Algorithm

An algorithm to determine IMRT optimization parameters within the Elekta Monaco® treatment planning system that increases dose homogeneity and dose conformity in the planning target volume was developed. This algorithm determines IMRT optimization parameters by calculating the difference between two pairs of dose points along the target volume’s dose volume histogram: Dmax – Dmin, and D2 – D98. The algorithm was tested on the Elekta Monaco® Treatment Planning System at GenesisCare of Coconut Creek, Florida using CT data from 10 anonymized patients with non-small cell lung cancer of various tumor sizes and locations. Nine iterations of parameters were tested on each patient. Once the ideal parameters were found, the results were evaluated using the ICRU report 83 homogeneity index as well as the Paddick conformity index. As an outcome of this research, it is recommended that at least three iterations of IMRT optimization parameters should be calculated to find the ideal parameters.

Atrial Fibrillation (AF) is a debilitating heart rhythm disorder affecting over 2.7 million people in the US and over 30 million people worldwide annually. It has a high correlation with causing a stroke and several other risk factors, resulting in increased mortality and morbidity rate. Currently, the non-pharmocological therapy followed to control AF is catheter ablation, in which the tissue surrounding the pulmonary veins (PVs) is cauterized (called the PV isolation - PVI procedure) aims to block the ectopic triggers originating from the PVs from entering the atrium. However, the success rate of PVI with or without other anatomy-based lesions is only 50%-60%.
A major reason for the suboptimal success rate is the failure to eliminate patientspecific non-PV sources present in the left atrium (LA), namely reentry source (a.k.a. rotor source) and focal source (a.k.a. point source). It has been shown from several animal and human studies that locating and ablating these sources significantly improves the long-term success rate of the ablation procedure. However, current technologies to locate these sources posses limitations with resolution, additional/special hardware requirements, etc. In this dissertation, the goal is to develop an efficient algorithm to locate AF reentry and focal sources using electrograms recorded from a conventionally used high-resolution multi-pole diagnostic catheter.