (P = 0.48), with mean csPC detection rate of 70% (29.5/42) and 74% (31/42), respectively, while with ACE-PET the mean csPC detection rate was 37% (15.5/42). Interobserver agreement was higher with PSMA-PET compared to mpMRI [79% (26/33) vs 67% (24/38)]. Including all detected lesions from each pair of observers, the detection rate increased to 90% (38/42) with mpMRI, and 79% (33/42) with PSMA-PET.Conclusion: PSMA-PET and mpMRI showed high csPC detection rates and superior performance compared to ACE-PET. The interobserver agreement indicates higher reproducibility with PSMA-PET. The combined result of all observers in both PSMA-PET and mpMRI showed the highest detection rate, suggesting an added value of a hybrid imaging approach.
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| 4. |
- Sandgren, Kristina, et al.
(författare)
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Registration of histopathology to magnetic resonance imaging of prostate cancer
- 2021
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Ingår i: Physics and Imaging in Radiation Oncology. - : Elsevier. - 2405-6316. ; 18, s. 19-25
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose: The diagnostic accuracy of new imaging techniques requires validation, preferably by histopathological verification. The aim of this study was to develop and present a registration procedure between histopathology and in-vivo magnetic resonance imaging (MRI) of the prostate, to estimate its uncertainty and to evaluate the benefit of adding a contour-correcting registration.Materials and methods: For twenty-five prostate cancer patients, planned for radical prostatectomy, a 3D-printed prostate mold based on in-vivo MRI was created and an ex-vivo MRI of the specimen, placed inside the mold, was performed. Each histopathology slice was registered to its corresponding ex-vivo MRI slice using a 2D-affine registration. The ex-vivo MRI was rigidly registered to the in-vivo MRI and the resulting transform was applied to the histopathology stack. A 2D deformable registration was used to correct for specimen distortion concerning the specimen's fit inside the mold. We estimated the spatial uncertainty by comparing positions of landmarks in the in-vivo MRI and the corresponding registered histopathology stack.Results: Eighty-four landmarks were identified, located in the urethra (62%), prostatic cysts (33%), and the ejaculatory ducts (5%). The median number of landmarks was 3 per patient. We showed a median in-plane error of 1.8 mm before and 1.7 mm after the contour-correcting deformable registration. In patients with extraprostatic margins, the median in-plane error improved from 2.1 mm to 1.8 mm after the contour-correcting deformable registration.Conclusions: Our registration procedure accurately registers histopathology to in-vivo MRI, with low uncertainty. The contour-correcting registration was beneficial in patients with extraprostatic surgical margins.
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| 5. |
- Zarei, Maryam, et al.
(författare)
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Accuracy of gross tumour volume delineation with [68Ga]-PSMA-PET compared to histopathology for high-risk prostate cancer
- 2024
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Ingår i: Acta Oncologica. - : MJS Publishing, Medical Journals Sweden. - 0284-186X .- 1651-226X. ; 63, s. 503-510
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The delineation of intraprostatic lesions is vital for correct delivery of focal radiotherapy boost in patients with prostate cancer (PC). Errors in the delineation could translate into reduced tumour control and potentially increase the side effects. The purpose of this study is to compare PET-based delineation methods with histopathology.MATERIALS AND METHODS: The study population consisted of 15 patients with confirmed high-risk PC intended for prostatectomy. [68Ga]-PSMA-PET/MR was performed prior to surgery. Prostate lesions identified in histopathology were transferred to the in vivo [68Ga]-PSMA-PET/MR coordinate system. Four radiation oncologists manually delineated intraprostatic lesions based on PET data. Various semi-automatic segmentation methods were employed, including absolute and relative thresholds, adaptive threshold, and multi-level Otsu threshold.RESULTS: The gross tumour volumes (GTVs) delineated by the oncologists showed a moderate level of interobserver agreement with Dice similarity coefficient (DSC) of 0.68. In comparison with histopathology, manual delineations exhibited the highest median DSC and the lowest false discovery rate (FDR) among all approaches. Among semi-automatic approaches, GTVs generated using standardized uptake value (SUV) thresholds above 4 (SUV > 4) demonstrated the highest median DSC (0.41), with 0.51 median lesion coverage ratio, FDR of 0.66 and the 95th percentile of the Hausdorff distance (HD95%) of 8.22 mm.INTERPRETATION: Manual delineations showed a moderate level of interobserver agreement. Compared to histopathology, manual delineations and SUV > 4 exhibited the highest DSC and the lowest HD95% values. The methods that resulted in a high lesion coverage were associated with a large overestimation of the size of the lesions.
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| 6. |
- Björeland, Ulrika, et al.
(författare)
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Hyaluronic acid spacer in prostate cancer radiotherapy : dosimetric effects, spacer stability and long-term toxicity and PRO in a phase II study
- 2023
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Ingår i: Radiation Oncology. - : BioMed Central (BMC). - 1748-717X. ; 18:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Perirectal spacers may be beneficial to reduce rectal side effects from radiotherapy (RT). Here, we present the impact of a hyaluronic acid (HA) perirectal spacer on rectal dose as well as spacer stability, long-term gastrointestinal (GI) and genitourinary (GU) toxicity and patient-reported outcome (PRO).METHODS: In this phase II study 81 patients with low- and intermediate-risk prostate cancer received transrectal injections with HA before external beam RT (78 Gy in 39 fractions). The HA spacer was evaluated with MRI four times; before (MR0) and after HA-injection (MR1), at the middle (MR2) and at the end (MR3) of RT. GI and GU toxicity was assessed by physician for up to five years according to the RTOG scale. PROs were collected using the Swedish National Prostate Cancer Registry and Prostate cancer symptom scale questionnaires.RESULTS: There was a significant reduction in rectal V70% (54.6 Gy) and V90% (70.2 Gy) between MR0 and MR1, as well as between MR0 to MR2 and MR3. From MR1 to MR2/MR3, HA thickness decreased with 28%/32% and CTV-rectum space with 19%/17% in the middle level. The cumulative late grade ≥ 2 GI toxicity at 5 years was 5% and the proportion of PRO moderate or severe overall bowel problems at 5 years follow-up was 12%. Cumulative late grade ≥ 2 GU toxicity at 5 years was 12% and moderate or severe overall urinary problems at 5 years were 10%.CONCLUSION: We show that the HA spacer reduced rectal dose and long-term toxicity.
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| 7. |
- Capitao Patrao, Alexandre, 1988, et al.
(författare)
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Compact heat exchangers for hydrogen-fueled aero engine intercooling and recuperation
- 2024
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Ingår i: Applied Thermal Engineering. - 1359-4311. ; 243
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Tidskriftsartikel (refereegranskat)abstract
- This study investigates the application of compact heat exchangers for the purpose of intercooling and recuperation systems for short-to-medium range aircraft equipped with hydrogen-fueled turbofan engines. The primary objective is to assess the potential effects of engine-integrated compact heat exchangers on fuel consumption and emissions. The paper encompasses the conceptual design of integrated heat exchangers and associated ducts, followed by aerodynamic optimization studies to identify suitable designs that minimize air-side pressure losses and ensure flow uniformity at the inlet of the high-pressure compressor. Pressure drop correlations are then established for selected duct designs and incorporated into a system-level performance model, allowing for a comparison of their impact on specific fuel consumption, NOx emissions, and fuel burn against an uncooled baseline engine. The intercooled-recuperated engine resulted in the most significant improvement in take-off specific fuel consumption, with a reduction of up to 7.7% compared to the baseline uncooled engine, whereas the best intercooled engine resulted in an improvement of about 4%. Furthermore, the best configuration demonstrated a decrease in NOx emissions by up to 37% at take-off and a reduction in mission fuel burn by 5.5%. These enhancements were attributed to reduced compression work, pre-heating of the hydrogen fuel, and lower high-pressure compressor outlet temperatures.
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| 8. |
- Capitao Patrao, Alexandre, 1988, et al.
(författare)
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The heat transfer potential of compressor vanes on a hydrogen fueled turbofan engine
- 2024
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Ingår i: Applied Thermal Engineering. - 1359-4311. ; 236
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Tidskriftsartikel (refereegranskat)abstract
- Hydrogen is a promising fuel for future aviation due to its CO2-free combustion. In addition, its excellent cooling properties as it is heated from cryogenic conditions to the appropriate combustion temperatures provides a multitude of opportunities. This paper investigates the heat transfer potential of stator surfaces in a modern high-speed low-pressure compressor by incorporating cooling channels within the stator vane surfaces, where hydrogen is allowed to flow and cool the engine core air. Computational Fluid Dynamics simulations were carried out to assess the aerothermal performance of this cooled compressor and were compared to heat transfer correlations. A core air temperature drop of 9.5 K was observed for this cooling channel design while being relatively insensitive to the thermal conductivity of the vane and cooling channel wall thickness. The thermal resistance was dominated by the air-side convective heat transfer, and more surface area on the air-side would therefore be required in order to increase overall heat flow. While good agreement with established heat transfer correlations was found for both turbulent and transitional flow, the correlation for the transitional case yielded decent accuracy only as long as the flow remains attached, and while transition was dominated by the bypass mode. A system level analysis, indicated a limited but favorable impact at engine performance level, amounting to a specific fuel consumption improvement of up to 0.8 % in cruise and an estimated reduction of 3.6 % in cruise NOx. The results clearly show that, although it is possible to achieve high heat transfer rate per unit area in compressor vanes, the impact on cycle performance is constrained by the limited available wetted area in the low-pressure compressor.
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| 9. |
- Jonsson, Isak, 1990, et al.
(författare)
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Design and pre-test evaluation of a low-pressure compressor test facility for cryogenic hydrogen fuel integration
- 2021
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Ingår i: Proceedings of the ASME Turbo Expo. ; 2A-2021
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Konferensbidrag (refereegranskat)abstract
- The use of hydrogen as aviation fuel is again resurfacing with unprecedented vigor. It is well known that hydrogen is a formidable heat sink and the use of heat sinks in the compression system of an aero engine may enable not only preheating of the fuel but also improve the gas turbine cycle itself. One such opportunity arises from extracting heat to the fuel as part of the compression process. This work presents the design process and pre-test evaluation of a low-speed compressor test facility dedicated to aerothermal measurements. The design has been derived from a high-speed transonic compressor developed for a large sized geared turbofan engine. The proposed pre-test evaluation methodology provides a comprehensive and affordable way to estimate facility accuracy by virtually addressing all the experimental procedures, from data acquisition to a final performance map. The evaluation of gathering compressor performance parameters via a gas-path investigation process was achieved while relying on results from numerical simulations. The pre-test evaluation details uncertainties introduced throughout this process with transducers, flow and probe specific errors, traverse discretization, and data normalization. A suitable instrumentation configuration is presented which shows that the performance parameters pressure ratio (P) and isentropic efficiency (hc) can be determined with uncertainties below 1% for most operating conditions and below 0.5% at design conditions.
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| 10. |
- Sethi, V., et al.
(författare)
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Enabling Cryogenic Hydrogen-Based CO 2 -Free Air Transport: Meeting the demands of zero carbon aviation
- 2022
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Ingår i: IEEE Electrification Magazine. - 2325-5889 .- 2325-5897. ; 10:2, s. 69-81
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Flightpath 2050 from the European Union (EU) sets ambitious targets for reducing the emissions from civil aviation that contribute to climate change. Relative to aircraft in service in year 2000, new aircraft in 2050 are to reduce CO2 emissions by 75% and nitrogen oxide (NOx) emissions by 90% per passenger kilometer flown. While significant improvements in asset management and aircraft and propulsion-system efficiency and are foreseen, it is recognized that the Flightpath 2050 targets will not be met with conventional jet fuel. Furthermore, demands are growing for civil aviation to target zero carbon emissions in line with other transportation sectors rather than relying on offsetting to achieve 'net zero.' A more thorough and rapid greening of the industry is seen to be needed to avoid the potential economic and social damage that would follow from constraining air travel. This requires a paradigm shift in propulsion technologies. Two technologies with potential for radical decarbonization are hydrogen and electrification. Hydrogen in some form seems an inevitable solution for a fully sustainable aviation future. It may be used directly as a fuel or combined with carbon from direct air capture of CO2 or other renewable carbon sources, to synthesize drop-in replacement jet fuels for existing aircraft and engines. As a fuel, pure hydrogen can be provided as a compressed gas, but the weight of the storage bottles limits the practical aircraft ranges to just a few times that is achievable with battery power. For longer ranges, the fuel needs to be stored at lower pressures in much lighter tanks in the form of cryogenic liquid hydrogen (LH2).
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