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OBJECTIVE: This research utilizes magnetic resonance angiography (MRA) to identify arterial locations during the parametric evaluation of concentration time curves (CTCs), and to prevent shape distortions in arterial input function (AIF). MATERIALS AND METHODS: We carried out cluster analysis with the CTC parameters of voxels located within and around the middle cerebral artery (MCA). Through MRA, we located voxels that meet the AIF criteria and those with distorted CTCs. To minimize partial volume effect, we re-scaled the time integral of CTCs by the time integral of venous output function (VOF). We calculated the steady-state value to area under curve ratio (SS:AUC) of VOF and used it as a reference in selecting AIF. CTCs close to this reference value (selected AIF) and those far from it were used (eliminated AIF) to compute cerebral blood flow (CBF). RESULTS: Eliminated AIFs were found to be either on or anterior to MCA, whereas selected AIFs were located superior, inferior, posterior, or anterior to MCA. If the SS:AUC of AIF was far from the reference value, CBF was either under- or over-estimated by a maximum of 41.1 ± 14.3 and 36.6 ± 19.2%, respectively. CONCLUSION: MRA enables excluding voxels on the MCA during cluster analysis, and avoiding the risk of shape distortions.

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PURPOSE: Fractal analysis is a mathematical method used to describe the internal architecture of complex structures such as trabecular bone. Fractal analysis of panoramic radiographs of implant recipient sites could help to predict the quality of the bone prior to implant placement. This study investigated the correlations between the fractal dimension values obtained from panoramic radiographs and the insertion torque and resonance frequency values of mandibular implants. MATERIALS AND METHODS: Thirty patients who received a total of 55 implants of the same brand, diameter, and length in the mandibular premolar and molar regions were included in the study. The same surgical procedures were applied to each patient, and the insertion torque and resonance frequency values were recorded for each implant at the time of placement. The radiographic fractal dimensions of the alveolar bone in the implant recipient area were calculated from preoperative panoramic radiographs using a box-counting algorithm. The insertion torque and resonance frequency values were compared with the fractal dimension values using the Spearman test. RESULTS: All implants were successful, and none were lost during the follow-up period. Linear correlations were observed between the fractal dimension and resonance frequency, between the fractal dimension and insertion torque, and between resonance frequency and insertion torque. CONCLUSION: These results suggest that the noninvasive measurement of the fractal dimension from panoramic radiographs might help to predict the bone quality, and thus the primary stability of dental implants, before implant surgery.

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Radiation fluence changes caused by the dosimeter itself and poor spatial resolution may lead to lack of 3-dimensional (3D) information depending on the features of the dosimeter and quality assurance of dose distributions for high-dose rate (HDR) iridium-192 ((192)Ir) brachytherapy sources is challenging and experimental dosimetry methods used for brachytherapy sources are limited. In this study, we investigated 3D dose distributions of (192)Ir brachytherapy sources for irradiation with single and multiple dwell positions using a normoxic gel dosimeter and compared them with treatment planning system (TPS) calculations. For dose calibration purposes, 100-mL gel-containing vials were irradiated at predefined doses and then scanned in an magnetic resonance (MR) imaging unit. Gel phantoms prepared in 2 spherical glasses were irradiated with (192)Ir for the calculated dwell positions, and MR scans of the phantoms were obtained. The images were analyzed with MATLAB software. Dose distributions and profiles derived with 1-mm resolution were compared with TPS calculations. Linearity was observed between the delivered dose and the reciprocal of the T2 relaxation time constant of the gel. The x-, y-, and z-axes were defined as the sagittal, coronal, and axial planes, respectively, the sagittal and axial planes were defined parallel to the long axis of the source while the coronal plane was defined horizontally to the long axis of the source. The differences between measured and calculated profile widths of 3-cm source length and point source for 70%, 50%, and 30% isodose lines were evaluated at 3 dose levels using 18 profiles of comparison. The calculations for 3-cm source length revealed a difference of > 3mm in 1 coordinate at 50% profile width on the sagittal plane and 3 coordinates at 70% profile width and 2 coordinates at 50% and 30% profile widths on the axial plane. Calculations on the coronal plane for 3-cm source length showed > 3-mm difference in 1 coordinate at 50% and 70% and 2 coordinates at 30% profile widths. The point source measurements and calculations for 50% profile widths revealed a difference > 3mm in 1 coordinate on the sagittal plane and 2 coordinates on the axial plane. The doses of 3 coordinates on the sagittal plane and 4 coordinates on the axial plane could not be evaluated in 30% profile width because of low doses. There was good agreement between the gel dosimetry and TPS results. Gel dosimetry provides dose distributions in all 3 planes at the same time, which enables us to define the dose distributions in any plane with high resolution. It can be used to obtain 3D dose distributions for HDR (192)Ir brachytherapy sources and 3D dose verification of TPS.

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The accuracy of the Leksell GammaPlan, the dose planning system of the Gamma Knife Model-B, was evaluated near tissue inhomogeneities, using the gel dosimetry method. The lack of electronic equilibrium around the small-diameter gamma beams can cause dose calculation errors in the neighborhood of an air-tissue interface. An experiment was designed to investigate the effects of inhomogeneity near the paranosal sinuses cavities. The homogeneous phantom was a spherical glass balloon of 16 cm diameter, filled with MAGIC gel; i.e., the normoxic polymer gel. Two hollow PVC balls of 2 cm radius, filled with N2 gas, represented the air cavities inside the inhomogeneous phantom. For dose calibration purposes, 100 ml gel-containing vials were irradiated at predefined doses, and then scanned in a MR unit. Linearity was observed between the delivered dose and the reciprocal of the T2 relaxation time constant of the gel. Dose distributions are the results of a single shot of irradiation, obtained by collimating all 201 cobalt sources to a known target in the phantom. Both phantoms were irradiated at the same dose level at the same coordinates. Stereotactic frames and fiducial markers were attached to the phantoms prior to MR scanning. The dose distribution predicted by the Gamma Knife planning system was compared with that of the gel dosimetry. As expected, for the homogeneous phantom the isodose diameters measured by the gel dosimetry and the GammaPlan differed by 5% at most. However, with the inhomogeneous phantom, the dose maps in the axial, coronal and sagittal planes were spatially different. The diameters of the 50% isodose curves differed 43% in the X axis and 32% in the Y axis for the Z =90 mm axial plane; by 44% in the X axis and 24% in the Z axis for the Y=90 mm coronal plane; and by 32% in the Z axis and 42% in the Y axis for the X=92 mm sagittal plane. The lack of ability of the GammaPlan to predict the rapid dose fall off, due to the air cavities behind or near the lesion led to an overestimation of the dose that was actually delivered. Clinically, this can result in underdosing of lesions near tissue inhomogeneities in patients under treatment.

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The primary goal in this study was to investigate 3-D dose distribution, near the areas of tissue inhomogeneities, in Gamma Knife Radiosurgery with the gel dosimetry. The spherical glass balloon of a diameter of 16 cm filled with the gel forms the homogeneous phantom; and an identical balloon with two corks placed on each side to represent the air cavities forms the inhomogeneous phantom. Dose calibration is performed by irradiating vials at known doses and then utilizing the R2- dose calibration curve. Stereotactic frames and fudicial markers were attached to the phantoms for MR scanning and image processing. Dose distributions from a single shot, using all 201 Cobalt sources, delivered to a known point with identical coordinates, are calculated both in homogeneous and inhomogeneous gel phantoms. In the aspect of dosimetrical quality control, the Gamma Knife planning system predicted dose distribution is compared with the experimental results. In the homogeneous phantom, the gel dosimetry calculated dose distribution is in good agreement with the GammaPlan predicted dose distribution. However, with the inhomogeneous phantom, the dose distribution is spatially different and significant differences in dose levels are observed.