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DOE OSTI2022

D 3 -creatine dilution for skeletal muscle mass measurement: historical development and current status

The French chemist Michel Eugène Chevreul discovered creatine in meat two centuries ago. Extensive biochemical and physiological studies of this organic molecule followed with confirmation that creatine is found within the cytoplasm and mitochondria of human skeletal muscles. Two groups of investigators exploited these relationships five decades ago by first estimating the creatine pool size in vivo with 14 C and 15 N labelled isotopes. Skeletal muscle mass (kg) was then calculated by dividing the creatine pool size (g) by muscle creatine concentration (g/kg) measured on a single muscle biopsy or estimated from the literature. This approach for quantifying skeletal muscle mass is generating renewed interest with the recent introduction of a practical stable isotope (creatine-(methyl-d 3 )) dilution method for estimating the creatine pool size across the full human lifespan. The need for a muscle biopsy has been eliminated by assuming a constant value for whole-body skeletal muscle creatine concentration of 4.3 g/kg wet weight. The current single compartment model of estimating creatine pool size and skeletal muscle mass rests on four main assumptions: tracer absorption is complete; tracer is all retained; tracer is distributed solely in skeletal muscle; and skeletal muscle creatine concentration is known and constant. Three of these assumptions are false to varying degrees. Not all tracer is retained with urinary isotope losses ranging from 0% to 9%; an empirical equation requiring further validation is used to correct for spillage. Not all tracer is distributed in skeletal muscle with non-muscle creatine sources ranging from 2% to 10% with a definitive value lacking. Lastly, skeletal muscle creatine concentration is not constant and varies between muscles (e.g. 3.89–4.62 g/kg), with diets (e.g. vegetarian and omnivore), across age groups (e.g. middle-age, ~4.5 g/kg; old-age, 4.0 g/kg), activity levels (e.g. athletes, ~5 g/kg) and in disease states (e.g. muscular dystrophies, <3 g/kg). Some of the variability in skeletal muscle creatine concentrations can be attributed to heterogeneity in the proportions of wet skeletal muscle as myofibres, connective tissues, and fat. These observations raise serious concerns regarding the accuracy of the deuterated-creatine dilution method for estimating total body skeletal muscle mass as now defined by cadaver analyses of whole wet tissues and in vivo approaches such as magnetic resonance imaging. A new framework is needed in thinking about how this potentially valuable method for measuring the creatine pool size in vivo can be used in the future to study skeletal muscle biology in health and disease.

body composition↗

DOE OSTI2021

Novel compound heterozygous CPLANE1 variants identified in a Chinese family with Joubert syndrome

Abstract Joubert syndrome (JS) and JS‐related disorders (JSRD) are a group of neurodevelopmental diseases that share the “molar tooth sign” on axial brain magnetic resonance imaging (MRI), accompanied by cerebellar vermis hypoplasia, ataxia, hypotonia, and developmental delay. To identify variants responsible for the clinical symptoms of a Chinese family with JS and to explore the genotype–phenotype associations, we conducted a series of clinical examinations, including blood tests, brain MRI scans, ultrasound imaging, and ophthalmologic examination. Genomic DNA was extracted from the peripheral blood of the six‐person family, and the pathogenic variants were detected by whole‐exome sequencing (WES) and verified by Sanger sequencing. WES revealed two novel compound heterozygous variants in CPLANE1 : c.1270C>T (p.Arg424*) in exon 10 and c.8901C>A (p.Tyr2967*) in exon 48 of one child, inherited from each parent. Both variants were absent in ethnically matched Chinese control individuals and were either absent or present at very low frequencies in public databases, suggesting that these variants could be the pathogenic triggers of the JS phenotype. Notably, these CPLANE1 sequence variants were related to the pathogenesis of autosomal recessive JS in this study. The newly discovered variants expand the mutation spectrum of CPLANE1 , which assists in understanding the molecular mechanism underlying JS and improving the recognition of genetic counseling, particularly for families with a history of autosomal recessive JS.

Zhang, Cheng↗

DOE OSTI2024

A semi–automatic analytical methodology for characterizing the energy consumption of MRI systems using load duration curves

Background and purpose: Magnetic resonance imaging (MRI) scanners are a major contributor to greenhouse gas emissions from the healthcare sector, and efforts to improve energy efficiency and reduce energy consumption rely on quantification of the characteristics of energy consumption. The purpose of this work was to develop a semi-automatic analytical methodology for the characterization of the energy consumption of MRI systems using only the load duration curve (LDC). LDCs are a fundamental tool used across various fields to analyze and understand the behavior of loads over time. Methods: An electric current transformer sensor and data logger were installed on two 3T MRI scanners from two vendors, termed M1 (outpatient scanner) and M2 (inpatient/emergency scanner). Data was collected for 1 month (7/11/2023 to 8/11/2023). Active power was calculated, assuming a balanced three-phase system, using the average current measured across all three phases, a 480 V reference voltage for both machines, and vendor-provided power factors. An LDC was constructed for each system by sorting the active power values in descending order and computing the cumulative time (in units of percentage) for each data point. The first derivative of the LDC was then computed (LDC’), smoothed by convolution with a window function (sLDC’), and used to detect transitions between different system modes including (in descending power levels): scan, prepared-to-scan, idle, low-power, and off. The final, segmented LDC was used to measure time (% total time), total energy (kWh), and mean power (kW) for each system mode on both scanners. The method was validated by comparing mean power values, computed using the segmented 1-month LDC, for each nonproductive system mode (i.e., prepared-to-scan, idle, lower-power, and off) against power levels measured after a deliberate system shutdown was performed for each scanner (1 day worth of data). Results: The validation revealed differences in mean power values <1.4% for all nonproductive modes and both scanners. In the scan system mode, the mean power values ranged from 29.8 to 37.2 kW and the total energy consumed for 1 month ranged from 11 106 to 14 466 kWh depending on the scanner. Over the course of 1 month, the portion of time the scanners were in nonproductive modes ranged from 76% to 80% across scanners and the nonproductive energy consumption ranged from 8010 to 6722 kWh depending on the scanner. The M1 (outpatient) scanner consumed 99.9 and 183.9 kWh/day in idle mode for weekdays and weekends, respectively, because the scanner spent 23% more time proportionally in idle mode on the weekends. Conclusions: A semi-automatic method for quantifying energy consumption characteristics of MRI scanners was introduced and validated. This method is relatively simple to implement as it requires only power data from the scanners and avoids the technical challenges associated with extracting and processing scanner log files. Finally, the methodology enables quantitative evaluation of the power, time, and energy characteristics of MRI scanners in scan and nonproductive system modes, providing baseline data and the capability of identifying potential opportunities for enhancing the energy efficiency of MRI scanners.

32 ENERGY CONSERVATION, CONSUMPTION, AND UTILIZATI↗

DOE OSTI2025

Modeling inter‐reader variability in clinical target volume delineation for soft tissue sarcomas using diffusion model

Abstract Background Accurate delineation of the clinical target volume (CTV) is essential in the radiotherapy treatment of soft tissue sarcomas. However, this process is subject to inter‐reader variability due to the need for clinical assessment of risk and extent of potential microscopic spread. This can lead to inconsistencies in treatment planning, potentially impacting treatment outcomes. Most existing automatic CTV delineation methods do not account for this variability and can only generate a single CTV for each case. Purpose This study aims to develop a deep learning‐based technique to generate multiple CTV contours for each case, simulating the inter‐reader variability in the clinical practice. Methods We employed a publicly available dataset consisting of fluorodeoxyglucose positron emission tomography (FDG‐PET), x‐ray computed tomography (CT), and pre‐contrast T1‐weighted magnetic resonance imaging (MRI) scans from 51 patients with soft tissue sarcoma, along with an independent validation set containing five additional patients. An experienced reader drew a contour of the gross tumor volume (GTV) for each patient based on multi‐modality images. Subsequently, two additional readers, together with the first one, were responsible for contouring three CTVs in total based on the GTV. We developed a diffusion model‐based deep learning method that is capable of generating arbitrary number of different and plausible CTVs to mimic the inter‐reader variability in CTV delineation. The proposed model incorporates a separate encoder to extract features from the GTV masks, leveraging the critical role of GTV information in accurate CTV delineation. Results The proposed diffusion model demonstrated superior performance with the highest Dice Index (0.902 compared to values below 0.881 for state‐of‐the‐art models) and the best generalized energy distance (GED) (0.209 compared to values exceeding 0.221 for state‐of‐the‐art models). It also achieved the second‐highest recall and precision metrics among the compared ambiguous image segmentation models. Results from both datasets exhibited consistent trends, reinforcing the reliability of our findings. Additionally, ablation studies exploring different model structures and input configurations highlighted the significance of incorporating prior GTV information for accurate CTV delineation. Conclusions The proposed diffusion model successfully generates multiple plausible CTV contours for soft tissue sarcomas, effectively capturing inter‐reader variability in CTV delineation.

Dong, Yafei [Yale Biomedical Imaging Institute Yal↗

DOE OSTI2021

Adaptive Proton Therapy for Pediatric Patients: Improving the Quality of the Delivered Plan With On-Treatment MRI

Pencil-beam scanning proton therapy is particularly sensitive to anatomic changes, which may affect the delivered dose distribution. This study examined whether offline adaptation using on-treatment magnetic resonance imaging (MRI) scan during proton therapy could improve plan quality for pediatric patients.