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Zookeeper Battle v3.3.8 (Unlimited CP)
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POND JOURNEY v1.0 [Mod]
By koumkouat
POND JOURNEY v1.0 [Mod]
Requirements: 4.0.3+
Overview: Train your brain in the pond!
Help the red block out of pond!
Taste the truly Chinese painting visual style! Training your brain anytime! Take the most smooth experience for you.
Hundreds of amazing creative challenge stage !
Come on! Burning your brain!
Short Desc:
-Chinese painting visual style!
-Nature behaviour, only need move!
-Hundreds of stages and keep update!
2.Fish Level
4.Ads Removed
This app has no advertisements
https://play.google.com/store/apps/details?id=me.dreamsky.pond Download Instructions:Credit:KoumKouaT //
RETSNOM v1.02
By koumkouat
RETSNOM v1.02
Requirements: 2.3+
Overview: ** INDIE STREAM FES 2015 Best of Narrative Award **
** Famitsu Gold Dendo Award **
Have you ever looked into a mirror carefully? How do you know whether the person looking at you from the other side is yourself or someone else inside the mirror?
Let me introduce you one of the greatest indie game, 'Retsnom' created by solo developer Somi and published by Magic Cube.
You have a daughter. She is unfortunately infected by a zombie virus. The only way to save your daughter is to visit the laboratory in the future and steal the medicine that is expected to be made by your colleagues. But the future research team is hiding in the maze using mirrors. They decorated the maze using features of a mirror in each level.
- Inventive puzzle platformer that allows players to break the map, by mirroring sections of the level, and rearranging it on the fly
- Unique puzzles using the features of a mirrors and various mechanics
- 61 levels in 5 different worlds, 3 hidden stages and collectable bonus items
- 17 Achievements
- Narratives of time-travel paradoxes and another world in the mirror with 2 different endings
- Deep sad story and hauntingly beautiful soundtrack
- Stunning retro pixel art style
Improved frame
This app has no advertisements
https://play.google.com/store/apps/details?id=com.magiccubegames.retsnom Download Instructions:
Tricky Test 2™: Halloween 2016 v4.2 (Mod)
By koumkouat
Tricky Test 2™: Halloween 2016 v4.2 (Mod)
Requirements: Android 4.1+
Overview: The spooky "Halloween Limited Edition" is coming your way!
Get ready to be treated in this trick-filled Halloween update, with pumpkin, bats, zombies and most evil tricks!
The goal of this game is not to be tricked! So far, over 3 million players worldwide has been tricked!
Tricky Test 2 is a whole new puzzle game with a series of cunning brain teasers and absurd solutions that you will never ever thought of! Each puzzle is unique and pushes your creative thinking to the limit. If you have 140 IQ points remaining after solving all the tricky puzzles, you will be pronounced a GENIUS!
- "100+ Tricky & Addictive Puzzles″ - new questions added every week!
- "Test Your Friend Mode" - select questions to trick your friends!
- "Out of the Box Solutions″ - let your imagination soar!
- "Fun for all ages" - yes, your parents and kids will love it too!
- "Enjoy with your Facebook friends" - you might be teased during the game!
- "Tap, Shake or Kick your Phone?″ - everything's possible!
What's in the MOD?
Coin increasing instead of decreasing
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https://play.google.com/store/apps/details?id=com.orangenose.trick Download Instructions:
Candy Crush Soda Saga v1.76.13 [Mods]
By koumkouat
Candy Crush Soda Saga v1.76.13 [Mods]
Requirements: 2.3+
Overview: Candy Crush Soda Saga is a brand new game from the makers of the legendary Candy Crush Saga. New candies, more divine combinations and challenging game modes brimming with purple soda!
Candy Crush Soda Saga is completely free to play, but some in-game items such as extra moves or lives will require payment.
By downloading this game you are agreeing to our terms of service; http://about.king.com/consumer-terms/terms
New Candy Crush Soda Saga features:
* Over 140 Sodalicious levels
* New Game Modes include:
Soda – switch bottles and candies to release purple soda and save the Candy Bears
Frosting – match candies to smash the ice and set the Candy Bears free
Honey – match candies next to the honey to release the trapped Candy Bears
* Scrumptious new candies and sublime new combinations:
Match 4 candies in a square to make a Swedish Fish
Match 7 candies to create the remarkable Coloring Candy
* Explore juicy new environments and meet the kookiest characters
* Mouth-watering new graphics, Candy Crush never looked so tasty
* Easy and fun to play, yet challenging to fully master
* For players that Facebook Connect, there are leaderboards for you and your friends to compare your Sodalicious scores
* Easily sync the game between mobile and tablet devices and unlock the full game features when connected to the internet
This mouth-watering puzzle adventure will instantly quench your thirst for fun. Join Kimmy on her juicy journey to find Tiffi, by switching and matching your way through new dimensions of magical gameplay. Take on this Sodalicious Saga alone or play with friends to see who can get the highest score!
Are you already a fan of the new Candy Crush Soda Saga? If so then visit our website, like us on Facebook or follow us on
What's new:
Sodalicious! We have a new juicy update!
- Play stickylicious NEW LEVELS!
- Explore the depths of the soda sea in our fizzy new Episodes!
Plus! Tusker the tasty narwal is having a party! And you're invited! No need to RSVP, just swing by! He's the best at throwing fizzy festivities.
- Normal moves.
- Unlimited Lives.
- Unlimited Boosters.
- Unlock all levels.
- Unlock all episodes.
- 100 plus moves.
- Unlimited Lives.
- Unlimited Boosters.
- Unlock all levels.
- Unlock all episodes.
1- Download The File to your card.
2- Uninstall / freeze Facebook.
3. Uninstall old version of the game.
4. Install the downloaded file, and connect to Facebook.
5. If you have any problem connecting Facebook, force stop game freeze/ uninstall Facebook then connect.
No.of levels: 1060
This app has no advertisements
https://play.google.com/store/apps/details?id=com.king.candycrushsodasaga Download Instructions:
Candy Crush Saga v188.8.131.52 [Mods]
By koumkouat
Candy Crush Saga v126.96.36.199 [Mods]
Requirements: 2.3 +
Overview: Candy Crush Saga, from the makers of Candy Crush Soda Saga & Farm Heroes Saga!
Join Tiffi and Mr. Toffee on their sweet adventure through the Candy Kingdom. Travel through magical lands, visiting wondrous places and meeting deliciously kooky characters! Switch and match your way through hundreds of fun levels in this delicious puzzle adventure. The sweetest game just keeps getting sweeter!
Take on this deliciously sweet Saga alone or play with friends to see who can get the top score!
Candy Crush Saga is completely free to play but some optional in-game items will require payment.
By downloading this game you are agreeing to our terms of service; http://about.king.com/consumer-terms/terms
Candy Crush Saga features:
● Tasty ways to play: Target Score, Timed Levels, Drop Down Mode and Order Mode
● Collect sugar drops to progress along the Sugar Track for super sweet surprises!
● Spin the Daily Booster Wheel for a delicious prize
● Pass level 50 to unlock Dreamworld and escape reality with Odus the Owl
● Unwrap delicious environments and meet the sweetest characters
● Tasty Candies, wrapped and striped Special Candies, Color Bombs and various other magical boosters to help with challenging levels
● Hundreds of the best levels in the Candy Kingdom with more added every 2 weeks for your entertainment
● Leaderboards to watch your friends and competitors!
● It's easy to sync the game between devices and unlock full game features when connected to the Internet
Oh my cake! It's time for a spook-tastic Candy Crush Saga update. We now have a total of 2030 delicious levels for you!
Soda has flooded the candy village in Soda Surf, our latest episode. Bring your costume and get ready to play 15 NEW LEVELS and sweet Halloween events that will make you forget you're stuck on a boring commute!
Version 1:
01. Normal moves.
02. Unlimited lives
03. Unlock all episodes.
06. Brush booster available (1 time/level Facebook connection required).
Version 2:
01. Normal moves.
02. Unlimited lives
03. Unlock all episodes.
06. Brush booster available (1 time/level Facebook connection required).
07. Always Win.
Version 3:
01. 100 Plus moves.
02. Bomb Counter set to 80.
03. Time is Set to 5 minutes (For all time levels).
04. Unlimited lives
05. Unlock all episodes.
08. Brush booster available (1 time/level Facebook connection required).
1- Download apk.
2- Uninstall / freeze Facebook.
3. Uninstall old version of the game.
4- Install, Connect to Facebook, Play.
This app has no advertisements
https://play.google.com/store/apps/details?id=com.king.candycrushsaga Download Instructions:
Farm Heroes Saga v2.62.4 [Mod]
By koumkouat
Farm Heroes Saga v2.62.4 [Mod]
Requirements: 2.3+
Overview: Farm Heroes Saga, from the makers of Candy Crush Soda Saga & Bubble Witch 2 Saga!
Rancid the Racoon is trying to spoil the precious Farm Lands, stealing as many Cropsies as he can along the way. Will you join forces with the Farm Heroes and help to collect the Cropsies and save the day? Play through hundreds of levels of switching and matching farming fun to find out!
Take on this fantastic Saga alone or play with friends to see who can get the highest score!
Farm Heroes Saga is completely free to play but some optional in-game items will require payment.
By downloading this game you are agreeing to our terms of service; http://about.king.com/consumer-terms/terms
Farm Heroes Saga features:
● Collect all kinds of Cropsies to win the level before you run out of moves
● Play levels and win magic beans to help you activate Farm Club
● Rechargable boosters, special power ups and Farm Club animals to help you win those challenging levels
● Easy to play but challenging to master
● Acres of luscious levels to complete - more added every 2 weeks!
● Leaderboards to watch your friends and competitors!
● Easily sync the game between devices and unlock full game features when connected to the Internet
Visit https://care.king.com/ or contact us in game by going to Settings > Customer Care if you need help!
Follow us to get news and updates:
Twitter @FarmHeroesSaga
Have fun playing Farm Heroes Saga!
A new update has arrived so be prepared as we're taking you on a journey to the Mongolian Steppe!
In this episode you'll tackle 15 NEW LEVELS. Of course, Rancid the Raccoon is lurking about the corner, but we're pretty sure you have the skills to defeat him.
Be sure to update Farm Heroes Saga for all the new content!
Good luck!
- Normal moves + 20.
- Unlimited Lives.
- Pre-Game boosters Activated, and Enabled.
- In-Game Boosters Reactivate time set to minimum Value.
- Active Hero Mode.
This app has no advertisements
https://play.google.com/store/apps/details?id=com.king.farmheroessaga Download Instructions:
Patchwork The Game v34
By koumkouat
Patchwork The Game v34
Requirements: 2.3.3 +
Overview: In this award-winning board game for two, quilting has never been more competitive! In the long-awaited digital adaptation of Uwe Rosenberg's Patchwork, players patch their way to victory using fabric pieces of assorted sizes, colors, and buttons.
The best quilt is the fullest, and whoever can patch up their quilt the most and collect more buttons wins the game – but be resourceful and plan every stitch! Keep an eye on the costs and the time it takes to stitch a patch to be the best patchwork master. Play against quilters from around the world on multiple platforms and compete for the highest rank. Face computer opponents, or stick to a local game with a friend. Patch your way to the top in Patchwork!
- True digital conversion of the award-winning board game Patchwork by Uwe Rosenberg
- Consider every stitch you make in this deceivingly simple game
- Worldwide cross-platform multiplayer
- Easy interactive tutorial
- Analyze your best games or even learn tricks from the pros with Playback
- Customize your app interface with an ever increasing number of backgrounds and colorful patterns
- Challenge the AI in easy, medium, or hard mode
he next game button now also activates when entering the game via a notification
This app has no advertisements
https://play.google.com/store/apps/details?id=com.digidiced.pxwrelease Download Instructions:
Ultimate Solid: Origins v1.0.1
By koumkouat
Ultimate Solid: Origins v1.0.1
Requirements: 4.4+
Overview: Ultimate Solid is a physics-based game in platform world full of challenging obstacles and fun puzzle elements.
Unlike the traditional platform games movement is limited to jumping only! By adjusting the strength and angle of each jump, the goal is to not collide with any hostile elements on the way to the finish line. Or rather, a vortex that sucks you all the way in to the next level.
>Over 60 Challenging Levels
>Simple Gameplay Design
>Custom Soundtrack
>No In-App Purchases or Adverts
Do you have the skill to navigate the puzzles and obstacles that await?
Begin your quest to become the Ultimate Solid now!
This app has no advertisements
https://play.google.com/store/apps/details?id=com.robotmafia.ultimatesolid Download Instructions:
Lost Journey v1.3.12
By koumkouat
Lost Journey v1.3.12
Requirements: 2.3+
Overview: "Lost Journey" is a puzzle game of space exploration, we have received:
"2015 IndiePlay Best Mobile Game" nomination
"2014 Imagine Cup" award in China
"2014's most anticipated ID @ Xbox game"
"Super interesting game!Worth every penny" --by Fishingfreak123
"I already watching this video.I liked this game...nicely". --by Rageh
"I really like this game. It is great puzzler! It gets more challenging after each level. And no, it doesn't give you instructions which I like because you need to really think for yourself to solve the level". --by Jenn808
On a Journey… Lost, but not without Hope
An angel of heaven comes to Jennifer in the form of a butterfly. This plane of existence mirrors the serene world she left behind, but there are secrets – memories – hidden here. As Jennifer collects the shards of her memories, she confronts many trials, but the happy memories and her strength of spirit solidify her resolve, spurring her onward. With her guide at her side, Jennifer sifts through time and space, reverses gravity, and does the otherwise impossible to find her happiness and her way back to heaven. Jennifer will uncover the truth; she will reach the end of her Lost Journey.
The serene music and uplifting backgrounds in Lost Journey convey hope and beauty even in the journey after death. Through Jennifer, players realize that their own strength of spirit will carry them through their own trials in life, and ultimately allow them to reach the end of any Lost Journey.
【Game Features】
- Nomination of Best China IndiePlay Game
-Colorful, soulful artwork draws players into the story and journey.
-Players can literally 'flip' the scene to expose new paths and opportunities.
-Reverse Gravity, Bend Time, Manipulate Space… this reality is not as straightforward as it appears!
-Music nicely compliments the Asian setting and relaxed feel of the game.
1, a number of bug fixes
2, an increase of close games feature music
3, buy a double medal
This app has no advertisements
https://play.google.com/store/apps/details?id=me.dreamsky.lostjourney2 Download Instructions:
Bee Brilliant v1.33.1 (Mod)
By koumkouat
Bee Brilliant v1.33.1 (Mod)
Requirements: 4.0 +
Overview: Explore the world of Beeland and meet the singing Babees, the crazy Busy Bees and the cheeky spiders in this buzzing FREE puzzle game. Get ready to connect colourful lines of Babees and make awesome combos!
Release your inner bee and join the beedazzling adventure TODAY!
• Easy, addictive gameplay! Match and connect one colourful line of bees after another to unleash combos!
• Play your way through Beeland in 6 different game modes and 120+ addictive levels!
• Challenge your friends! Can you Bee Brilliant enough to top their high scores?
• Lots of crazy bees! Meet Ms. Honey, Sgt. Sting, Beecasso and others! And, of course, the singing Babees will not miss a chance to break into their buzzing mix of disco and barber shop!
• Loads of different game modes: Pop the cheeky spiders' web, collect honey pots and much, much more!
• Not to forget: A lifetime's supply of bee puns!
Here's why other people love Bee Brilliant:
"Bee Brilliant is a match-3 puzzler with quite possibly the best theme song ever" - AppSpy.com
"Love this game. It's addictive and the little songs are so cute. Waaayyyy better than candy crush!" - NaijahYasmin
"Luv this app. Colorful, easy until you get to a certain level - then very challenging and fun!" - coozoe
"Always love finding these gems. Great game." - andrewthewriter
Already played and enjoyed the game? Stay tuned for updates and do drop us a review! Also, check out these sources for all the latest news:
See you in Beeland! THANK YOU!
Bee afraid! Monster bees have come to Beeland! Luckily, they are a friendly bunch and are here to help celebrate Halloween!
• Go trick or treating in the Haunted Graveyard and play through the scary NEW LEVELS!
• No Halloween would be complete without a scary NEW SONG by The Werebees!
• Not afraid of ghosts? Then come and join the Halloween Challenge!
Like the game? Please leave a review!
Check out www.facebook.com/beebrilliantgame for help and support!
1. Infinite Lives
2. Infinite Coins
3. Infinite Boosters[Increased Instead Of Decrease]
4. 50 Moves
5. Infinite Gold,Bronze,Silver, Tickets
6. V.I.P. Unlocked
7. Juke Box Unlocked
8. Hit Bomber Bee 999 Score
9. Hit Buzy Bee 999 Score
This app has no advertisements
https://play.google.com/store/apps/details?id=dk.tactile.beebrilliant Download Instructions:


text:
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Is AM back in the game for Shugarts
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subset: commoncrawl


text:
Has the Export Pricing Behaviour of German Enterprises Changed? Empirical Evidence from German Sectoral Export Prices
The question as to whether the globalisation-related increase in competitive pressure may have caused the importance of cost pass-through (CPT) and pricing-to-market (PTM) for export pricing in Germany to shift since the 1990s is addressed by testing the long-run export pricing behaviour of German enterprises for changes in the impact of its determinants. As globalisation may have affected competitive pressure in individual product markets differently, export pricing is analysed for 11 product categories. Analytically, this problem is solved by applying the Saikkonen (1991) approach to estimate the individual export price categories in single equations. The first hypothesis - that CPT is stronger, and PTM weaker, for heterogeneous products than for homogeneous products - is found to hold more for CPT than for PTM. The second hypothesis, which presumes that CPT has weakened and PTM has strengthened since the 1990s, is confirmed with respect to the overall outcome, although for several product categories the results conflict with the hypothesis. Moreover, error correction models are used to test exporters' short-run price-setting behaviour for asymmetry, ie whether short-run increases in the export price determinants are passed through to a different extent than decreases. It is shown that symmetric export pricing is seldom rejected.
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Volume (Year): 227 (2007)
Issue (Month): 3 (June)
Pages: 295-329
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- Kasa, Kenneth, 1992. "Adjustment costs and pricing-to-market theory and evidence," Journal of International Economics, Elsevier, vol. 32(1-2), pages 1-30, February.
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- Mario Marazzi & Nathan Sheets & Robert J. Vigfusson & Jon Faust & Joseph E. Gagnon & Jaime R. Marquez & Robert F. Martin & Trevor A. Reeve & John H. Rogers, 2005. "Exchange rate pass-through to U.S. import prices: some new evidence," International Finance Discussion Papers 833, Board of Governors of the Federal Reserve System (U.S.).
- Mick Silver, 2007. "Do Unit Value Export, Import, and Terms of Trade Indices Represent or Misrepresent Price Indices?," IMF Working Papers 07/121, International Monetary Fund.
- Stahn, Kerstin, 2006. "Has the impact of key determinants of German exports changed? Results from estimations of Germany's intra euro-area and extra euro-area exports," Discussion Paper Series 1: Economic Studies 2006,07, Deutsche Bundesbank, Research Centre.
- Menon, Jayant, 1995. " Exchange Rate Pass-Through," Journal of Economic Surveys, Wiley Blackwell, vol. 9(2), pages 197-231, June.
- Warmedinger, Thomas, 2004. "Import prices and pricing-to-market effects in the euro area," Working Paper Series 0299, European Central Bank.
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- Feinberg, Robert M, 1986. "The Interaction of Foreign Exchange and Market Power Effects on German Domestic Prices," Journal of Industrial Economics, Wiley Blackwell, vol. 35(1), pages 61-70, September.
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- Hung, Wansing & Kim, Yoonbai & Ohno, Kenichi, 1993. "Pricing exports: a cross-country study," Journal of International Money and Finance, Elsevier, vol. 12(1), pages 3-28, February.
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- Rebecca Hellerstein, 2004. "Who Bears the Cost of a Change in the Exchange Rate?," Econometric Society 2004 North American Summer Meetings 589, Econometric Society.
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Volume 34, Issue 6, June 2007
- Joint Imaging/Therapy Moderated Poster Session: Exhibit Hall C
- Moderated Poster — Area 3 (Joint): Correction Strategies
SU‐DD‐A3‐01: Dosimetric Evaluation of Daily Rigid and Non‐Rigid Geometric Correction Strategies During On‐Line Image‐Guided Radiation Therapy (IGRT) of Prostate Cancer34(2007); http://dx.doi.org/10.1118/1.2760332View Description Hide Description
Purpose: To evaluate a geometric image guidance strategy that simultaneously correct for various interfractional rigid and non‐rigid geometric uncertainties in an on‐line environment, using field shape corrections (by modifying MLC). This technique was dosimetrically compared to simpler and more popular image guidance strategies (e.g., linear corrections). Method and Materials: Five prostate cancer patients with daily CT studies were analyzed. All patients were planned with a simplified intensity modulated radiation therapy (SIMAT) technique. A uniform 5‐mm margin was used. The image‐guided geometric correction strategies simulated were (1) translational correction based on daily gross CTV registration ("CTV"), (2) translational correction with daily MU recalculation ("MU‐CTV"), and finally, (3) translational correction with MU re‐calculation and daily MLC corrections to account for prostate deformations ("MU‐MLC"). Deformable image registration was performed on all treatment CT studies for dose accumulation. Generalized equivalent uniform dose (gEUD) index was used for dosimetric comparisons. Results: As expected, some dosimetric differences in the target volume were observed between the three image guidance strategies. For example, up to ± 2% discrepancy in prostate minimum dose were observed among the techniques. Of them, only the "MU‐MLC" technique did not reduce the prostate minimum dose for all patients (i.e., ⩾ 100%). However, the differences were clinically not significant to indicate the preference of one strategy over another, when using a uniform 5‐mm margin size. For the organ‐at‐risks (OARs), large rectum sparing effect (⩽ 5.7 Gy, gEUD) and bladder overdosing effect (⩽ 16 Gy, gEUD) were observed. Conclusion: The results suggest that a linear translational correction (i.e., "CTV") is adequate to maintain target coverage, for margin sizes at least as large as 5 mm. In addition, due to large fluctuations in OAR volumes, innovative image guidance strategies are needed to minimize dose and maintain consistent sparing during the whole course of radiation therapy.
SU‐DD‐A3‐02: Automatic Detection of Positional and Anatomical Setup Errors in CT‐Based Image Guided Radiation Therapy34(2007); http://dx.doi.org/10.1118/1.2760333View Description Hide Description
Purpose: The primary objective of this study was to develop a novel tool using Kernel Classification that could be used to assist in identifying patients with setup issues that result in unacceptable random and systematic errors. Method and Materials: Inter‐Fraction motion was retrospectively analyzed for 30 H&N patients that were positioned for treatment using megavoltage CT (MVCT) images acquired on a helical tomotherapy system. Manual adjustments, in the AP, SI, LAT and Roll planes, were made to ensure correct target alignment from MVCT images acquired on the tomotherapy system. Results: A total of 30 Head and Neck patients were MVCT imaged prior to treatment delivery for a total of 992 imaging sessions. All 30 patients had a decrease in the cross‐sectional volume due to a combination of weight loss and/or tissue response to radiation. Patient errors ranged form incorrect headrest to a shirt and tie that where not removed before treatment. A Principal Component Analysis was performed and showed that there was a relationship present between the stage of the cancer, the patient's overall percent weight loss, and the mean lateral, longitudinal, and vertical shift values.
The kernel classification technique correctly identified 23 out of the 24 Head & Neck patients as either having normal set‐up or problematic setup using their respective shift data sets. These classifications were made using only the shift values from the first 14 treatments. The predictive performance seriously degraded when data from fewer than 14 treatments were used. Conclusion: This study demonstrated that the kernel regression classification method was able to correctly identify the cause behind IGRT positioning problems for individual Head & Neck patients. The study also validated the fact that IGRT positioning problems cause abnormal problem‐specific distributions in the shift data without using the complicated, and generally time‐consuming, statistical distribution tests.
SU‐DD‐A3‐03: Improvement in the Daily Alignment of Mobile Lung Tumors Using Implanted Fiducials34(2007); http://dx.doi.org/10.1118/1.2760334View Description Hide Description
Purpose: The purpose of this work is to develop, validate, and implement a technique in which imaged‐guided patient setup using gated kV images of implanted fiducials can be implemented for mobile lungtumors.Method and Materials:Software for matching markers by comparing 2D images with projections of 3D CTdata sets was validated by acquiring respiratory‐gated kV images of a phantom on a moving platform. The procedures were implemented for patients in our clinic who have mobile lungtumors with fiducials implanted in the periphery of the tumors. Treatment was delivered using respiratory gating, and cine images of each of the gated treatment fields were acquired each treatment to examine uncertainties in tumor location after gated image guided alignment. Results: For the phantom study, the 2D‐3D marker matching software is accurate to within 1 mm. This accuracy is limited by the ability to locate the fiducials in the CTimages (slice thickness 2.5 mm). Setup errors were reduced from 4 to 1 and 6 to 2 mm in the LR and SI directions (p<0.001 f‐test) respectively for our first patient. Shifts larger than 7 mm (PTV margin used to account for setup uncertainties) were observed on 13 of the 33 fractions for our first patient. Similar results were obtained for the other fiducial patients. Conclusion: Large variations in daily tumor position were observed and corrected for by acquiring gated kV images using the fiducials in these images for daily alignment. Respiratory gating in conjunction with image guided patient setup (planar kV imaging) using fiducials implanted near mobile lungtumors is an effective method of accurately aligning tumors without acquiring higher‐dose volumetric CT scans. This technique can be implemented using both kV imaging and standard MV portal imaging.
SU‐DD‐A3‐04: On‐Line Re‐Optimization of Prostate IMRT Plans for Image Guided Adaptive Radiation Therapy34(2007); http://dx.doi.org/10.1118/1.2760335View Description Hide Description
Purpose: This study proposes a novel on‐line adaptive planning technique for the prostate treatment by directly re‐optimizing the IMRT plan based on both the "anatomy‐of‐the‐day" and the original plan information. Method & Materials: Using a commercial treatment planning system, an initial IMRT plan for prostate cancertreatment was optimized using seven coplanar 15‐MV beams based on the structures of interest (SOIs) delineated in the planning CT. Then, the optimized plan with both intensity fluence maps and dose distributions was exported to an in‐house adaptive planning platform. To correct for target variations, a set of on‐board cone‐beam CT(CBCT)images were acquired prior to treatment and the daily SOIs ("anatomy‐of‐the‐day") were identified. The original planning SOIs and daily SOIs were registered using a thin‐plate‐spline based deformable registration algorithm. The optimal dose distribution was then deformed to match the "anatomy‐of‐the‐day" and served as the "prescription dose distribution" for the re‐optimization process. Linear programming algorithm was used for re‐optimization and could reach a solution in seconds. The algorithm also used the original IMRT plan information as the initial solution. Both hard and soft constraints were used to differentiate the priorities of meeting the prescription dose distribution. A proof‐of‐concept case using an IMRT prostate plan was presented. The dose‐volume histograms from the original, the uncorrected and re‐optimized plans were compared. Results: The proposed re‐optimization technique reached solutions within 1minute on a desktop PC. The D95(min/max) doses to the GTV were 99.3%(90.0%/104.1%), 83%(57.6%/104.1%) and 98.3%(90.0%/103.8%), for the original, uncorrected and re‐optimized plans, respectively. The median doses to the rectum and bladder were comparable for the original and re‐optimized plans (41.0% vs. 45.0%, and 14.0% vs. 16.4%, respectively). Conclusion: It is technically feasible to perform on‐line re‐optimization based on the "anatomy‐of‐the‐day" and to achieve results similar to the original dose distribution.
SU‐DD‐A3‐05: Scatter Kernel Estimation and Correction with Edge‐Spread‐Function Method for CBCT Imaging34(2007); http://dx.doi.org/10.1118/1.2760336View Description Hide Description
Purpose: To study the characteristics of scatter in kilo‐voltage CBCTimaging, and to develop a method of reducing or removing scatter related artifacts and improve CBCTimage quality. Methods and Materials: The scattered radiations were modeled as depth‐dependents pencil‐beam kernels, which were derived using an edge‐spread‐function (ESF) method, for a CBCTimaging system. The ESF geometry was achieved with a half‐beam block created by a 3‐mm‐thick lead sheet placed on top of a stack of slab solid‐water phantoms. Measurements for 8 water‐equivalent thicknesses (range from 0 to 41 cm) were taken with (half‐blocked) and without (unblocked) the lead sheet, and corresponding pencil‐beam scatter kernels or point‐spread‐functions (PSF), were then derived without assuming any empirical trial function. Scatter correction was incorporated into the reconstruction process to improve CBCTimage quality. The process is summarized as the following: 1) The ESF was extracted from the half‐blocked images; 2) The line‐spread‐function (LSF) of the system was calculated by taking the derivative of the ESF; 3) By assuming a symmetrical scatter kernel, the PSF was derived using a filtered‐back‐projection technique; 4) For thicknesses not measured, the corresponding PSF was interpolated from the measured data; 5) An iterative method was used to remove scatter from the projection image; 6) A reconstruction algorithm was applied to the scatter removed projection to derive CBCTimages with improved image quality. Results: The scatter kernels were successfully derived and verified with phantoms. The scatter artifacts were reduced and the image quality was improved for CBCTimages incorporating the scatter removal technique. For a 32 cm‐diameter uniform phantom, the flatness of reconstruction image was improved from 21.6% to 3.8%. Conclusion: We developed a method to determine the scatter kernel in CBCT system and reduce the scatter related artifacts utilizing the derived kernel. Conflict of Interest: Supported by Varian.
SU‐DD‐A3‐06: Tumor Trailing Strategy for IMRT in the Presence of Target Motion: Preliminary Studies34(2007); http://dx.doi.org/10.1118/1.2760337View Description Hide Description
Purpose: Previously proposed approaches to mitigate the effect of internal motion in IMRT include motion‐correlated delivery (gating, tracking), and adaptive treatment plan optimization employing a probabilistic description of motion (pdf). We test "tumor trailing" strategy, utilizing the synergy of motion‐adaptive treatment planning and delivery methods. Methods: The target motion is a superposition of a "fast" cyclic component (respiratory) and "slow" aperiodic trends (exhale baseline drift). The trailing strategy employs real‐time motion monitoring to identify "slow" shifts, and corrects for these by applying set‐up (e.g., couch position) adjustments. Delivery does not track the target position exactly, but trails the slow systematic trend due to the delay between the time a shift occurs, is reliably detected and, subsequently, corrected. The "fast" cyclic motion is accounted for with robust motion‐adaptive treatment planning, which allows for variability in motion parameters [Chan et al. Phys. Med. Biol. 51:2567–83 (2006)]. Motion‐surrogate data from gated IMRT treatments were used to test algorithms that identified systematic shifts (based on observation of "running mean" position), and to provide pdf data for motion‐adaptive planning. Test IMRT fields were delivered on linac to a programmable moving phantom. Dose measurements were performed with a commercial two‐dimensional ion‐chamber array. Results: Detection of systematic shifts was possible with a delay of 12–15 seconds. Correcting for slow systematic shifts during delivery of motion‐adaptive plans led to improvement in dose uniformity, conformity to target (vs. standard). Conclusion: By reducing intrafractional pdf variability, trailing strategy enhances relevance and applicability of motion‐adaptive planning methods, improves conformity of delivered dose to the target in the presence of irregular motion. In combination with respiratory gating, trailing can increase the duty cycle, account for residual motion within the gating window. It requires relatively minor modifications to software, equipment already in place for respiratory‐gated treatments.
Supported by NIH (5P01‐CA21239‐25), MIT, DKFZ grants.
- Moderated Poster — Area 3 (Joint): Imaging for Therapy Assessment
SU‐EE‐A3‐01: Beyond SUV: New Methods for Assessing Treatment Response in PET Images34(2007); http://dx.doi.org/10.1118/1.2760358View Description Hide Description
Purpose:PET use for radiotherapytreatment planning and monitoring has rapidly increased. Accumulating evidence suggests that characteristics of pre‐treatment FDG‐PET could be utilized as prognostic factors to predict radiotherapy outcomes in different cancer sites. Direct standardized uptake value (SUV) measurements were traditionally used to assess risk. However, such measurements are limited to intensity values irrespective of tumor‐microenvironment topological features. To improve our understanding of embedded information in PET, we are investigating new approaches for analyzing and extracting statistically robust candidate variables for predicting post‐radiotherapy relative‐risk. Method and Materials: We investigated two approaches for summarizing reliable information from PETimages to predict outcomes. The first approach is a generalization of the dose‐volume histogram (DVH) concept into functional imaging referred to as intensity‐volume histogram (IVH). An IVH would summarize the 3D functional imaging information for any anatomical structure into a single curve. Analogous to its DVH counterpart, intensity‐volume metrics are derived. The second approach utilizes extraction of shape and texture features that would characterize the structure of interest. These features enable mimicking of human perception of in terms of geometrical differences and texture variability. The tools are demonstrated on a subset of 14 cervix cancer patients who underwent pre‐treatment FDG‐PET scanning. Results: Nineteen candidate features, extracted from delineated tumor volumes, were analyzed for assessment of patients' risk of failure. Our preliminary results indicate that an intensity‐volume difference metric and texture energy had the strongest predictive power. A combined multivariable logistic regression model of these two variables yielded a Spearman's correlation of 0.53 (p=0.02) and area under ROC curve of 0.8. Conclusion: We have demonstrated new methods for analyzing functional imaging data. These methods allow for extracting visual cues and metrics that could facilitate incorporation of PETimaging information into assessment predictors of patient's response to radiotherapy treatment.
SU‐EE‐A3‐02: Incorporating a Priori Knowledge Into Deformable Registration Model34(2007); http://dx.doi.org/10.1118/1.2760359View Description Hide Description
Purpose: Conventional deformable registration treats every voxel in an image set equally. In reality, not all regions are equal: some parts are rigid and some are deformable. We investigate a strategy of using a priori knowledge of the system to improve the accuracy and robustness of deformable registration. Method: Our calculation consisted of two natural steps. First, the input images are auto‐classified into feature regions based on the intensity information. The feature regions in the fixed and moving images are matched as feature region pairs using SIFT (scale‐invariance feature transformation) method. Secondly, the established feature region pairs are used as pre‐determined control point associations to facilitate the thin plate spline (TPS) deformable registration. Because of the pre‐association of the feature pairs, there is no need to manually place the homologous control points, which is a difficult task (as detailed anatomy knowledge is often required) and has been a major source of inaccuracy. The proposed algorithm is evaluated by using a digital phantom and five sets of 4D CTimages of different disease sites. Results: A method of incorporating prior knowledge into TPS deformable image registration has been developed. Using SIFT method, the feature region pairs can be easily identified. For example, for a region inside or close to a piece of bony structure, the correspondence can be found using SIFT because of the lack of deformation. In the digital phantom experiments, the new TPS algorithm is able to obtain a transformation matrix, which agrees with the known ones to within 3%. For the patients, similar level of success was achieved. A comparison with conventional TPS or BSpline approaches, the technique improves the accuracy and robustness. Conclusions: With incorporation of feature pairs, the deformable registration is significantly improved and much robust and accurate registration is attainable.
SU‐EE‐A3‐03: Automatic Target Position Verification with 3‐D Reconstruction of Implanted Markers Using EPID Images34(2007); http://dx.doi.org/10.1118/1.2760360View Description Hide Description
Introduction: In previous studies, a technique using an electronic portal imaging devices(EPIDs) in cine mode has been validated for tracking gold fiducials implanted in the liver for respiratory gating and stereotactic body radiation therapy. However, it was time‐consuming and labor‐intensive since the marker recognition was not performed automatically. In this study, we present an automatic algorithm to quickly and accurately extract the markers in EPIDimages and reconstruct their 3‐D positions. Materials and Methods: The markers were placed in a solid water phantom. Images were acquired using a linear accelerator operating with the 6 MV photon beam at several gantry angles and couch angle positions. A sequence of images was created by collecting the exit radiation using the EPID in cine mode. The fiducials were recognized and detected using a sequence of filters including the Wiener, median, and Laplacian filters. The position of each seed in the EPIDimages was backprojected towards the source position at each beam angle. To reconstruct the optimized seed position in 3‐D, the centroid and Gaussian fit were applied respectively to the distribution of the center points. Results: The average displacement between the seed positions reconstructed with the EPIDimages and the seed locations in 3‐D CTimage is measured to be 3.57 ± 2.59 mm (0.44–7.66 mm) using the centroid. Using Gaussian fit we can accurately reconstruct the marker locations with 0.98 ± 0.38 mm positioning error (0.39–1.47 mm) by significantly reducing the statistical error introduced by the outliers arising from anti‐parallel beam projections. Conclusions: The 3D positions of implanted fiducials can be reconstructed using images from several beam angles. This algorithm will be used for patient data to find the average 3D target position duringradiotherapy treatment.
This work was partially supported by a grant from Varian Medical Systems, Inc.
SU‐EE‐A3‐04: ROI‐Based Response Assessment Using Pre‐ and Post‐RT 18F‐FDG PET/CT34(2007); http://dx.doi.org/10.1118/1.2760361View Description Hide Description
Purpose: To assess the therapy‐induced changes of head and neck cancers using 18F‐FDG PET/CT imaging studies performed prior to and following the completion of a course of radiotherapy (RT) through a region‐of‐interest based (ROI) analysis.Method and Materials: As part of an ongoing study, nine patients with carcinoma of the head and neck had PET/CT imaging studies performed prior to the start of treatment (range: 4 – 58 days; median: 36 days) and following the conclusion of treatment (range: 33 – 63 days; median: 59 days). RT contours, created with the Pinnacle treatment planning system and CT simulation images, from physician‐approved plans were collected to align with pre‐ and post‐RT PET/CT images. Utilizing in‐house developed software, the contours were deformed to the pre‐ and post‐RT PET/CT images through a non‐rigid registration. The non‐rigidly aligned RT contours were then used as ROIs to collect data from the pre‐and post‐RT PET images. The standard uptake value (SUV) was calculated assuming that identical structures were contained in the pre‐ and post‐RT deformed volumes, which were altered by anatomic changes as a result of RT. Results: For the GTV contour, the mean pre‐ and post‐RT SUV and standard deviation was (5.6 ± 0.9) and (2.4 ± 0.6), respectively. Within the GTV, the mean maximum SUV prior to RT was (23 ± 4.6), while after the conclusion of RT, the mean maximum SUV was (5.0 ± 1.9). Additionally, the mean ratio of the pre‐ to post‐RT mean SUV was (2.5 ± 0.7), indicating an overall decrease in uptake of the tracer in tissues within the GTV contour. Conclusion: Through the use of deformable image registration, the feasibility of 18F‐FDG PET/CT ROI‐based analyses of RT‐induced changes in patients with head and neck cancers has been demonstrated.
SU‐EE‐A3‐05: Evaluation of Kilo‐Voltage Cone Beam CT Image Quality in Context to Dose Re‐Computation34(2007); http://dx.doi.org/10.1118/1.2760362View Description Hide Description
Purpose: The purpose of this study was to evaluate volumetric kV Cone Beam CT(CBCT)image quality at different scan parameter settings in context to treatment planning tolerances. Method and Materials: Both large and small density phantoms with eight density inserts were scanned by GE LS CT/PET system, as well as the Varian's OBITM system in half fan and full fan scanning modes. Scans for CBCTimages were performed at different tube currents (20‐, 40‐ and 80‐mA) and source‐imager distance (SID) (150cm and 160cm) after prior calibration of each mode. Deviation of the Hounsfield Unit (HU) values at different settings compared to conventional kV CTimages were obtained for further evaluation. We also adjusted the CT number in CTimages to simulate CBCT artifacts that was not produced by our experiments, and to see how much degradation of image would violate dosimetric feasibility of CBCT based treatment planning. Treatment plans for single beam or multiple beams were calculated based on CT,CBCT and modified CTimages for various phantoms geometries and patients. Results and Conclusions: Results show that the HU for different anatomies in the body have different amount of change for different scan parameters settings (including current, SID and fan angle used) for CBCTimage acquisition. Larger variations in HU appeared in lung and dense bone regions, compared to those with HU closer to tissue. Maximum variations in HU were found in the images with data truncation. Dose profiles, dose volume histograms, isodose distributions and Gamma values of CBCT based plan with images scanned at full fan mode agree relatively well with CT based plan. Larger dose discrepancy appears in lung or dense bone region. Results from the CT‐modified images based plans show that the dosimetric error becomes significant as the HU variation goes beyond 50.
SU‐EE‐A3‐06: Onboard SPECT: Functional‐Image‐Based Target Localization34(2007); http://dx.doi.org/10.1118/1.2760363View Description Hide Description
Purpose: To investigate clinical feasibility for functional‐image‐based target localization via onboard single photon emission computed tomography (onboard SPECT). Specifically, to understand lesion visibility and signal‐to‐noise ratio (SNR) of onboard SPECTimaging with the following simulated variables: lesion size, target‐to‐background radiotracer uptake, and scan time. Method and Materials: We simulated onboard SPECTimaging for a patient in treatment position who had received a diagnostic‐level dose of hypoxia radiotracer. The planning CT of a typical breast cancer patient with lung mets was segmented into bone, lung, and soft tissue. Lesions were simulated in the right lung that varied in diameter (0.5cm, 1cm, 1.5cm, 2cm, 3cm) and radiotracer uptake (lesion:lung:soft tissue — 6:1:3, 12:1:3, 18:1:3). Radiotracer concentration was 1.4μCi/g in aerobic soft tissue. Attenuation was modeled for 140 keV photons. Projection images were simulated for a gamma camera with parallel collimation, and Poisson noise was added to projections to simulate several scan times: 1min, 2min, 5min, 10min, 20min. Noisy projection images were reconstructed by OSEM (10 subsets, 5 iterations). Post‐filtered reconstructed images were then analyzed by plotting image profiles across each lesion and calculating SNR.Results: One minute scan time provided good visualization of a 2cm lesion with 12:1:3 uptake ratio. When scan time remained constant at 5 minutes, 2cm lesions were visible for each uptake ratio. In another simulation, a 1cm lesion (18:1:3) was clearly visible following 5 minutes of scan time. As expected, SNR generally improved with increased lesion size, scan time, and relative radiotracer uptake. Conclusion: Scan times on the order of a few minutes yield sufficient information to visualize lesions as small as 1cm in the lung. These results suggest that onboard SPECT may be effective for real‐time and functional‐image‐based target localization.
- Moderated Poster — Area 3 (Joint): Localization
TU‐EE‐A3‐01: Evaluating the Impact of Probe Depression On Prostate Displacement in Ultrasound‐Guided Prostate IMRT Treatment34(2007); http://dx.doi.org/10.1118/1.2761410View Description Hide Description
Purpose: The prostate displacement under the mechanical pressure of abdominal ultrasound probe may compromise the accuracy of ultrasound‐guided prostate IMRT treatment. The purpose of this study is to investigate the impact of ultrasound probe depression on the prostate displacement by finite element method(FEM).Method and Materials: An ultrasound system (Restitu™, Resonant Medical System, Montreal, Canada) integrated with a CT‐Sim was used to acquire a full set of 3‐D ultrasound (US)‐CT images for a typical prostate cancer patient. The patient's structures, such as body, bone, bladder, and prostate, were contoured on the CTimages. These structures were utilized to generate a 3D finite element model. The mechanical properties of the patient's tissues and ultrasound probe, including elastic module (E) and Poisson's ratio (v), were set as: body (E=55kPa, v=0.45), bone (E=10GPa, v=0.45), bladder (E=10kPa, v=0.45), prostate (E=100kPa, v=0.45), and probe (E=3GPa, v=0.35), respectively. The corresponding displacement of prostate centroid during ultrasound localization was calculated by a FEM software (Ansys). Results: When the depression of ultrasound probe increased from 10mm to 50mm with an increment of 10mm on the patient's abdomen at an angle of 45 degree to horizontal plane, the displacement of prostate centroid was increased from 0.5mm to 4.9mm in the inferior direction and 0.4mm to 3.6mm in the posterior direction. There was no significant left‐right displacement of the prostate. The 3D vector displacement of prostate centroid is increased from 0.6mm to 6.1mm based on FEM calculation. Conclusion: The displacement of prostate was non‐negligible when the depression of ultrasound probe was more than 20mm on the patient's abdomen. This displacement should be considered in the 3‐D US—CT image‐registration and US‐guided radiation therapy.
TU‐EE‐A3‐02: Registration of Ultrasound Tissue‐Typing Images with CT Images for Image‐Guided Prostate Cancer Radiation Therapy34(2007); http://dx.doi.org/10.1118/1.2761411View Description Hide Description
Purpose: To develop an image registration scheme, which combines both rigid and deformable registration techniques, to map the ultrasonic tissue typing (UTT) images to the computed tomography(CT)images for tumor targeted prostate IMRTtreatment.Method and Materials: UTT spectrum analysis can identify the cancerous regions inside the prostate to guide prostate radiation therapy. Current IMRTtreatment plans for the prostate are designed on CTimages. We developed a rigid registration followed by a deformable registration scheme for tumor region mapping between CT and UTT images. The rigid registration was achieved by adjusting the relative position of the two image sets until the mutual information between them was maximized. The deformable registration was based on a biomechanical model and finite element method(FEM). The prostate from both image sets was outlined by the clinician and the surface deformation between the two contour sets were fed into the FEM software algorithm to derive the volumetric displacement inside the prostate. When the voxel points correspondence between two image sets were known, the tumor area detected with UTT was mapped onto the CTimages and used for 3D planning for dose escalation. Results: The algorithm was validated using a tissue mimicking deformable prostate phantom and ten prostate specimens. The urethra served as a marker for verifying the registration process. For phantom and ex vivo study, the displacement of the urethra matched well between the CTimages and the deformed ultrasoundimages. The distribution of the 2D matching errors for the urethra central point had a mean and standard deviation of 2.0mm ± 1.1mm. We started to apply our registration scheme using in vivo prostate scans.
Conclusion: We validated our registration scheme with our phantom and ex vivo studies. We demonstrated the feasibility of clinically employing this UTT method for intra‐prostatic tumordose escalation.
TU‐EE‐A3‐03: Performing Concurrent Kilovoltage Imaging While Delivering Megavoltage Treatment Beams34(2007); http://dx.doi.org/10.1118/1.2761412View Description Hide Description
Purpose: To investigate the clinical feasibility of performing concurrent kilovoltage (kV) x‐ray imaging while the patient at the treatment position was irradiated by megavoltage (MV) beams. Method and Materials: Anatomical visibility and contrast details in kV images acquired with and without concurrent MV irradiations were compared. An on‐board imager (OBI) mounted to the gantry of a Varian 21EX Linac with an electronic portal imager (EPI) was used in this study. A pelvis (Rando) and a contrast (Vegas) phantoms were placed near the treatment isocenter with a detector‐to‐isocenter distance of 50 cm. The effect of MV beam and its dose rate on noise‐to‐signal ratio (NSR), defined as the ratio of the standard deviation to the mean pixel value in a region‐of‐interest (ROI), and relative contrast, defined as the ratio of mean pixel values between the signal ROI and the background ROI, were studied based on Vegas phantom. Results: Scattering MV beams and electronic noises due to kV detector scanning rate and MV beam pulse rate are two major factors affect the concurrent kV image quality. The calculated NSR increases as dose rate increases. Compared to kV images without concurrent MV irradiation, the NSRs of the contrast phantom were increased by a factor of 2.6 with 300MU/min MV beams and 4.5 with 600MU/min MV beams. However, the relative contrasts were increased by a factor of 1.02 with 300MU/min MV beam and 1.06 with 600MU/min MV beam. Conclusion: It is clinically feasible to acquire concurrent kV images during treatment with MV beams. The kV image quality may be improved by minimizing MV scattering effect and by correcting electronic noises. The ability to take kV images with concurrent MV irradiation allows real‐time verification and tracking of moving target during the gated treatment.
Partially supported by a research grant from Varian Medical Systems.
TU‐EE‐A3‐04: Processing of Respiratory Signals From Tracking Systems for Motion Compensated IGRT34(2007); http://dx.doi.org/10.1118/1.2761413View Description Hide Description
Purpose: Improving the quality of signals obtained with optical and magnetic tracking systems.Special focus is placed on the measurement of respiratory motion signals for motion compensated IGRT and the possibility of filtering this data to obtain low‐noise breathing signals. Method and Materials: The accuracy of five different tracking systems (NDI Polaris™, active and passive,Clarion MicronTracker™,BIG FP5000, NDI Aurora™) was examined by (a)tracking stationary markers over several hours,and (b) by attaching the markers to a Kuka KR16 robot to simulate human respiration.The à trous wavelet decomposition was used to decompose the measured signal into scales, and to remove scales related to high frequencies, i.e., noise. The method was applied to a sinusoidal signal with artificial noise modeled according to (a), to real measurements for a sinusoidal motion of the robot,and to a set of breathing motion data from an actual patient treated with the CyberKnife®. Motion prediction was applied to the data. Results: The error on the measurements of the stationary marker approaches a Gaussian distribution.For a tracking rate of 60 Hz, information related to breathing motion is represented by higher scales of the à trous wavelet decomposition. Removing the first three scales and resconstructing the signal from the remaining scales and trend it is possible to obtain close and smooth approximations of the original signal. The normalized RMS error for motion prediction is 0.3368 mm and 0.1378 mm for a simulated and the smoothed signal using normalized LMS prediction. Conclusion: Data from tracking devices is subject to device specific measurement noise. The à trous wavelet decomposition can be used to remove frequencies related to noise from measured breathing signals. The resulting signal is suitable for further processing, e.g., correlation with or prediction of tumor motion in the context of motion compensated IGRT.
TU‐EE‐A3‐05: Assessment of Treatment Site‐Specific Setup Accuracy and Reproducibility in Patient Positioning Using Daily MVCT Imaging34(2007); http://dx.doi.org/10.1118/1.2761414View Description Hide Description
Purpose: To assess treatment site‐specific corrections in patient positioning from TomoTherapy Hi‐ART® megavoltage images.Method and Materials: Initial positioning corrections, determined by fusion of daily pre‐treatment MVCT to planning CTimages,wereanalyzed for different anatomical treatment sites.Over 600,1400, and 1200 fractions of head and neck (H&N) and brain,lung, and prostate tomotherapy treatments, respectively, were assessed. Translational and rotational, per‐fraction setup corrections were retrospectively compiled from individual patient archive files. Setup corrections were compared amongst anatomical treatment sites. Setup reproducibility was assessed by analyzing standard deviations and histograms of setup corrections. Setup accuracy was also assessed by analyzing 3D vector lengths and magnitudes of corrections. Results: Large variations in setup corrections were seen in all three disease sites. H&N treatments had a significantly smaller (p<0.001) vector length standard deviation of 2.54 mm compared with 6.99 mm and 6.46 mm for lung and prostate treatments, respectively, but had no significantly different standard deviation in roll rotations. The frequency of translations of vector lengths ⩾ 10 mm were 48.9% and 48.1% of all lung and prostate treatments, respectively, whereas corrections of that magnitude occurred in only 1.56% of H&N treatments. Frequencies of roll rotations were more comparable among the three disease sites. Conclusions:Analysis of patient positioning corrections indicates large variations between patients and treatments, suggesting a role for imaging every patient per‐fraction to ensure the most accurate reproducibility. H&N treatments had a higher setup reproducibility and accuracy in the lateral,longitudinal,and vertical directions. Even so, they were not significantly different rotationally than prostate and lungtreatments, suggesting a role for daily imaging in all three treatment sites. In quantifying site‐specific positioning reproducibility and accuracy, this work may be useful for assessing new treatment planning margins for image‐guided procedures or for developing adaptive radiotherapy techniques.
TU‐EE‐A3‐06: Comparison of Prostate Localization with Online Ultrasound and Mega‐Voltage Cone‐Beam Computed Tomography34(2007); http://dx.doi.org/10.1118/1.2761415View Description Hide Description
Purpose: To analyze the online image‐guided localization data from 846 ultrasound (US)and 350 MV‐CBCT couch alignments for patients undergoing IMRT of the prostate. Method and Materials: Daily volumetric MV‐CBCT and USimages were acquired for 11 and 23 patients, respectively, after each patient was immobilized in a vacuum cradle and setup to skin markers as the center‐of‐mass. The couch shifts applied in the lateral (left‐right/LR), vertical (anterior‐posterior/AP), and longitudinal (superior‐inferior/SI) directions, along with the magnitude of the three‐dimensional (3D) shift vector, were analyzed and compared for both methods. The percentage of shifts larger than 5 mm in all directions was also compared. CTV‐to‐PTV expansion margins were estimated based on the localization data with US and CB image‐guidance.Results: Systematic and random shifts from CB versus US were: laterally, 1.6 ± 3.8 mm vs. − 0.7 ± 6.9 mm; vertically, − 0.9 ± 5.4 mm vs. − 0.2 ± 6.4 mm; longitudinally, −1.4 ± 2.9 mm vs. −2.9 ± 5.2 mm. The mean 3D shift distance was smaller using CB (6.6 ± 3.6 mm vs. 9.1 ± 6.5 mm) with a p‐value < 0.05. The US data show greater variability. The percentage of US shifts larger than 5 mm were 33%, 40%, and 31% in the LR, AP, and SI directions, respectively, compared to 17%, 31%, and 7% for CB. Conclusion: MV‐CBCT localization data suggest a different distribution of prostate center‐of‐mass shifts with smaller variability, compared to US. The online MV‐CBCT image‐guidance data show that for treatments that do not include daily prostate localization,one can use a CTV‐to‐PTV margin that is 2.5 mm smaller than the one suggested by US data,hence allowing more rectum and bladder sparing and potentially improving the therapeutic ratio.
- Moderated Poster — Area 3 (Joint): Motion Modeling
TU‐FF‐A3‐01: Periodic Autoregressive Moving Average Model for the Prediction of Intrafraction Respiratory Motion34(2007); http://dx.doi.org/10.1118/1.2761443View Description Hide Description
Purpose: The prediction of intrafractional tumor motion is required for the development of real‐time motion managed radiation therapy. This work investigates the ability of a Periodic Autoregressive Moving Average (PARMA) algorithm to model and predict respiration motion. Methods and Materials: The PARMA algorithm models input signals as partially correlated time‐series superimposed onto periodic waveforms. This investigation assessed the limitations of the PARMA method for accurately predicting signals with varying levels of non‐periodic behaviour. A one‐dimensional respiratory motion phantom was developed, which generates waveforms to simulate breathing patterns with randomized non‐periodicity and noise. Multiple signals were analysed for each of 441 levels of non‐uniformity in cycle‐length and amplitude. These signals were approximately 200 seconds long with 50 inhale‐exhale cycles on average. Results: Prediction errors were found to be dependent on prediction lag and the level of variation in the signal. At 0.5 s ahead of the input signal, the PARMA prediction was accurate to within 4.8±0.4%of the total motion extent when the respiration signals had a 14% standard deviation in cycle‐length and 14% standard deviation in inhale‐exhale amplitude. These errors increased to 9.4±0.8% for predictions made at 1.0 second ahead of the input signal. As the inter‐cycle variation in the phantom signals increased to 34%, the prediction errors also increased to 11.6±1.4% at 0.5 second and 21.6±2.0% at 1.0 second. Conclusion: Our investigation showed the PARMA prediction algorithm can be used to predict respiration patterns within the lag‐time required to make the mechanical adjustments to steer the treatment beam in‐sync with the motion of the target. However, an assumption of a single harmonic component results in a strong dependence on the stability in cycle‐length, with less dependence on the cycle‐to‐cycle amplitude of motion. As such, the PARMA algorithm may be used to predict resting respiration and well coached breathing patterns.
TU‐FF‐A3‐02: A Novel 4D‐CT Reconstruction Method and Estimation of Respiratory Motion34(2007); http://dx.doi.org/10.1118/1.2761444View Description Hide Description
Purpose: We have developed a novel 4D‐CT reconstruction method based on deformable image registration. We used it to reconstructlung 4D‐CT images at any breathing tidal volume. We also fitted the estimated the lung motion field to the 5D lung motion model (Low 2005). Method and Materials: The multi‐slice 3D‐CT images were acquired by scanning the patient multiple times at each couch position and at multiple couch positions while the patient was free breathing. For 4D‐CT reconstruction, firstly we reconstructed the reference 3D‐CT image by using scans from the end of exhalation phases. We then computed the image motion for all multi‐slice scans with respect to the common reference image. The motion computation was accurate and free from the boundary occlusion problem. Motion field at any target tidal volume can be generated by interpolation on the computed motion fields. We then deformed the reference image according to the interpolated motion field to get the full volume 3D‐CT images at the target tidal volume. Finally, we fitted the computed image motion to the 5D lung motion model at selected voxel positions. Results: The reconstructed 3D‐CT images were smooth and without misalignment on the couch position boundaries. Statistical analysis results suggest that our new 4D‐CT reconstruction method typically (for over 87% situations) generates more accurate 3D‐CT images than conventional amplitude or phase angle sorting 4D‐CT reconstruction methods. The motion field fitted very well with the 5D lung motion model. Conclusion: Our new method to compute image motion with 4D‐CT dataset enables more accurate estimation of the respiratory motion parameters and allows for motion free 4D‐CT reconstruction. This help would help improve the lung breathing motion models and enhance its integration into radiation therapytreatment planning systems.


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To raise awareness and support, the ADDF hosts a series of events throughout the year.
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The ADDF is an official charity partner of the 2016 TCS New York City Marathon. Support our team and help us conquer Alzheimer's!
Seventh Annual Fall Symposium & Luncheon
Date: November 14, 2016
Location: New York, NY
Seventh Annual Great Ladies Luncheon & Fashion Show
Date: April 26, 2017
Location: Washington, DC


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B. Interestingly, the prevalence for AIH-3 shows geographic differences. Autoantibodies LKM-1 autoantibodies are the serological markers of AIH-5.
These geographic differences may suggest that environmental factors may be important for the development of AIH-3 (79,120). Western blots with 220 Obermayer-Straub and Manns hepatic and renal microsomes reveal a protein band at 50 kDa. By indirect immunofluorescence LKM-1 autoantibodies show an even cytoplasmic staining of the entire liver lobule and the exclusive staining of the proximal renal tubules.
AIH-1 is practically unknown in Sweden and is rare in the United States, while AIH-3 comprises about 6% of all patients with autoimmune hepatitis in southern Europe.
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Ventral (A ) and dorsal (B ) surfaces of the brain stem, diencephalon, and telencephalon. The next several sections address brain stem anatomy by examining transverse sections through five key levels. the spinal cord-medullary junction, the caudal medulla, the middle medulla, the caudal pons, and the rostral midbrain.
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The authors concluded that the decrease in D4 receptors and decreases in dopamine system activity would result in decreased sensitivity of reward circuits to 396 5. NEUROBIOLOGICAL THEORIES OF ADDICTION FIGURE 8.4 Model proposing a network of four circuits involved with addiction, reward, motivation/drive, memory and control.


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Burning Steel and Blood
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Join Date: Jun 2008
Location: Undaa da sea
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IGN: FearmyLEGS
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Burning Steel and Blood
Skip, skip, skip.
A beautiful, young girl with snow white hair skipped along the path in the Forest of Souls just on the outskirts of Chokma. On her back a pair of white, angelic wings rest on her back as her dress of whites and light greens trails behind her. She was wearing no footwear, but it didn't matter to her. The little angel enjoyed the feeling of the mana-rich ground against her flesh. She eventually stopped at a grand tree deep within the wood; surrounding it many small transient lights of all colours and at the foot of the tree a small spring. All around were trees, most likely thousands of years old.. Lush with life and magic.
Behind her was a silver haired man with brilliant sunset eyes. He walked up to the girl's side and looked up at the tree. On his head black horns and a tail like a devil's... An incubus.
"Look, Kai," the angel said with such glee in her voice, "The souls are dancing! Dancing into the tree!"
He smiled, "Yes. It's part of the ritual for a new Yggdrasil to be born. The old one is withering away, after all..."
"Mmm... Poor older tree... At least the new one will be able to carry on it's legacy, right?" the girl smiled, her eyes filled with wonder and curiosity.
Kai gave her a nod, "... Yes, Bianca... That is, if it lives through the war."
Bianca knelt down next to the spring and cupped her hands. She dipped them in the water, then brought her hands to her lips to drink the cool liquid.
"Anyways we best get going. Bianca, put the choker back on before we run into any demons... You know what it would mean for the both of us if anyone saw your wings," Kai knelt down and quickly took a drink of water himself. He then reached into his pocket and held out a simple, black leather choker with a buckle to fasten it. Much like a belt.
Bianca gave him a nod and took it. She stared down at it in her hands as both she and Kai rose. "... It's been three hundred years... And even when it started... There were no problems..."
The incubus said nothing more and turned away from the tree and the girl. The girl on the other hand put on the collar and felt as the magic took hold of her wings and tucked them away, almost as if forcing them into a dark crevice, never to be seen.
Never to be seen.
After looking at the marvellous tree longingly, she began to recite something. A poem. Or perhaps a prophecy?
"Brilliant pitch-black overtaking the sky
What I dream under it is equally as dark,
perishing just before I reach my paradise
Ringing stirs my thousand year slumber
Hoping to hear the shaking of that bell again,
within my dreams every sheep is made of brass
Gorgeous carpet stretches like sea
trembling along as his heart misses a beat,
the fool disappears deep inside an evil den
A wealth of gears twisting into motion
lowering the latch, and unbarring the entrance;
now I can give in to that beautiful music
Abyss. Corruption.
The pleasure is being eaten up.
Give me it. Blind my eyes.
Play for me melodies of ruin
Gathering. Building up.
Overlapping into the final song.
Echoing harmonies,
Saying to me, "Turn back now!"
Ash returning to ash...
Dust returning to dust..."
As the main battles of the war took place in Asgard, most of Utgard remained fairly peaceful. It was currently the afternoon, so the streets of the capital of Utgard and the country of Banem, Chokma, were bustling with the activity of citizens. Demons of all sorts of shapes and sizes were about, up to their own devices. Newsies were running around, handing out newspapers on the current worldly events... The war claiming its rightful place on the front page.
"Makoto Yuuki once again claims a brilliant victory for us of Utgard!"
The city, surrounded by a great stone wall to protect from invasions, has grown incredibly in the last centuries. Was it due to people from different corners of the world moving to the wondrous capital? Of course!
In the city of Chokma the royal family resides, and is well guarded by the militia whom are stationed here in Utgard. Not only that but the well known oriental restaurant named
The Red Papaya
owned by the Kagamiya cubi clan is here, always filled with nobles and delicious aromas from the unique menu. Though the special it quite questionable...
On the outskirts of the city were demon forces patrolling the area, making sure to dispose of any angels that fall into Utgard territory. Also in the same general area was a rather usual duo traveling- A slave Baubma girl with snow white hair and a incubus man with silver hair.
"Hey! We're almost there!" Bianca exclaimed excitedly.
"Great. I feel like I could eat a platypus bear!"
"But those are poisonous!" the young girl shot a worried look at Kai.
Kai crossed his arms behind his head, "Really?... But still..."
Bianca grabbed him by the arm and began to shook him, "Nooooooo!"
"Okay okay," Kai laughed, "I was just joking, anyways."
ggFTW Rules
ggFTW Events
My fingers trace lines of azures and scarlets, following the viridian milky ways above
To the poetry of fourteen billion years of light that mellows my heart into a melody
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Florida Men's Basketball had no difficulty defeating Marquette Thursday night, 82-49. Florida's Michael Frazier lead the team with 17 points.Read More »
Photo Gallery: Florida Shuts Out Jacksonville State Saturday 23-0
The Florida Gators stay undefeated in the Swamp this season by finishing off with a victory over the Jacksonville State Gamecocks Saturday, 23-0. Saturday was also Senior Day and prior to the game, all of the Florida Seniors were recognized.Read More »
Photo Gallery: Florida Men's Basketball Beats Wisconsin 74-56 Wednesday
Florida Basketball took down the Wisconsin Badgers Wednesday night in the O'Connell 74-56. Forward Erik Murphy had a career-high night with 24 points.Read More »
Photo Gallery: Men's Basketball Takes Easy Win Over Alabama State Sunday
The Florida Men's Basketball team had no difficulty defeating the Alabama State Hornets Sunday afternoon, 84-35.Read More »
Photo Gallery: Florida Takes Victory Over Louisiana In Final Seconds
"A win is a win." These were the words spoken by both Florida head coach Will Mushcamp and quarterback Jacoby Brissett in the post-game conference after Florida defeated Louisiana 27-20 Saturday afternoon. With the score going back and forth throughout the game and then tied 20-20 in the final minutes, …Read More »
Photo Gallery: Gators Take the Win Over Missouri Saturday
The Florida Gators beat the Missouri Tigers 14-7 Saturday afternoon, leaving the Gators 7-1 in the SEC.Read More »
Photo Gallery: Georgia Tarnishes Florida's Undefeated Record Saturday
The Florida Gators couldn't manage to maintain their undefeated record after Saturday's game against the Georgia Bulldogs in EverBank Stadium in Jacksonville, Fla.. With Florida's six fumbles, the Bulldogs pulled a 17-9 victory over the Gators Saturday afternoon.Read More »
Gators Continue Undefeated Season With Win Over South Carolina 44-11
The Florida Gators are now 7-0 after defeating the South Carolina Gamecocks in the Swamp Saturday afternoon, 44-11. The Florida Gators will take on the Georgia Bulldogs next Saturday, the 27th.Read More »
Photo Gallery: Florida Baseball Outlasts Georgia 3-2, in 16 Innings in Friday Night Opener
No. 1 UF Baseball beat the Georgia Bulldogs in the series opener Friday night, 3-2, after 16 innings. Nolan Fontana was up to bat, with 2 outs and 2 strikes, and teammate Vickash Ramjit was on third. On the third strike, Georgia catcher, Brandon Stephens, dropped the ball and Fontana …Read More »
Florida Women's Tennis Defeats LSU 7-0 Sunday PHOTO GALLERY
Florida Women's Tennis celebrated lone senior Joanna Mather on Sunday afternoon prior to the match up against LSU with Senior Day. The No.2-ranked University of Florida women's tennis team defeated LSU in a 7-0 sweep. Joanna Mather achieved her 100th victory, a record for Women's Gators Tennis, after winning her …Read More »


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Recaro is, if you'll pardon the pun, the Cadillac of automotive seating. Perhaps it's fitting, then, that Recaro bucket seating is now a production option for the 2010 Cadillac CTS.
Although similar buckets are standard equipment in the high-performance CTS-V model, this is the first time the premium, 14-way adjustable seats will offered in another CTS model. Trimmed in black leather and accented by microfiber suede inserts, the seats are also heated and ventilated. We're a little disappointed the buckets don't include the traditional "Recaro" embroidery (a subtle black stitching would be fitting), but the brand's ornamentation does appear near the seat controls.
As is usually the case with luxury, springing for these seats will cost you a good chunk of change. Cadillac says opting for the buckets will add an additional $2800, and the option is only available on the Premium and Performance trim levels. Cadillac won't make these available on the CTS Sport Wagon, but will offer them on the forthcoming 2011 CTS Coupe.
Source: Cadillac
–Steve Diehlman


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